MJHS Vol.

17
3/2018

Categoria B
 MJHS
Moldovan Journal of Health Sciences
‡˜‹•–ƒ†‡f–‹‹ì‡ƒŽ‡££–£ì‹‹†‹‘Ž†‘˜ƒ
vol. 16(2)/2018

SUMAR CONTENT

EDITORIAL EDITORIAL
Gabriel M. Gurman 5 Gabriel M. Gurman
‘†‡•–‹ƒÁŽ—‡ƒ‡†‹…ƒŽ£ Modesty in the medical world

ARTICOLE DE CERCETARE RESEARCH ARTICLES

Natalia Ciobanu, Valentin Gudumac, Lucia Ciobanu, Natalia Ciobanu, Valentin Gudumac, Lucia Ciobanu,
Stanislav Groppa 9 Stanislav Groppa
Corelarea nivelului matrix metaloproteinazei-9 serice cu The correlation of serum matrix metalloproteinase-9 level
severitatea accidentului cerebral vascular ischemic with the severity of stroke

Ž‰ƒ‡Ž‹…ǡ‡”‰Š‡‹‘˜ƒì‡˜ǡƒ–ƒŽ‹ƒƒœ—”—…ǡ Ž‰ƒ‡Ž‹…ǡ‡”‰Š‡‹‘˜ƒ–‡˜ǡƒ–ƒŽ‹ƒƒœ—”—…ǡ
Irina Burdeniuc Irina Burdeniuc
Variante anatomice individuale ale arterei 15 Individual anatomical variants of the superior
mezenterice superioare mesenteric artery

Alexandru Voloc, Natalia Bivol Alexandru Voloc, Natalia Bivol

‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ƒ…‘’‹‹Ž‘”苃†‘Ž‡•…‡ì‹Ž‘”†‹…‡–”—Ž Physical development of children and adolescents in the
‡’—„Ž‹…‹‹‘Ž†‘˜ƒÁ…‘”‡Žƒì‹‡…—ˆƒ…–‘”—ŽƒŽ‹‡–ƒ”è‹ 22 center of the Republic of Moldova in correlation with the
cadrul legislativ în vigoare food factor and the legislative framework in force

Oxana Bujor, Liliana Groppa Oxana Bujor, Liliana Groppa

’”‡…‹‡”‡ƒ‹’ƒ…–—Ž—‹ƒ•—’”ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ƒŽ–”ƒ–ƒ‡–—Ž—‹ Assessment of the impact on the quality of life of the biological
„‹‘Ž‘‰‹…ƒ–‹͸˜‡”•—•‘‘–‡”ƒ’‹ƒ‡–‘–”‡šƒ–è‹…‘„‹ƒì‹ƒ 31 treatment with IL6 versus methotrexate monotherapy and the
‡–‘–”‡šƒ–è‹•—Žˆƒ•ƒŽƒœ‹£Žƒ„‘Žƒ˜‹‹…—ƒ”–”‹–£”‡—ƒ–‘‹†£ǣ combination of methotrexate and sulfasalazine in patients with
studiu prospectiv, randomizat ”Š‡—ƒ–‘‹†ƒ”–Š”‹–‹•ǣ’”‘•’‡…–‹˜‡ǡ”ƒ†‘‹œ‡†•–—†›

Anastasia Bendelic, Marius Raica Anastasia Bendelic, Marius Raica

ƒ”–‹…—Žƒ”‹–£ì‹Š‹•–‘’ƒ–‘Ž‘‰‹…‡è‹‹—‘Š‹•–‘…Š‹‹…‡ƒŽ‡ 44 Histopathological and immunohistochemical peculiarities of
venelor varicoase ale membrului inferior varicose veins of the lower limbs

Ž‹‘ƒ£‹Ž£ Aliona Danila

‘•‹„‹Ž‹–£ì‹Ž‡–”ƒ–ƒ‡–—Ž—‹”‡…£†‡”‹Ž‘”Žƒ’ƒ…‹‡ì‹‹…— The treatment possibilities of patients with relapsed
•–ƒ†‹‹Ž‡è‹ƒŽ‡Ž‹ˆ‘—Ž—‹‘†‰‹ǣ•–—†‹—†‡•…”‹’–‹˜ǡ 52 ‘†‰‹ǯ•Ž›’Š‘ƒǡ•–ƒ‰‡•ƒ†ǣ†‡•…”‹’–‹˜‡ǡ
retrospectiv retrospective study

Angela Baroncea, Tudor Grejdean Angela Baroncea, Tudor Grejdean

’–‹‹œƒ”‡ƒƒ…–‹˜‹–£ì‹‹ƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹Á’”‘‘˜ƒ”‡ƒ 61 Optimizing the activity of nurses in promoting health at
•££–£ì‹‹Žƒ‹˜‡Ž…‘—‹–ƒ” community level

$ REVIEW ARTICLES

Stela Vudu, Carolina Piterschi, Lorina Vudu, Stela Vudu, Carolina Piterschi, Lorina Vudu,
Larisa Zota 68 Larisa Zota
Mecanismele etiopatogenetice implicate în dezvoltarea Current etiopathogenetic mechanisms involved in the
–‹”‘‹†‹–‡‹ƒ—–‘‹—‡ǣ•‹–‡œ£ƒ”ƒ–‹˜£†‡Ž‹–‡”ƒ–—”£ †‡˜‡Ž‘’‡–‘ˆƒ—–‘‹—‡–Š›”‘‹†‹–‹•ǣƒ””ƒ–‹˜‡”‡˜‹‡™
2

Olga Cheptanaru Olga Cheptanaru

”‘–‡œ‡Ž‡’ƒ”싃Ž‡ϐ‹š‡è‹•‹•–‡—Ž‹’Žƒ–‘Ǧ’”‘–‡–‹…Á ƒ”–‹ƒŽϐ‹š‡††‡–ƒŽ’”‘•–Š‡•‡•ƒ†‹’Žƒ–Ǧ’”‘•–Š‡–‹…
–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡ǣ•‹–‡œ£ƒ”ƒ–‹˜£†‡ 75 system in the prosthetic treatment of single edentulism
Ž‹–‡”ƒ–—”£


$ IMAGES FROM CLINICAL PRACTICE
‹…–‘”‘–ƒ”—ǡŽ‡šƒ†”—‘”Ž£–‡ƒ—ǡ‹…–‘”‹ƒÁ”…—ǡ Victor Botnaru, Alexandru Corlateanu, Victoria Sircu,
—‰‡‹ƒ…—–ƒ”—ǡ‡”‰Š‡‹‘˜ƒì‡˜ 90 Eugenia Scutaru, Serghei Covantev
„‡œ‹–ƒ–‡ƒ‘”„‹†£…—ƒ‹ˆ‡•–£”‹”‡•’‹”ƒ–‘”‹‹ Morbid obesity with respiratory manifestations

Ghidul autorului 94 Guidelines for authors

…”‹•‘ƒ”‡†‡Á•‘ì‹”‡ 103 Cover letter

‡…Žƒ”ƒì‹ƒƒ—–‘”‹Ž‘” 104 Authorship statement

 MJHS 17(3)/2018 3

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Editorial board

EDITORIAL
‘†‡•–‹ƒÁŽ—‡ƒ‡†‹…ƒŽ£
Moto:
Ƿ ‹‹ …‘˜‹• …£ — ‡è–‹ •‹‰—”—Ž Á Ž—‡Ǥ ‡ ƒ…‡‡ƒ ϔ‹‹
‘†‡•– è‹ •£ — …”‡œ‹ ˜”‡‘†ƒ–£ …£ ƒ‹ †‡•…‘’‡”‹– •ƒ—
–‡Ǧƒ‹ ‰Ÿ†‹– Žƒ …‡˜ƒ …— –‘–—Ž ‘—ǡ …ƒ”‡ ƒŽ–‘”ƒ ‹…‹ — Ž‡Ǧƒ
–”‡…—– ’”‹ …ƒ’Ǥ g‹ …Š‹ƒ” †ƒ…£ ‡ ƒ†‡˜£”ƒ– è‹ ‡è–‹ ‘”‹‰‹ƒŽǡ
…‘•‹†‡”£ ƒ…‡•– ˆƒ’– …ƒ — †ƒ” †‹ …‡”—”‹ǡ ’‡ …ƒ”‡ ‡è–‹
‘„Ž‹‰ƒ– •£ǦŽ Á’ƒ”ì‹ è‹ …— ƒŽì‹‹Ǥdz
Robert Schumann
 „— è‹ ˜‡…Š‹ ’”‹‡–‡ è‹ –‘˜ƒ”£è †‡ „”‡ƒ•Ž£ ‘„‹è—‹ƒ •£
MJHS 17(3)/2018 5
EDITORIAL
Modesty in the medical world
Moto:
Dz‡ …‘˜‹…‡† –Šƒ– ›‘— ƒ”‡ ‘– –Š‡ ‘Ž› ‘‡ ‹ –Š‡ ™‘”Ž†Ǥ
‘ „‡ ‘†‡•– ƒ† ‡˜‡” „‡Ž‹‡˜‡ –Šƒ– ›‘— Šƒ˜‡ †‹•…‘˜‡”‡†
‘” –Š‘—‰Š– ƒ„‘—– •‘‡–Š‹‰ –‘–ƒŽŽ› ‡™ǡ –Šƒ– Šƒ• ‡˜‡”
’ƒ••‡† ‘ –‘ ‘–Š‡”•Ǥ † ‡˜‡ ‹ˆ ‹– ‹• –”—‡ ƒ† ›‘— ƒ”‡
‘”‹‰‹ƒŽǡ …‘•‹†‡” –Š‹• ƒ• ƒ ‰‹ˆ– ˆ”‘ Š‡ƒ˜‡ǡ ™Š‹…Š ›‘—
ƒ”‡ „‘—† –‘ •Šƒ”‡ ™‹–Š ‘–Š‡”•Ǥdz
‘„‡”– …Š—ƒ
A good old friend and guild comrade used to start each pre-
Á…‡ƒ’£ϐ‹‡…ƒ”‡’”‡œ‡–ƒ”‡ƒ—‡‹‹†‡‹‘‹…—ˆ”ƒœƒǣǷ— ’”‹—Žǡ
è‹ Áƒ‹–‡ƒ ‡ƒ —Žì‹ ƒŽì‹‹ ȋǤǤǤȌǨdz. Pe vremuri, orice individ avea
胐•ƒ•£Ƿ”‡†‡•…‘’‡”‡ ‡”‹…ƒdzǤ—”•‡Ž‡†‡‹ˆ‘”ƒì‹‹‡”ƒ—‡š-
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–‡’”‹˜‹–‘ƒ”‡Žƒ†”‡’–—Ž†‡ƒϐ‹…‘•‹†‡”ƒ–’”‹—Žǡ‹˜‡–ƒ–‘”—Ž
è‹’”‘‘–‘”—Ž—‡‹‹†‡‹•ƒ—ƒŽ——‹ƒ’ƒ”ƒ–Ǥ
•‡–ƒ–‹‘‘ˆƒ‡™‹†‡ƒǡ™‹–Š–Š‡’Š”ƒ•‡ǣDz ƒ –Š‡ ϔ‹”•–ǡ ƒ† „‡Ǧ
ˆ‘”‡ ‡ ƒ› ‘–Š‡”• ȋǤǤǤȌǨdz In the past, every individual had the
…Šƒ…‡–‘Dz”‡†‹•…‘˜‡”‡”‹…ƒǤdzŠ‡‹ˆ‘”ƒ–‹‘•‘—”…‡•™‡”‡
extremely limited, access to limited news and no wonder that
we encounter in the history of art, literature and technology
†‹•’—–‡•ƒ„‘—––Š‡”‹‰Š––‘„‡…‘•‹†‡”‡†–Š‡ϐ‹”•–ǡ–Š‡‹˜‡-
tor and the promoter of an idea or a device.
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Ž—‹Ǥ‹‡’‘ƒ–‡ϐ‹…‘•‹†‡”ƒ–’”‘‘–‘”—Ž–‡Š‹…‹‹Ȃ…‡Ž…ƒ”‡ƒ
publicat primul sau cel care a fost primul care a trimis artico-
Ž—Ž”‡†ƒ…싇‹•’”‡ƒϐ‹’—„Ž‹…ƒ–ǫǨ
The idea of epidural opioid injection appeared almost con-
comitantly in two medical journals, just over a few months.
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Ž‹…ƒ–‹‘ǫǨ
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sau inventate de altcineva. Nu degeaba industria patentelor e
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primul în acest subiect.
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•‡è–‡ †‡ ‹†‡‹ è‹ ‹‹ì‹ƒ–‹˜‡ ’”‘’—•‡ è‹Ȁ•ƒ— ’—•‡ Á ƒ’Ž‹…ƒ”‡ †‡
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la dezvoltarea unui subiect, aceasta poate reprezenta, în cel
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—‰ƒ–£Žƒ…‘•–”—…싃——‹•‹•–‡…”‡ƒ–†‡ƒŽ–—Ž•ƒ—†‡ƒŽì‹‹…—
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Á’”‘ˆ‡•‹—‡ƒ’‡…ƒ”‡‘’”ƒ…–‹…‹Ǥ‡–”—…£†‘ƒ”Áˆ‘ƒ”–‡’—-
싐‡…ƒœ—”‹—‹†‹˜‹†’‘ƒ–‡’”‡–‹†‡…£ƒ…‡ƒ…‘–”‹„—싇ƒ•ƒ
ƒ†‡•…Š‹•—‘—†”—•ƒ—…£ˆ£”£‡ƒ†‘‡‹—Ž’”‡‘…—’£”‹Ž‘”
•ƒŽ‡ƒ”ϐ‹ƒ”£–ƒ–…‘’Ž‡–ƒŽ–ˆ‡ŽǤg‹ƒ–—…‹ǡ’‡„—£†”‡’–ƒ–‡ǡ–‡
Á–”‡„‹…ƒ”‡‘ϐ‹‘”‹‰‹‡ƒ‡˜‹†‡–‡‹Ž‹’•‡†‡‘†‡•–‹‡ƒ—Ž–‘”ƒ
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Needless to remember here, once again, the simple fact
that today it is much harder to initiate something of value,
because most ideas and projects have a good chance of being
Dz„‘”dzǡ‹‹–‹ƒ–‡†‘”‹˜‡–‡†„›•‘‡„‘†›‡Ž•‡Ǥ‘–ˆ‘”‘–Š-
ing the patent industry is one of the most successful, it is the
ϐ‹”•–…‘–ƒ…–ƒ††”‡••ˆ‘”ƒ›‘‡™Š‘ˆ‡‡Ž•‹–‹•–Š‡‘™‡”‘ˆ
ƒ‘”‹‰‹ƒŽ‹†‡ƒǤ†‘–‹˜ƒ‹–Š‡ϐ‹”•–ƒ†˜‹…‡›‘—”‡…‡‹˜‡
when you share with someone that you have discovered or
initiated something new is to look into the literature if you
™‡”‡‘––Š‡ϐ‹”•–‹–Š‹••—„Œ‡…–Ǥ
We have made this long introduction to put forward a com-
‘ •‡•‡ǣ ˆ‘” ‘•– ‘ˆ ‘—” ’‡”•‘ƒŽ ƒ† ’”‘ˆ‡••‹‘ƒŽ Ž‹˜‡•ǡ
each of us is using ideas and initiatives proposed and/or im-
plemented by another. Even when we manage to offer our own
contribution to the development of a subject, this may be a
very small step forward, a small brick added to the construc-
tion of a system created by another or others, long before your
input be brought to the attention of the general public.
Being aware of this infallible reality, means recognizing the
place you deserve in the society you are in, and in the profes-
sion you practice. Because only in very few cases, an individual
can claim that his contribution has opened a new path or that
™‹–Š‘—–Š‹–Š‡ϐ‹‡Ž†‘ˆŠ‹•’”‡‘……—’ƒ–‹‘•™‘—Ž†Šƒ˜‡„‡‡
completely different. And then, rightly, you wonder what the
origin of the lack of modesty of many of our colleagues, willing
at all times to give a success that, at best, belongs to many, he/
•Š‡‹•Œ—•–ƒ™Š‡‡Ž‹–Š‡•—……‡••ˆ—Ž‡…Šƒ‹•ǫ
 6
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†‘ƒ”‘”‘–‹ì£Á”‡—è‹–—Ž‡…ƒ‹•ǫ
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Á…‡’—–—Ž …ƒ”‹‡”‡‹ •ƒŽ‡ǡ †‡ Ƿ•‹’Ž—dz •’‡…‹ƒŽ‹•–ǡ ‡†‹…—Ž •‡ …”‡-
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de acord cu semnatarul acestor rânduri, recunoscând sâmburi
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‘è–”‹Ǥ
’‡”…£‹•‡˜ƒ’‡”‹–‡•£–”ƒ‰•’—œƒ’‡–—”–ƒ‡ƒè‹•£
In one of my recent conferences I assert (copying, of course,
the anonymous author of the famous witticism) that the phy-
sician’s evolution comprises several clear and obvious phases.
––Š‡„‡‰‹‹‰‘ˆŠ‹•…ƒ”‡‡”ǡƒ•ƒDz•‹’Ž‡dz•’‡…‹ƒŽ‹•–ǡ–Š‡†‘…-
tor thinks he is the deputy of the God. At a later stage, say af-
ter obtaining the title of primary physician, he/she is even the
God, and then somewhere at the end of the road to be perfectly
convinced that the Supreme Power is actually his deputy. I am
convinced that many of the readers of this heading will agree
with the signatories of these lines, recognizing the pits of such
a concept in the attitude of some of our colleagues.
I hope I will be able to take advantage of this and refer to
the early years of my ICU medical apprenticeship, when I had
the opportunity to meet and work side by side with vener-
‘—••—”‰‡‘•Ǥ™Š‘ϐ‹–’‡”ˆ‡…–Ž›™‹–Š–Š‡ˆƒ‘—•Œ‘‡‹™Š‹…Š
£”‡ˆ‡”Žƒ’”‹‹‹ƒ‹ƒ‹—…‡‹…‹‡‹‡Ž‡†‡‡†‹…ǡ…Ÿ†ƒ
ƒ˜—–‘…ƒœ‹ƒ•££Á–ŸŽ‡•…è‹•£Ž—…”‡œ…‘–Žƒ…‘–…—…Š‹”—”‰‹†‡
˜ƒœ£ǡ…£”‘”ƒŽ‹•‡’‘–”‹˜‡ƒ’‡”ˆ‡…–…‡Ž‡„”ƒ‰Ž—£Á…ƒ”‡Á–”‡-
„ƒ”‡ƒ‡”ƒŽ‡‰ƒ–£†‡†‹ˆ‡”‡ìƒ†‹–”‡ƒ‹…ƒ‡”‡œƒè‹‘ƒ•‹•–‡-
–£†‡•ƒŽ£†‡‘’‡”ƒì‹‡ǡ”£•’—•—Žϐ‹‹†…£…‡ƒ†‹–Ÿ‹•Ž—Œ‡ƒ—
•‹‰—”—‡œ‡—Ǥ‹’•ƒ†‡‘†‡•–‹‡—‡—ƒ‹‘–”£•£–—”£
†‡…ƒ”ƒ…–‡”ǡ‡ƒƒ†£’‘•–‡è–‡è‹—…Žƒ”’‡”‹…‘Ž†‡•—„‡•–‹ƒ”‡ƒ
…‡Ž‘”†‹Œ—”ǡ—‡‘”‹…—…‘•‡…‹ì‡‡ˆƒ•–‡Ǥ
‹‘—£”‡ˆ‡”Žƒ’”ƒ…–‹…ƒ‡•‡”‹‡‹‘ƒ•–”‡Ǥ—£˜‘‹
întoarce la mult discutata realitate în care nimeni nu mai e în
•–ƒ”‡•£ƒ…‘’‡”‡…—•—……‡•—Á–”‡‰†‘‡‹—’”‘ˆ‡•‹‘ƒŽǡ…‹‡
‡˜‘‹–•£•‡ƒŒ—–‡†‡‡š’‡”‹‡ìƒè‹…—‘è–‹ì‡Ž‡…‘ˆ”ƒì‹Ž‘”…—
…ƒ”‡Á’ƒ”–‡ƒ…‡‡ƒè‹•’‡…‹ƒŽ‹–ƒ–‡Ǥ£”‡ˆ‡”Žƒ—…ƒ†‡‡…Š‹’£Ǥ
BƒŒ‘”‹–ƒ–‡ƒ…ƒœ—”‹Ž‘”ǡ‡†‹…—Ž…—”ƒ–•‡˜‡†‡‡˜‘‹–•£
ƒ’‡Ž‡œ‡ŽƒƒŒ—–‘”—Ž…‘Ž‡‰‹Ž‘”ǡ†‡…‡Ž‡ƒ‹—Ž–‡‘”‹ƒ’ƒ”싐Ÿ†
ƒŽ–‘”•’‡…‹ƒŽ‹–£ì‹Ǥ†‹ƒ‰‘•–‹…’”‡…‹•‡ƒ’ƒƒŒ—Žƒ‹—Ž–‘”
•’‡…‹ƒŽ‹è–‹ǡ — …ƒœ ‘…‘Ž‘‰‹… ‡…‡•‹–£ …‘‘’‡”ƒ”‡ƒ ƒ‹ —Ž–‘”
‡š’‡”ì‹Á†‹˜‡”•‡†‘‡‹‹ǡ—’ƒ…‹‡–…—‘–”ƒ—£—Ž–‹’Ž£˜ƒ
ϐ‹ –”ƒ–ƒ– ƒ’”‘ƒ’‡ …‘…‘‹–‡– †‡ ƒ‹ —Žì‹ ‡†‹…‹ǡ ƒ•‹•–‡–‡
medicale, tehnicieni de radiologie etc.
ƒƒŽ‹–£ì‹ǫ ƒ è‹ —Ǥ ‡ †‡ ‘ ’ƒ”–‡ǡ ƒ…‡•–‡ Ž—…”—”‹ •—– †‡
mult cunoscute, ele fac parte din realitatea de zi cu zi. Dar, pe
†‡ƒŽ–£’ƒ”–‡ǡ—’—싐‡•—–…ƒœ—”‹Ž‡Á…ƒ”‡•—……‡•—Ž——‹–”ƒ-
tament e prezentat ca rezultatul unui singur individ. E de-ajuns
•£—”£”‡è–‹”‡’‘”–ƒŒ‡Ž‡†‡–‡Ž‡˜‹œ‹—‡•ƒ—”ƒ†‹‘…ƒ•£ƒŒ—‰‹Žƒ
…‘…Ž—œ‹ƒ…£Á†‡•…”‹‡”‡ƒ——‹…ƒœ•’‡…‹ƒŽǡ†‡†‡ƒ•‡„—…—”ƒ
†‡’—„Ž‹…‹–ƒ–‡ǡ‡‡ì‹‘ƒ–—•‹‰—”—‡ǡ‘•‹‰—”£’‡”•‘ƒ£ǡ
†‡’ƒ”…£–‘–—Ž•Ǧƒ”ϐ‹’‡–”‡…—–…‘ˆ‘”‡š’”‡•‹‡‹‘‡Ǧƒ •Š‘™.
—‡Á‹–‡ì‹ƒ‡ƒ•£†‹•…—–†‡•’”‡…£‹Ž‡•—……‡•—Ž—‹’”‘-
ˆ‡•‹‘ƒŽǤ—ˆ£…—–Ǧ‘†‡—Ž–ƒŽì‹‹è‹ǡ†‹’£…ƒ–‡ǡ—’”‡ƒ‡š‹•–£
†ƒ–‡‘‹Áƒ…‡•–•—„‹‡…–…ƒ”‡•£‡”‹–‡ƒϐ‹‡ì‹‘ƒ–‡Ǥƒ”Ǧƒè
˜”‡ƒ•£‹‰‘”…‡ƒ†‡Ǧƒ†‘—ƒ’ƒ”–‡ƒ…‹–ƒ–—Ž—‹…ƒ”‡ƒ’ƒ”싐‡”‡-
question was related to the difference between Mother Teresa
ƒ†ƒ‘’‡”ƒ–‹‰”‘‘—”•‡ǡ–Š‡ƒ•™‡”„‡‹‰–Šƒ––Š‡ϐ‹”•–
served only one God. Lack of modesty is not just a feature of
character, it also harbors a clear danger of underestimating
others, sometimes with bad consequences.
Again I mean the practice of our job. I will not go back to
the much-discussed reality in which no one is able to success-
ˆ—ŽŽ›…‘˜‡”ƒ™Š‘Ž‡’”‘ˆ‡••‹‘ƒŽϐ‹‡Ž†ǡ„—–Šƒ•–‘Š‡Ž’™‹–Š–Š‡
experience and knowledge of the associates with whom he
shares the same specialty. I mean teamwork.
In most cases, the attending physician has to resort to the
help of colleagues, most of them belonging to other specialties.
A clear diagnosis is the case for many specialists, an oncologi-
cal case requires the co-operation of several experts in various
ϐ‹‡Ž†•ǡ ƒ ’ƒ–‹‡– ™‹–Š —Ž–‹’Ž‡ –”ƒ—ƒ ™‹ŽŽ „‡ –”‡ƒ–‡† ƒŽ‘•–
concomitantly by several doctors, nurses, radiology techni-
cians etc.
Žƒ–‹–—†‡•ǫ‡•ƒ†‘Ǥ–Š‡‘‡Šƒ†ǡ–Š‡•‡–Š‹‰•ƒ”‡
well-known, they are part of everyday reality. But on the other
hand, there are few cases, where the success of a treatment
is presented as the result of a single individual. It’s enough
to watch television or radio reports, to conclude that in the
description of a special case worthy of advertising, one name,
one person is mentioned, as if everything had happened ‘‡Ǧ
ƒ •Š‘™.
It is not my intention to discuss the ways of professional
success. Many others have done it and, unfortunately, there
is not much new data on this topic that deserves to be men-
tioned. But I do not want to ignore the second part of the quote
that belongs to the famous composer of the XIXth century,
which refers to the notion of originality, which I want to com-
—‹–—Ž—‹…‘’‘œ‹–‘”ƒŽ•‡…‘Ž—Ž—‹ƒŽǦŽ‡ƒǡ…ƒ”‡•‡”‡ˆ‡”£Žƒ
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†‡‰‡‹ƒŽ‹–ƒ–‡Ǥ”‹‰‹ƒŽ‹–ƒ–‡ƒè‹‰‡‹ƒŽ‹–ƒ–‡ƒ—•‡†‘„Ÿ†‡•…’‡
„£…‹Ž‡腑Ž‹‹Ǥ胅—…—Ž‘ƒ”‡ƒ’‹‡Ž‹‹•‡‘è–‡‡è–‡ǡ–ƒŽ‡–—Ž‡
†‡ˆ‘ƒ”–‡—Ž–‡‘”‹”‡œ—Ž–ƒ–—Ž—‡‹…‘„‹ƒì‹‹‰‡‡–‹…‡—‹…‡Ǥ
ƒ…£ƒèƒ•–ƒ—Ž—…”—”‹Ž‡ǡ‹‡‹—•‡’‘ƒ–‡Ÿ†”‹…——
†ƒ”’”‹‹– †‡Žƒ ƒ–—”£ǡ ’‡–”— …ƒ”‡ ‹†‹˜‹†—Ž ”‡•’‡…–‹˜ — ƒ
ˆ‘•–‡˜‘‹–•£Á–”‡’”‹†£‹‹…ǡ…‹’—”è‹•‹’Ž—‡ŽȀ‡ƒ•‡„—-
…—”£†‡‘胐•£’‡…ƒ”‡ƒŽì‹‹—ƒ—ƒ˜—–Ǧ‘Ǥ…Š—ƒ˜‘”„‡è–‡
†‡—†ƒ”’”‘˜‡‹–†‹…‡”—”‹ǡ‘‡š’”‡•‹‡…ƒ”‡†‡ˆƒ’–ȋ…‡Ž’—싐
Á‘’‹‹ƒ‡ƒȌ‹†‹…£‹†‡‡ƒ—‡‹†‘œ‡•‡‹ϐ‹…ƒ–‹˜‡†‡‘”‘…Ǥ
Ÿ£ƒ‹…‹Ž—…”—”‹Ž‡’ƒ”…Žƒ”‡ǡ‹ƒ”Á†‡—ŽŽ—‹…Š—ƒ†‡
bine with the genius. Originality and genius are not acquired
in the school’s banks. As the color of the skin is inherited, tal-
ent is often the result of a unique genetic combination.
If this is the case, no one can boast a gift from nature, for
which the individual did not have to do anything, but he/she
simply enjoys a chance that others have not had. Schumann
speaks of a gift from heaven, an expression that actually (at
Ž‡ƒ•–‹›‘’‹‹‘Ȍ‹†‹…ƒ–‡•–Š‡‹†‡ƒ‘ˆƒ•‹‰‹ϐ‹…ƒ–†‘•‡‘ˆ
luck.
So far, things seem clear, and Schumann’s urge to recognize
the merit of fate at the service of the individual is self-evident.
By the way, the idea of the heavenly gift or the chance that you

ƒ”‡…—‘ƒè–‡‡”‹–—Ž•‘”ì‹‹ǡƒϐŽƒ–£Á•Ž—Œ„ƒ‹†‹˜‹†—Ž—‹ǡ‡†‡Žƒ
•‹‡Áì‡Ž‡•Ǥ’”‘’‘ǡ‹†‡‡ƒ†ƒ”—Ž—‹…‡”‡•…•ƒ—ƒ胐•‡‹…—…ƒ”‡
–‡ƒè–‹•‡Á’‘–”‹˜‡è–‡‘ƒ”‡…—–‡‘”‹‡‹Ž—‹ƒ•‡Ž›‡ǡ†‡…ƒ”‡
Ǧƒ ‘…—’ƒ– Á …ƒ†”—Ž ƒ…‡•–‡‹ ”—„”‹…‹ Á —”£ …— …Ÿì‹˜ƒ ƒ‹Ǥ
‘ˆ‘”ƒ…‡•–‡‹–‡‘”‹‹ǡϐ‹‡…ƒ”‡‹†‹˜‹†–”‡„—‹‡•£’‘”‡ƒ•…£Á
˜‹ƒì£†‡’‡ƒ…‡‡ƒè‹Ž‹‹‡†‡•–ƒ”–ǡ…‘—£–—–—”‘”ǡ—”Ÿ†…ƒ’‡
’ƒ”…—”•…ƒ’ƒ…‹–ƒ–‡ƒϐ‹‡…£”—‹ƒ•£Ǧè‹•’—£…—˜Ÿ–—Žè‹•£Ǧè‹’—£
’‡…‡–‡ƒ’‡‡˜‘Ž—싃•ƒǤ‹…‹£…ƒ”†‹’—…–†‡˜‡†‡”‡–‡‘”‡–‹…ǡ
‘ƒ‡‹‹—Áè‹Á…‡’‡š‹•–‡ìƒ–‡”‡•–”£†‹ƒ…‡Žƒè‹’—…–†‡’Ž‡-
…ƒ”‡Ǥƒ”’‡’ƒ”…—”•ǡ‡Ž›‡è‹–‡‘”‹ƒ胐•‡‹…—…ƒ”‡ϐ‹‡…ƒ”‡†‹–”‡
‘‹•‡ƒè–‡ǡ…‘Ž—…”‡ƒœ£’‡–”—ƒ’”‡…‹œƒ…ƒ”‡‡”‘Ž—Žϐ‹‡…£”—‹
‹†‹˜‹†Á…‘•–”—…싃†”——Ž—‹’‡…ƒ”‡ǦŽ˜ƒ’ƒ”…—”‰‡Á˜‹ƒì£Ǥ
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…Ÿ–è‹Á…‡ƒ’”‘ˆ‡•‹‘ƒŽ£Ǥƒ”‡…Ÿ–‡–ƒŽ‡–‡Á£•…—–‡•Ǧƒ—’‹‡”-
†—–’‡†”—†‹…ƒ—œƒŽ‡‡‹•ƒ—‹…ƒ’ƒ…‹–£ì‹‹‹†‹˜‹†—Ž—‹†‡ƒ
…‘–”‹„—‹‡ŽÁ•—è‹Žƒ•—……‡•—Ž’”‘’”‹‡‹…ƒ”‹‡”‡ǫ ‹‡…ƒ”‡†‹–”‡
ϐ‹†‡Ž‹‹…‹–‹–‘”‹ƒ‹ƒ…‡•–‡‹”—„”‹…‹Áè‹’‘ƒ–‡ƒ†—…‡…‘–”‹„—싃Žƒ
ƒŽ…£–—‹”‡ƒ—‡‹Á–”‡‰‹Ž‹•–‡…—’”‹œŸ†‹†‹˜‹œ‹…ƒ”‡•Ǧƒ—£•-
…—–…—‘‘‡†£ƒ—”‹–£Á‰—”£ȋ–”ƒ†—…‡”‡Ž‹„‡”£†‹‡„”ƒ‹…£Ȍǡ
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”£ƒ•—†‡˜ƒ…—–ƒŽ‡–—Žè‹…—‹‹…ƒŽ–…‡˜ƒǤ
ƒ”ƒ‹‡š‹•–£Á…£—ƒ•’‡…–ǡ†‡—Ž–‡‘”‹‡‰Ž‹Œƒ–†‡…‡‹
…ƒ”‡•‡‘…—’£†‡•—„‹‡…–ǤB—”£…—…Ÿì‹˜ƒƒ‹ǡŽƒ”ƒ†‡ƒǡƒ
ƒ•‹•–ƒ–Žƒ‘…‘ˆ‡”‹ì£ƒ——‹†‹•–‹•…‘Ž‡‰…ƒ”‡’”‡œ‡–ƒ‘–‡‘-
”‹‡‡š–”‡†‡‹–‡”‡•ƒ–£ǣ‹…‹‘‹†‡‡‘—£ǡ‘”‹‰‹ƒŽ£ǡ—ƒ”‡˜ƒ-
Ž‘ƒ”‡†ƒ…£‹‹ì‹ƒ–‘”—Ž‡‹—ƒ”‡—è‹–•£…‘˜‹‰£’‡—ƒŽ†‘‹Ž‡ƒ
†‡‹’‘”–ƒìƒ‡‹Ǥ‹‹ì‹ƒ–‹˜£…ƒ”‡—•‡„—…—”£†‡”‡…—‘ƒè-
–‡”‡ƒ…‡Ž‘”†‹Œ—”ƒ”‡ˆ‘ƒ”–‡’—싐‡胐•‡†‡”‡—è‹–£Ǥ‹…‹—
’ƒ”–‹†—’‘ƒ–‡•—’”ƒ˜‹‡ì—‹ƒ˜Ÿ††‘ƒ”—•‹‰—”‡„”—Ǥ
Robert Schumann, ca orice mare compozitor, s-a bucurat de
—‹‡•–ƒŽ‡–Ǥ‘’‘œ‹ì‹‹Ž‡•ƒŽ‡…—…‡”‡•…苃œ‹ǡ†—’£ƒ’”‘ƒ-
’‡†‘—£•‡…‘Ž‡ǡ•£Ž‹Ž‡†‡…‘…‡”–†‹Ž—‡ƒÁ–”‡ƒ‰£ǤB•£•‘ƒ”–ƒ
—‹Ǧƒˆ‘•–†‡Ž‘…’”‹‡Ž‹…£Ǥ‡’ƒ”‡…£ƒ•—ˆ‡”‹–†‡‘ƒŽƒ†‹‡„‹-
’‘Žƒ”£ǡ…—…”‹œ‡…‡ŽǦƒ—ƒ†—•è‹Žƒ‘Á…‡”…ƒ”‡†‡•‹—…‹†‡”‡Ǥƒ”
—ƒÁ…‡”…ƒ–•£‹ƒ•£ŽƒŽ—‹£ˆ£…Ÿ†’—„Ž‹…‹–ƒ–‡…‘’‘œ‹ì‹‹Ž‘”
sale. Ba mai mult, Schumann a fost unul dintre primii muzicieni
‡—”‘’‡‹ …ƒ”‡ ŽǦƒ— ƒ’”‡…‹ƒ– ’‡ ”ƒŠ• è‹ ƒ è‹ •…”‹• — ƒ”–‹…‘Ž
elogios la adresa celui care va deveni unul dintre cei mai impor-
MJHS 17(3)/2018 7
are born with, resists somewhat of Hans Selye’s theory, which
I have occupied within this heading a few years ago. According
to this theory, each individual has to start alive from the same
starting line, common to all, and as a result the ability of each
person to speak his word and to seal his evolution. Even from
a theoretical point of view, people do not begin their terres-
trial existence from the same starting point. But along the way,
Selye and the theory of chance with which each of us is born,
work together to specify the role of each individual in the con-
struction of the road he will go through in life.
It seems that talent, chance or fate cannot have a decisive
‹ϐŽ—‡…‡‹–Š‡ƒ„•‡…‡‘ˆ–Š‡’‡”ƒ‡–‡ˆˆ‘”–•–Šƒ–‡ƒ…Š‹-
dividual has to do to succeed in both his personal and profes-
sional lives. How many innate talents have lost on the road due
to laziness or the inability of the individual to contribute to the
•—……‡••‘ˆŠ‹•‘™…ƒ”‡‡”ǫƒ…Š‘ˆ–Š‡ˆƒ‹–Šˆ—Ž”‡ƒ†‡”•‘ˆ–Š‹•
heading can make a contribution to compiling a whole list of
individuals who were born with a golden coin in the mouth (a
free Hebrew translation), but who did not know how to use
the opportunity offered by nature and remained somewhere
with talent and nothing else.
But there is still one aspect, often neglected by those who
deal with the subject. A few years ago, in Oradea, I attended
a distinguished colleague conference that presented an ex-
–”‡‡Ž›‹–‡”‡•–‹‰–Š‡‘”›ǣ‘‡™ǡ‘”‹‰‹ƒŽ‹†‡ƒ‹•™‘”–ŠŽ‡••
if its initiator failed to convince a second of its importance. An
initiative that does not enjoy the recognition of those around
has very little chance of success. No party can survive with just
one member.
Robert Schumann, like any great composer, enjoyed a huge
talent. His compositions still conquer today, after nearly two
centuries, concert halls around the world. But fate was not
good at all. He seems to have suffered from a bipolar disor-
der with crises that brought him to a suicide attempt. But he
did not try to become famous by advertising his compositions.
‘”‡‘˜‡”ǡ…Š—ƒ™ƒ•‘‡‘ˆ–Š‡ϐ‹”•–—”‘’‡ƒ—•‹…‹ƒ•
to appreciate Brahms and wrote an eloquent article to the one,
who will become one of the most important composers of the
late nineteenth century.
–ƒì‹…‘’‘œ‹–‘”‹ƒ‹•ˆŸ”è‹–—Ž—‹•‡…‘Ž—Ž—‹ƒŽǦŽ‡ƒǤ –•‡šƒ’Ž‡‹•‘–—‹“—‡Ǥ‘•–Ƿ…Žƒ••‹…ƒŽdz—•‹…‹ƒ•Šƒ˜‡
š‡’Ž—Ž•£——‡—‹…ǤƒŒ‘”‹–ƒ–‡ƒ—œ‹…‹‡‹Ž‘”Ƿ…Žƒ•‹…‹dz
•Ǧƒ—ˆ‡”‹–†‡ƒ•‡ƒ—–‘†‡ϐ‹‹…ƒƒ‡è–”‹ƒ‹—œ‹…‹‹•ƒ—…ƒ†‡•…Š‹-
œ£–‘”‹†‡†”——”‹ǤǦƒ‹…‹‘Á†‘‹ƒŽ£…£ÁŽ—‡ƒ‘ƒ•–”£ǡƒ
medicilor, exemple de acest gen sunt mult mai rare. Probabil
…£†‹ƒ…‡•–’—…–†‡˜‡†‡”‡•‡Ž‡…싃ƒ–—”ƒŽ£Áè‹•’—‡…—˜Ÿ-
–—Ž è‹ …£ ƒ’”‘ƒ’‡ ’”‹ †‡ϐ‹‹ì‹‡ ‡†‹…—Ž — •‡ ’‘ƒ–‡ Ž‹’•‹ †‡
‡‰‘—Žè‹‘”‰‘Ž‹—Ž•£—ǡƒŽ–‹–‡”‹—è‹Ǧƒ”ϐ‹ƒŽ‡•ƒ…‡ƒ•–£…ƒ”‹‡”£Ǥ
‘ƒ–‡†‹ƒ…‡ƒ•–£…ƒ—œ£‡‡˜‘‹‡…ƒ†‹…Ÿ†Á…Ÿ†•£‹
•‡”‡ƒ†—…£ƒ‹–‡…£†‡ˆƒ’–‘‹—•—–‡…—‹‹…ƒ‹’”‡-
•—•ˆƒì£†‡…‡‹†‹Œ—”—Ž‘•–”—è‹…£‘‹…£†‘œ£†‡‘†‡•–‹‡
—’‘ƒ–‡ƒˆ‡…–ƒ…—‹‹…’‡‹…‹——Ž†‹–”‡…‡‹…ƒ”‡è‹Ǧƒ—†‡†‹-
…ƒ–˜‹ƒìƒ•—ˆ‡”‹ì‡‹ƒŽ–‘”ƒǤ
Prof. Dr. Gabriel M. Gurman,
Omer, Israel,
gurman@bgu.ac.il
‹ƒìƒ‡†‹…ƒŽ£ǡ”Ǥ͵Ͷ†‹ʹͲͳͺ
ϐŽ‡†–‘•‡ŽˆǦ†‡ˆ‡ƒ–ƒ•—•‹…ƒ•–‡”•‘”ƒ•”‘ƒ†‘’‡‡”ǤŠƒ˜‡
no doubt that in our doctors’ world, examples of this kind are
much rarer. Perhaps, from this point of view, natural selection
Šƒ• ‹–• •ƒ›ǡ ƒ† ƒŽ‘•– „› †‡ϐ‹‹–‹‘ –Š‡ †‘…–‘” …ƒ‘– ‹••
his ego and his pride, otherwise he would not have chosen his
career.
Perhaps this is why we need to remind ourselves that, actu-
ally; we are in fact not superior to those around us and that, a
small amount of modesty, cannot affect any of those who de-
voted life to the suffering of others.
Prof. Dr. Gabriel M. Gurman,
Omer, Israel,
gurman@bgu.ac.il
Medical Life, no. 34 of 2018
 8

ARTICOL DE CERCETARE RESEARCH ARTICLE

Corelarea nivelului matrix The correlation of serum

‡–ƒŽ‘’”‘–‡‹ƒœ‡‹Ǧͻ•‡”‹…‡ ƒ–”‹š‡–ƒŽŽ‘’”‘–‡‹ƒ•‡Ǧͻ
cu severitatea accidentului level with the severity
vascular cerebral ischemic of stroke
Natalia Ciobanu*1, Valentin Gudumac†2, Lucia Ciobanu1, Natalia Ciobanu*1, Valentin Gudumac†2, Lucia Ciobanu1,
Stanislav Groppa†1 Stanislav Groppa†1
1
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͸
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Data primirii manuscrisului: 26.06.2018 Manuscript received on: 26.06.2018

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Autor corespondent: Corresponding author:

ƒ–ƒŽ‹ƒ ‹‘„ƒ—ǡ †‘…–‘”ƒ† ƒ–ƒŽ‹ƒ ‹‘„ƒ—ǡ Š ˆ‡ŽŽ‘™
ƒ–‡†”ƒ ‡—”‘Ž‘‰‹‡ ”Ǥ ͸ Šƒ‹” ‘ˆ ‡—”‘Ž‘‰› ‘Ǥ ͸
‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ ç‹ ƒ”ƒ…‹‡ Dz‹…‘Žƒ‡ ‡•–‡‹ìƒ—dz ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‹˜‡”•‹–› ‘ˆ ‡†‹…‹‡ ƒ† Šƒ”ƒ…›
„†Ǥ f–‡ˆƒ …‡Ž ƒ”‡ ç‹ ˆŸ–ǡ 1ͼͻǡ Š‹ç‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ 1ͼͻǡ –‡ˆƒ …‡Ž ƒ”‡ •‹ ˆƒ– ƒ˜‡Ǥǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ƒ–ƒŽ‹ƒƒ†”‘‹…̻›ƒŠ‘‘Ǥ…‘ ‡Ǧƒ‹Ž: ƒ–ƒŽ‹ƒƒ†”‘‹…̻›ƒŠ‘‘Ǥ…‘

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœ‡Ž‡ •‡”‹…‡ •—– •–—†‹ƒ–‡ ’‡ •…ƒ”£
Žƒ”‰£ Žƒ ’ƒ…‹‡ì‹‹ …‡ ƒ— •—’‘”–ƒ– ƒ……‹†‡– ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ
ischemic, dar rolul lor exact în calitate de co-predictor al
‡˜‘Ž—싇‹†‡ϐ‹…‹–—Ž—‹‡—”‘Ž‘‰‹…Žƒ’ƒ…‹‡ì‹‹…—ƒ……‹†‡–˜ƒ•…—-
Žƒ”…‡”‡„”ƒŽƒ…—–”£Ÿ‡—•—„‹‡…–†‡†‹•…—싇Ǥ
Serum matrix metalloproteinases are widely studied in pa-
tients with ischemic stroke, but their role as a co-predictor
of outcome in patients with acute stroke remains a topic for
discussion.
Research hypothesis
’‘–‡œƒ†‡…‡”…‡–ƒ”‡ Serum matrix metalloprotenase-9 measurement can be
ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœƒǦͻ •‡”‹…£ ’‘ƒ–‡ ϐ‹ ˆ‘Ž‘•‹–£ †”‡’– used as an early marker of brain damage.
marker timpuriu al leziunilor cerebrale ischemice. ”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹— The correlation between serum MMP-9 and NIHSS scores
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•‹„‹Ž‹–ƒ–‡ †‡ ͳͲͲΨ ç‹ ‘ •’‡…‹ϐ‹…‹–ƒ–‡ †‡ ͺ͸Ψ ’‡–”— ‡˜‘Ž—싃
‡ˆƒ˜‘”ƒ„‹Ž£ƒǦ—Ž—‹‹•…Š‡‹…Ǥ
‡œ—ƒ–
Introducere. ……‹†‡–—Ž ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‡•–‡ ‘ …ƒ—œ£
ˆ”‡…˜‡–£†‡†‡…‡•ç‹†‡‹˜ƒŽ‹†‹–ƒ–‡Žƒ‹˜‡Ž‘†‹ƒŽǤƒ–”‹š
‡–ƒŽ‘’”‘–‡‹ƒœ‡Ž‡ ȋȌ •—– ‹’Ž‹…ƒ–‡ Á ϐ‹œ‹‘’ƒ–‘Ž‘‰‹ƒ
ƒ……‹†‡–‡Ž‘”˜ƒ•…—Žƒ”‡…‡”‡„”ƒŽ‡Ǥ‡Žƒì‹ƒ†‹–”‡Ǧͻ狃…-
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’‘–‡ì‹ƒŽǤBƒ…‡•–•–—†‹—•Ǧƒ…‡”…‡–ƒ–…‘”‡Žƒì‹ƒ†‹–”‡‹˜‡Ž—Ž
™ƒ•…Ž‘•‡”‘†ƒ›‘ˆƒ†‹••‹‘ȋ”αͲǤͶͳȌƒ†‘†ƒ›͹‘ˆŠ‘•-
’‹–ƒŽ‹œƒ–‹‘ ȋ”αͲǤ͵͹ȌǤ Š‡ Ǧͻ <ͳͲ Ɋ‰ȀŽ …‘…‡–”ƒ–‹‘
Šƒ•ƒͳͲͲΨ•‡•‹–‹˜‹–›ƒ†ƒͺ͸Ψ•’‡…‹ϐ‹…‹–›ˆ‘”–Š‡—ˆƒ˜‘”ƒ-
ble progression of ischemic stroke.
Abstract
Introduction. Stroke is a frequent cause of death and long-
term disability worldwide. Matrix metalloproteinases (MMP)
have been implicated in stroke pathophysiology. The relation
between MMP-9 and stroke is gaining much interest as it is in-
volved in stroke pathophysiology and its inhibition is of poten-
tial therapeutic role. This study investigated the correlation
between the level of serum MMP-9, stroke subtype and stroke
severity using the National Institute of Health Stroke Scale
ƒ–”‹š ‡–ƒŽŽ‘’”‘–‡‹ƒ•‡ǦͿ Ž‡˜‡Ž ƒ† –Š‡ •‡˜‡”‹–› ‘ˆ •–”‘‡ MJHS 17(3)/2018 9

•‡”‹…ƒŽǦͻǡ•—„–‹’—Žƒ……‹†‡–—Ž—‹˜ƒ•…—Žƒ”…‡”‡„”ƒŽç‹•‡- (NIHSS) of the patients admitted to the Institute of Emergency

veritatea accidentului vascular cerebral, utilizând scala de Medicine, Neurology and Cerebrovascular diseases unit, Insti-
ƒ’”‡…‹‡”‡ ƒ †‡ϐ‹…‹–—Ž—‹ ‡—”‘Ž‘‰‹… ƒ–‹‘ƒŽ •–‹–—–‡ –”‘‡ tute of Emergency Medicine, Chisinau, Republic of Moldova,
…ƒŽ‡ȋȌŽƒ’ƒ…‹‡ì‹‹‹–‡”ƒì‹Á‡…싃‡—”‘Ž‘‰‹‡ǡ and diagnosed with an ischemic stroke.
•–‹–—–—Ž†‡‡†‹…‹£”‰‡–£ǡŠ‹ç‹£—ǡ‡’—„Ž‹…ƒ‘Ž†‘˜ƒ
狆‹ƒ‰‘•–‹…ƒì‹…——‹•…Š‡‹…Ǥ
ƒ–‡”‹ƒŽç‹‡–‘†‡ǤǦƒ…‘Ž‡…–ƒ–•Ÿ‰‡˜‡‘•Žƒ’ƒ…‹‡ì‹‹
…— ƒ……‹†‡– ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‹•…Š‡‹… ȋα͵ͻȌ ’‡–”— ƒ †‡-
termina nivelul MMP-9. Datele au fost comparate cu cele
†‡ Žƒ ͵ͻ †‡ ‹†‹˜‹œ‹ •££–‘ç‹ǡ …ƒ”‡ ƒ— …‘”‡•’—• †—’£ •‡š ç‹
˜Ÿ”•–£ǡƒ…‡ç–‡ƒ•‡”˜‹††”‡’–Ž‘–ƒ”–‘”Ǥ‘ì‹’ƒ…‹‡ì‹‹ƒ—ˆ‘•–
‡šƒ‹ƒì‹’”‹–‘‘‰”ƒϐ‹‡…‘’—–‡”‹œƒ–£…”ƒ‹ƒ£Á’”‹‡Ž‡
ʹͶ†‡‘”‡†‡Žƒ†‡„—–—ŽƒŽƒ†‹‡‹Ǥ˜ƒŽ—ƒ”‡ƒ‡—”‘Ž‘‰‹…£ƒˆ‘•–
Material and methods. Blood was collected from the
’ƒ–‹‡–• ™‹–Š ‹•…Š‡‹… •–”‘‡ ȋα͵ͻȌ –‘ †‡–‡”‹‡ Ǧͻ
Ž‡˜‡Žǡ•‡šƒ†ƒ‰‡Ǧƒ–…Š‡†Š‡ƒŽ–Š›‹†‹˜‹†—ƒŽ•ȋα͵ͻȌ•‡”˜‡†
as control. All patients had cranial computerized tomogra-
’Š› •…ƒ ‹ –Š‡ ϐ‹”•– ʹͶ Š‘—”•Ǥ Š‡ ‡—”‘Ž‘‰‹…ƒŽ ‡˜ƒŽ—ƒ–‹‘
was made with the National Institute of Health Stroke Scale
(NIHSS) in the acute stage.
Results. ‘’ƒ”‡† –‘ …‘–”‘Ž•ǡ Ǧͻ ™ƒ• •‹‰‹ϐ‹…ƒ–Ž›
higher in the ischemic stroke group. Positive correlation was
‡ˆ‡…–—ƒ–£—–‹Ž‹œŸ†•…ƒŽƒÁ•–ƒ†‹—Žƒ…—–ƒŽƒ……‹†‡–—Ž—‹
vascular cerebral.
‡œ—Ž–ƒ–‡Ǥ B …‘’ƒ”ƒì‹‡ …— ƒ”–‘”‹‹ǡ ‹˜‡Ž—Ž Ǧͻ ƒ
ˆ‘•–•‡‹ϐ‹…ƒ–‹˜ƒ‹ƒ”‡Á‰”—’—Ž†‡’ƒ…‹‡ì‹…—‹•…Š-
‡‹…Ǥ Ǧƒ †‡–‡”‹ƒ– ‘ …‘”‡Žƒì‹‡ ’‘œ‹–‹˜£ †‹–”‡ ‹˜‡Ž—Ž •‡”‹…
established between the serum level of MMP-9 and the NI-
HSS score. This correlation was closer on the day of admis-
•‹‘ȋ”αͲǤͶͳȌƒ†‘–Š‡͹th†ƒ›‘ˆŠ‘•’‹–ƒŽ‹œƒ–‹‘ȋ”αͲǤ͵͹ȌǤ
Ǧͻ…‘…‡–”ƒ–‹‘ƒ„‘˜‡ͳͲɊ‰ȀŽŠƒ•ƒͳͲͲΨ•‡•‹–‹˜‹–›
ƒ†ͺ͸Ψ•’‡…‹ϐ‹…‹–›ˆ‘”–Š‡—ˆƒ˜‘”ƒ„Ž‡’”‘‰”‡••‹‘‘ˆ‹•…Š‡Ǧ
ƒŽǦͻç‹•…‘”—ŽǤ‘”‡Žƒ”‡ƒ†ƒ–£ƒˆ‘•–ƒ‹•–”Ÿ•£Á
œ‹—ƒ‹–‡”£”‹‹ ȋ”αͲǡͶͳȌ ç‹ Á ƒ ͹Ǧƒ œ‹ †‡ •’‹–ƒŽ‹œƒ”‡ȋ”αͲǡ͵͹ȌǤ 
…‘…‡–”ƒì‹‡ƒǦͻ†‡’‡•–‡ͳͲɊ‰ȀŽƒ”‡‘•‡•‹„‹Ž‹–ƒ–‡†‡
ͳͲͲΨç‹‘•’‡…‹ϐ‹…‹–ƒ–‡†‡ͺ͸Ψ’‡–”—‡˜‘Ž—싃‡ˆƒ˜‘”ƒ„‹Ž£ƒ
AVC-ului ischemic.
‘…Ž—œ‹‡Ǥ‡–‡”‹ƒ”‡ƒ•‡”‹…£ƒǦͻ’‘ƒ–‡ϐ‹—–‹Ž‹œƒ–£
ca marker timpuriu al leziunilor cerebrale. De asemenea,
Ǧͻ’‘ƒ–‡ϐ‹—–‹Ž‹œƒ–Á…ƒŽ‹–ƒ–‡†‡…‘Ǧ’”‡†‹…–‘”ƒŽ’”‘‰‘•-
–‹…—Ž—‹’ƒ…‹‡ì‹Ž‘”…—‹•…Š‡‹…Áˆƒœƒƒ…—–£Ǥ
Cuvinte cheie:’”‘‰‘•–‹…ǡ…‘”‡Žƒì‹‡ǡǦͻǡƒ……‹†‡–˜ƒ•-
cular cerebral ischemic.
Introducere
……‹†‡–—Ž ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‡•–‡ ‘ …ƒ—œ£ ˆ”‡…˜‡–£ †‡
†‡…‡• ç‹ †‡ ‹˜ƒŽ‹†‹–ƒ–‡ Žƒ ‹˜‡Ž ‘†‹ƒŽǤ ’”‘š‹ƒ–‹˜ ͺͷΨ
†‹ ƒ……‹†‡–‡Ž‡ ˜ƒ•…—Žƒ”‡ …‡”‡„”ƒŽ‡ •—– ‹•…Š‡‹…‡ǡ ”‡•–—Ž ϐ‹-
ind hemoragice [1, 2]. Matrix metaloproteinazele (MMP) au
ˆ‘•–‹’Ž‹…ƒ–‡Áϐ‹œ‹‘’ƒ–‘Ž‘‰‹ƒǤǦʹç‹Ǧͻ•—–Á
…ƒ–‹–£ì‹ƒŒ‘”ƒ–‡Áœ‘ƒ‹•…Š‡‹…£ƒ…”‡‹‡”—Ž—‹ƒ–Ÿ–’‡‘†-
mic stroke.
Conclusion. Serum MMP-9 measurement can be used as
an early marker of brain damage. There is a role of MMP-9 as a
co-predictor of outcome in patients with acute stroke.
Key words: prognosis, correlation, MMP-9, stroke.
Introduction
Stroke is a frequent cause of death and long-term disability
worldwide. About 85% of strokes are ischemic, the rest being
hemorrhagic [1, 2]. Matrix metalloproteinases (MMP) have
been implicated in stroke pathophysiology. MMP-2 and MMP-
9 are rapidly upregulated in ischemic brain in animal models
and stroke patients. Pharmacological inhibition or genetic
knockdown of MMP reduces neuronal death, blood-brain bar-
rier damage, edema, and hemorrhage [3, 4].
Matrix metalloproteinases, also known as matrixins, are
calcium-dependent zinc-containing endopeptidases. They
‡Ž‡Ž‡ƒ‹ƒŽ‡ǡ…Ÿ–ç‹Žƒ’ƒ…‹‡ì‹‹…—ǤŠ‹„ƒ”‡ƒˆƒ”ƒ…‘Ž‘‰‹…£
•ƒ— †‹•–”—‰‡”‡ƒ ‰‡‡–‹…£ ƒ  ƒ” ”‡†—…‡ ”‹•…—Ž †‡ ‘ƒ”–‡
‡—”‘ƒŽ£ǡ†‡Ž‡œ‹—‡ƒ„ƒ”‹‡”‡‹Š‡ƒ–‘Ǧ‡…‡ˆƒŽ‹…‡ǡ†‡‡š–‹-
†‡”‡ƒ‡†‡—Ž—‹…‡”‡„”ƒŽç‹†‡–”ƒ•ˆ‘”ƒ”‡Š‡‘”ƒ‰‹…£ƒˆ‘-
carului ischemic [3, 4].
ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœ‡Ž‡ǡ …—‘•…—–‡ ç‹ •—„ †‡—‹”‡ƒ
de matrixine, sunt endopeptidaze dependente de calciu, cu un
…‘ì‹—–•’‘”‹–†‡œ‹…Ǥ…‡•–‡‡œ‹‡‘†—Ž‡ƒœ£—Ž–‡’”‘-
…‡•‡†‡†‡œ˜‘Ž–ƒ”‡ç‹”‡‰‡‡”ƒ”‡ƒŽ‡•‹•–‡—Ž—‹‡”˜‘•…‡–”ƒŽǤ
Ǧͻ‡•–‡‹’Ž‹…ƒ–£Á†‹•–”—‰‡”‡ƒƒ–”‹…‡‹‡š–”ƒ…‡Ž—Žƒ”‡Á
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…‡”‡„”ƒŽ‡†‡‘”‹‰‹‡˜ƒ•…—Žƒ”£ǡƒ…‡•–‡‡œ‹‡ƒ–ƒ…£ƒ–”‹…‡ƒ
‡š–”ƒ…‡Ž—Žƒ”£ç‹‡—”‘‹‹†‹Œ—”—Ž˜ƒ•‡Ž‘”†‡•Ÿ‰‡ǡˆƒ…‹Ž‹–Ÿ†
‘ƒ”–‡ƒ…‡Ž—Ž‡Ž‘”‡—”ƒŽ‡ǤǦ‡Ž‡’‡”–—”„£„ƒ”‹‡”ƒŠ‡ƒ–‘Ǧ
‡…‡ˆƒŽ‹…£Áˆƒœƒ–‹’—”‹‡†—’£†‡„—–—Ž‹•…Š‡‹‡‹…‡”‡„”ƒŽ‡ǡ
†—…Ÿ† Žƒ ‹ϐ‹Ž–”ƒ”‡ Ž‡—…‘…‹–ƒ”£ǡ ‡†‡ …‡”‡„”ƒŽ ç‹ Š‡‘”ƒ‰‹‡
ȏͷȐǤ‡‰‹—‡ƒ’”‘‘–‘”ƒǦͻ’‘ƒ–‡ϐ‹—Ž‘…—•†‡•—•…‡’-
tibilitate pentru accidentul vascular cerebral. Expresia ei este
modulate many central nervous system developmental and
regenerative processes. MMP-9 are involved in the breakdown
of extracellular matrix during tissue remodeling [3, 4]. Dur-
ing stroke, it attacks the extracellular matrix around the blood
vessels and neurons, facilitating neural cell death. MMPs dis-
rupt the blood-brain barrier in the early phase following cere-
„”ƒŽ‹•…Š‡‹ƒǡŽ‡ƒ†‹‰–‘Ž‡ƒƒ‰‡ǡŽ‡—‘…›–‡‹ϐ‹Ž–”ƒ–‹‘ǡ„”ƒ‹
edema, and hemorrhage [5]. MMP-9 promoter region may be
a susceptibility locus for stroke. Its expression is upregulated
after cerebral ischemia, and contributes to infarct extent, and
blood-brain barrier breakdown. Investigation on the relation
between MMP-9 and stroke is gaining much interest as it is in-
volved in stroke pathophysiology and its inhibition is of poten-
tial therapeutic role. MMP-9 is a promising marker of ischemic
stroke [5, 6].
The purpose of our study was to investigate the correlation
between the serum level of MMP-9 and the subtype of stroke
—•‹‰ –Š‡  …Žƒ••‹ϐ‹…ƒ–‹‘ ȋͳͻͻ͵Ȍǡ –Š‡ ƒˆ‘”†Ȁšˆ‘”†
10
”‡‰Žƒ–£ †—’£ †‡„—–—Ž ‹•…Š‡‹‡‹ …‡”‡„”ƒŽ‡ ç‹ …‘–”‹„—‹‡ Žƒ ‡š-
–‹†‡”‡ƒ ‹ˆƒ”…–—Ž—‹ ç‹ Žƒ †‡–‡”‹‘”ƒ”‡ƒ „ƒ”‹‡”‡‹ Š‡ƒ–‘Ǧ‡…‡-
ˆƒŽ‹…‡Ǥ‡”…‡–ƒ”‡ƒ”‡Žƒì‹‡‹†‹–”‡Ǧͻç‹•–”‘‡†‘„Ÿ†‡ç–‡
—ƒ”‡‹–‡”‡•ǡ†‡‘ƒ”‡…‡‡•–‡‹’Ž‹…ƒ–£Áϐ‹œ‹‘’ƒ–‘Ž‘‰‹ƒǡ
‹ƒ”‹Š‹„ƒ”‡ƒƒ…‡•–—‹Ž‘…—•ƒ”ƒ˜‡ƒ—”‘Ž–‡”ƒ’‡—–‹…’‘–‡ì‹ƒŽǤ
Ǧͻ‡•–‡—ƒ”‡”’”‘‹ì£–‘”’‡–”—‹•…Š‡‹…ȏͷǡ͸ȐǤ
…‘’—Ž•–—†‹—Ž—‹‘•–”—ƒˆ‘•–†‡ƒ…‡”…‡–ƒ…‘”‡Žƒì‹ƒ†‹–”‡
‹˜‡Ž—Ž•‡”‹…ƒŽǦͻǡç‹•—„–‹’—Ž†‡ƒ……‹†‡–˜ƒ•…—Žƒ”…‡”‡-
„”ƒŽǡ ˆ‘Ž‘•‹† …Žƒ•‹ϐ‹…ƒ”‡ƒ  ȋͳͻͻ͵Ȍǡ …Žƒ•‹ϐ‹…ƒ”‡ƒ ƒ-
ˆ‘”†Ȁšˆ‘”†ȋͳͻͻͳȌç‹•‡˜‡”‹–ƒ–‡ƒƒ……‹†‡–—Ž—‹˜ƒ•…—Žƒ”…‡”‡-
bral, utilizând scala NIHSS.
ƒ–‡”‹ƒŽç‹‡–‘†‡
Ǧƒ‡ˆ‡…–—ƒ–—•–—†‹—’”‘•’‡…–‹˜ǡ…ƒ”‡ƒ‹…Ž—•’ƒ…‹‡ì‹…—
ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœƒǦͿ •‡”‹…£ ç‹ •‡˜‡”‹–ƒ–‡ƒ ƒ……‹†‡–—Ž—‹ ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‹•…Š‡‹…
…Žƒ••‹ϐ‹…ƒ–‹‘ȋͳͻͻͳȌƒ†–Š‡•‡˜‡”‹–›‘ˆ–Š‡•–”‘‡—•‹‰–Š‡
NIHSS scale.
Material and methods
Š‹•™ƒ•ƒ’”‘•’‡…–‹˜‡‘„•‡”˜ƒ–‹‘ƒŽ•–—†›™‹–Šƒ†‡ϐ‹‹–‡
diagnosis of ischemic stroke made both clinically and radio-
logically, conducted among patients admitted at the Institute
of Emergency Medicine, Neurology and Cerebrovascular dis-
eases unit, Chisinau, Republic of Moldova.
The protocol of this study was approved by Ethics Re-
search Committee of Nicolae Testemitanu State University of
Medicine and Pharmacy, Chisinau, Republic of Moldova (min-
utes no. 26/19 from 8.02.2016). The patients gave unanimous
written consent to participate in the research project.
‹•…Š‡‹…Áˆƒœƒƒ…—–£ǡ‹–‡”ƒì‹Á‡…싃†‡‡—”‘Ž‘‰‹‡ …Ž—•‹‘ …”‹–‡”‹ƒ ˆ‘” –Š‡ •–—†› ™‡”‡ǣ ’ƒ–‹‡–• ™‹–Š ƒ…—–‡
ǡ•–‹–—–—Ž†‡‡†‹…‹£”‰‡–£ǡŠ‹ç‹£—ǡ‡’—„Ž‹…ƒ‘Ž-
†‘˜ƒǤ Ǧ—Ž ƒ ˆ‘•– …‘ϐ‹”ƒ– …Ž‹‹… ç‹ ”ƒ†‹‘Ž‘‰‹… ’”‹ –‘‘-
‰”ƒϐ‹‡…‘’—–‡”‹œƒ–£…‡”‡„”ƒŽ£Ǥ
Protocolul acestui studiu a fost aprobat de Comitetul de
–‹…£ƒ‡”…‡–£”‹‹ƒŽ‹˜‡”•‹–£ì‹‹†‡–ƒ–†‡‡†‹…‹£ç‹ ƒ”ƒ-
…‹‡ Ƿ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ Š‹ç‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒ ȋ”Ǥ
ʹ͸Ȁͳͻ †‹ ͺǤͲʹǤʹͲͳ͸ȌǤ ƒ…‹‡ì‹‹ ƒ— •‡ƒ– …‘•‹ì£Ÿ–—Ž
informat pentru a participa în cadrul proiectul de cercetare.
”‹–‡”‹‹Ž‡ †‡ ‹…Ž—†‡”‡ ’‡–”— •–—†‹— ƒ— ˆ‘•–ǣ ’ƒ…‹‡ì‹‹ …—
Áˆƒœƒƒ…—–£ǡ‹–‡”ƒì‹Á†‡…—”•†‡ʹͶ†‡‘”‡†‡Žƒ†‡„—-
–—Ž ƒŽƒ†‹‡‹ǡ †‹ƒ‰‘•–‹…—Ž ϐ‹‹† …‘ϐ‹”ƒ– ’”‹ ‡šƒ‡—Ž ‹-
ƒ‰‹•–‹…Ȃ–‘‘‰”ƒϐ‹‡…‘’—–‡”‹œƒ–£Ǥƒ…‹‡ì‹‹–”‡„—‹ƒ—•£ƒ‹„£
˜Ÿ”•–ƒ’‡•–‡ͳͺƒ‹ç‹•£•‡‡œ‡…‘•‹ì£Ÿ–—Ž‹ˆ‘”ƒ–…—
privire la participarea în studiu.
”‹–‡”‹‹Ž‡†‡‡š…Ž—†‡”‡ƒ—ˆ‘•–ǣ’ƒ…‹‡ì‹‹…—„‘Ž‹†‡…‘’‡-
•ƒ–‡”‡ƒŽ‡•ƒ—…ƒ”†‹ƒ…‡ǡ–—Ž„—”£”‹•‹•–‡‹…‡‹ϐŽƒƒ–‘”‹‹•ƒ—
–—‘”‹ǡ †‘”‹ìƒ ‡š’”‹ƒ–£ ƒ ’ƒ…‹‡–—Ž—‹ †‡ ƒ ’£”£•‹ •–—†‹—Žǡ
‘„싐‡”‡ƒ†ƒ–‡Ž‘”‹…‘’Ž‡–‡ƒŽ‡’ƒ…‹‡ì‹Ž‘”Ǥ
Sângele venos a fost colectat în primele 24 de ore de la de-
„—–—Ž„‘Ž‹‹ç‹Žƒƒ͹Ǧƒœ‹†‡•’‹–ƒŽ‹œƒ”‡Ǥ‘œƒ”‡ƒǦͻƒˆ‘•–
‡ˆ‡…–—ƒ–£Žƒƒ„‘”ƒ–‘”—Ž†‡„‹‘…Š‹‹‡ƒŽ‹˜‡”•‹–£ì‹‹†‡–ƒ–
†‡‡†‹…‹£ç‹ ƒ”ƒ…‹‡Ƿ‹…‘Žƒ‡‡•–‡‹ìƒ—ǯǯǤ
”‡Ž—…”ƒ”‡ƒ †ƒ–‡Ž‘” ƒ ˆ‘•– ‡ˆ‡…–—ƒ–£ —–‹Ž‹œŸ† ‹…”‘•‘ˆ–
š…‡Ž ʹͲͳͲ ç‹ –ƒ–Ǥ ƒ–‡Ž‡ ’ƒ”ƒ‡–”‹…‡ •—– ‡š’”‹ƒ–‡ …ƒ
˜ƒŽ‘”‹‡†‹‹ά†‡˜‹ƒì‹‡•–ƒ†ƒ”†ǡ‹ƒ”˜ƒ”‹ƒ„‹Ž‡Ž‡…ƒ–‡‰‘”‹ƒŽ‡Ȃ
…ƒ’”‘…‡–‡ǤƒŽ‹œƒ†‡…‘”‡Žƒì‹‡ƒ˜ƒ”‹ƒ„‹Ž‡Ž‘”•Ǧƒ”‡ƒŽ‹œƒ–…—
stroke, admitted within 24 hours of onset, diagnosis being
…‘ϐ‹”‡† „› …‘’—–‡”‹œ‡† –‘‘‰”ƒ’Š› ‹ƒ‰‹‰Ǥ Ž•‘ǡ ’ƒ-
tients should be above the age of 18 years and sign informed
consent regarding enrollment into the study.
š…Ž—•‹‘ …”‹–‡”‹ƒ ™‡”‡ǣ ’ƒ–‹‡–• ™‹–Š ”‡ƒŽ ‘” Š‡ƒ”– †‡-
…‘’‡•ƒ–‡† †‹•‡ƒ•‡•ǡ •›•–‡‹… ‹ϐŽƒƒ–‘”› †‹•‘”†‡” ‘”
tumor, expressed desire of the patient to leave the study, in-
complete standardized data chart.
Venous samples were drawn within 24 hours of the onset
of symptoms and the 7th day of hospitalization, and sent for
routine blood examinations, including measurement of the
MMP-9 level at the Laboratory of biochemistry, ‹…‘Žƒ‡ ‡•Ǧ
–‡‹–ƒ— State Medical and Pharmaceutical University.
Data processing was done using Microsoft Excel 2010 and
XLStat. Parametric data are expressed as mean value ± stan-
†ƒ”††‡˜‹ƒ–‹‘ǡƒ†…ƒ–‡‰‘”‹…ƒŽ˜ƒ”‹ƒ„Ž‡•Ȃƒ•’‡”…‡–ƒ‰‡•ǤŠ‡
correlation analysis of the variables was performed with the
use of Pearson’s test (when the variables were normally dis-
tributed). T-test was used to analyze the parameters resulting
from the estimation of the linear regression model; the statis-
–‹…ƒŽ‘†‡Ž™ƒ•˜ƒŽ‹†ƒ–‡†—•‹‰–Š‡…‘‡ˆϐ‹…‹‡–‘ˆ†‡–‡”‹ƒ-
tion (R square). In all the analyses, p<0.05 were considered
•–ƒ–‹•–‹…ƒŽŽ›•‹‰‹ϐ‹…ƒ–Ǥ
Results
The study included 39 patients with acute ischemic stroke
ƒŒ—–‘”—Ž–‡•–—Ž—‹‡ƒ”•‘ȋ…Ÿ†˜ƒ”‹ƒ„‹Ž‡Ž‡ƒ—ƒ˜—–†‹•–”‹„—싇
‘”ƒŽ£ȌǤ‡•–—Žƒˆ‘•–—–‹Ž‹œƒ–’‡–”—ƒƒƒŽ‹œƒ’ƒ”ƒ‡–”‹‹
…ƒ”‡”‡œ—Ž–£†‹‡•–‹ƒ”‡ƒ‘†‡Ž—Ž—‹†‡”‡‰”‡•‹‡Ž‹‹ƒ”£Ǣ‘†-
‡Ž—Ž•–ƒ–‹•–‹…ƒˆ‘•–˜ƒŽ‹†ƒ–ˆ‘Ž‘•‹†…‘‡ϐ‹…‹‡–—Ž†‡†‡–‡”‹ƒ”‡
ȋ’£–”ƒ–ȌǤB–‘ƒ–‡…‘’ƒ”£”‹Ž‡ǡ˜ƒŽ‘”‹Ž‡’δͲǡͲͷƒ—ˆ‘•–…‘•‹†-
‡”ƒ–‡•–ƒ–‹•–‹…•‡‹ϐ‹…ƒ–‹˜‡Ǥ
‡œ—Ž–ƒ–‡
–—†‹—Žƒ‹…Ž—•͵ͻ†‡’ƒ…‹‡ì‹…—‹•…Š‡‹…Áˆƒœƒƒ…—–£ǡ
…ƒ”‡ ƒ— Á†‡’Ž‹‹– …”‹–‡”‹‹Ž‡ †‡ ‹…Ž—†‡”‡ ç‹ ƒ— ˆ‘•– ‹–‡”ƒì‹
™Š‘ˆ—Žϐ‹ŽŽ‡†‹…Ž—•‹‘…”‹–‡”‹ƒƒ†™‡”‡ƒ†‹––‡†–‘–Š‡•–‹-
tute of Emergency Medicine, Neurology and Cerebrovascular
Diseases unit, Chisinau, Republic of Moldova. Out of total, 17
(43.6%) were male and 22 (56.4%) were female. In addition,
39 healthy volunteers, similar to the patients’ cohort in term
of age and sex, formed the control group. The mean age of the
entire stroke group was 66.9±9.0 years old, the mean age of
™‘‡™ƒ•͸ͺǤ͵άͻǤʹƒ†‹ƒŽ‡‰”‘—’Ȃ͸ͷǤʹάͺǤ͹›‡ƒ”•‘Ž†ǡ
–Š‡”‡™ƒ•ǯ–ƒ•‹‰‹ϐ‹…ƒ–†‹ˆˆ‡”‡…‡„‡–™‡‡–Š‡ƒ‰‡‘ˆ™‘-
‡ƒ†‡ȋ’αͲǤʹͺȌǤ
Á ‡…싃 †‡ ‡—”‘Ž‘‰‹‡ ǡ •–‹–—–—Ž †‡ ‡†‹…‹£ ”‰‡–£ǡ
Š‹ç‹£—ǡ‡’—„Ž‹…ƒ‘Ž†‘˜ƒǤ‡’ƒ”–‹ì‹ƒ’‡•‡š‡ƒ’ƒ…‹‡ì‹Ž‘”
Á”‘Žƒì‹‡•–‡—”£–‘ƒ”‡ƒǣͳ͹ȋͶ͵ǡ͸ΨȌƒ—ˆ‘•–†‡‰‡ƒ•…—Ž‹
ç‹ʹʹȋͷ͸ǡͶΨȌƒ—ˆ‘•–†‡‰‡ˆ‡‹‹Ǥ—ˆ‘•–‹…Ž—ç‹Á•–—†‹—
ç‹ ͵ͻ †‡ ˜‘Ž—–ƒ”‹ •££–‘ç‹ǡ ƒ•‡££–‘”‹ …— Ž‘–—Ž †‡ „ƒœ£ Á
The most common condition in stroke patients was high
blood pressure 38 (97.4%), followed by ischemic heart dis-
ease 26 (66.7%), diabetes mellitus was seen in 17 (43,6%) and
obesity (body mass index >30 kg/m2) was seen in 16 (41.0%)
patients, dyslipidemia was seen in 14 (35.9%) patients.
ƒ–”‹š ‡–ƒŽŽ‘’”‘–‡‹ƒ•‡ǦͿ Ž‡˜‡Ž ƒ† –Š‡ •‡˜‡”‹–› ‘ˆ •–”‘‡
ˆ—…싇 †‡ ˜Ÿ”•–£ ç‹ •‡šǡ ˆ‘”Ÿ† ‰”—’—Ž †‡ …‘–”‘ŽǤ Ÿ”•–ƒ
‡†‹‡ ƒ Á–”‡‰—Ž—‹ ‰”—’ †‡ ’ƒ…‹‡ì‹ …—  ‹•…Š‡‹… ƒ ˆ‘•–
͸͸ǡͻάͻǡͲƒ‹ǡ˜Ÿ”•–ƒ‡†‹‡ƒˆ‡‡‹Ž‘”ϐ‹‹††‡͸ͺǡ͵άͻǡʹƒ‹ǡ‹ƒ”
ƒ’ƒ…‹‡ì‹Ž‘”†‡•‡šƒ•…—Ž‹Ȃ͸ͷǡʹάͺǡ͹ƒ‹Ǥ—•Ǧƒ†‡–‡”‹ƒ–
‘†‹ˆ‡”‡ì£•‡‹ϐ‹…ƒ–‹˜£•–ƒ–‹•–‹…†‹–”‡˜Ÿ”•–ƒˆ‡‡‹Ž‘”ç‹…‡ƒ
ƒ„£”„ƒì‹Ž‘”ȋ’αͲǡʹͺȌǤ
‡ƒƒ‹ˆ”‡…˜‡–£…‘‘”„‹†‹–ƒ–‡†‡’‹•–ƒ–£Žƒ’ƒ…‹‡ì‹‹…—
 ‹•…Š‡‹… ƒ ˆ‘•– Š‹’‡”–‡•‹—‡ƒ ƒ”–‡”‹ƒŽ£ ͵ͺ ȋͻ͹ǡͶΨȌ †‡
…ƒœ—”‹ǡ —”ƒ–£ †‡ „‘ƒŽƒ …ƒ”†‹ƒ…£ ‹•…Š‡‹…£ Ȃ ʹ͸ ȋ͸͸ǡ͹ΨȌ †‡
…ƒœ—”‹Ǣ†‹ƒ„‡–—ŽœƒŠƒ”ƒ–ƒˆ‘•–…‘•–ƒ–ƒ–Žƒͳ͹ȋͶ͵ǡ͸ΨȌ’ƒ…‹‡ì‹ǡ
‹ƒ” ‘„‡œ‹–ƒ–‡ƒ ȋ‹†‹…‡Ž‡ †‡ ƒ•£ …‘”’‘”ƒŽ£ ε͵Ͳ ‰Ȁ2)
ƒ ˆ‘•– ‘„•‡”˜ƒ–£ Žƒ ͳ͸ ȋͶͳǡͲΨȌ ’‡”•‘ƒ‡Ǥ ‹•Ž‹’‹†‡‹ƒ ƒ ˆ‘•–
†‡–‡”‹ƒ–£ŽƒͳͶȋ͵ͷǡͻΨȌ’ƒ…‹‡ì‹Ǥ
‘…‡–”ƒì‹ƒ•‡”‹…£ƒǦͻƒˆ‘•–…”‡•…—–£’‡•–‡˜ƒŽ‘ƒ”-
‡ƒ…‘•‹†‡”ƒ–£‘”ƒŽ£Žƒ–‘ì‹’ƒ…‹‡ì‹‹…—‹•…Š‡‹…ǡ˜ƒŽ‘-
ƒ”‡ƒ‡†‹‡ƒǦͻϐ‹‹††‡͹ǡͶͶάͷǡ͵ʹɊ‰ȀŽȋ‡š–”‡‡ǣͳǡͷͷ
Ȃ ͵ͶǡͺͶ Ɋ‰ȀŽȌǡ ƒ…‡ƒ•–ƒ ϐ‹‹† •‡‹ϐ‹…ƒ–‹˜ •–ƒ–‹•–‹… ȋ’δͲǡͲͲͳȌ
ƒ‹ƒ”‡†‡…Ÿ–Žƒ‰”—’—Žƒ”–‘”ȋʹǡͳͺάͳǡͲɊ‰ȀŽȌǤBƒ͹Ǧƒœ‹
de spitalizare, nivelul seric al MMP-9 nu a fost statistic sem-
‹ϐ‹…ƒ–‹˜ ƒ‹ ‹… †‡…Ÿ– Á ’”‹ƒ œ‹ †‡ •’‹–ƒŽ‹œƒ”‡ ȋ’δͲǡ͵Ȍǡ
˜ƒŽ‘”‹Ž‡‡†‹‹ƒŽ‡ƒ…‡•–—‹ƒϐ‹‹††‡͸ǡ͵ͶάͶǡͲ͵Ɋ‰ȀŽȋ‡š–”‡‡ǣ
ͳǡͻͳɊ‰ȀŽȂʹʹǡ͹ͶɊ‰ȀŽȌǤ
 ’ƒ…‹‡– ƒ •—ˆ‡”‹––”ƒ•ˆ‘”ƒ”‡Š‡‘”ƒ‰‹…£ ƒ œ‘‡‹‹-
ˆƒ”…–—Ž—‹ …‡”‡„”ƒŽǡ Žƒ …ƒ”‡ ‹˜‡Ž—Ž Ǧͻ ƒ ˆ‘•– •‡‹ϐ‹…ƒ–‹˜
mai mare decât a întregului grup de cercetare (în prima zi de
•’‹–ƒŽ‹œƒ”‡Ȃ͵ͶǡͺͶɊ‰ȀŽǡÁƒ͹Ǧƒœ‹†‡•’‹–ƒŽ‹œƒ”‡Ȃʹʹǡ͹ͶɊ‰ȀŽȌǤ
Ǧƒ…‘’ƒ”ƒ–‰”ƒ†—Ž†‡‡š’”‡•‹‡ƒǦͻÁˆ—…싇†‡•—„-
tipul de AVC (Tabelul 1). Gradul de expresie al MMP-9 seric
MJHS 17(3)/2018 11
Serum MMP-9 concentration were increased above the
‘”ƒŽ ˜ƒŽ—‡ ͹ǤͶͶάͷǤ͵ʹ Ɋ‰ȀŽ ȋ‡š–”‡‡•ǣ ͳǤͷͷ –‘ ͵ͶǤͺͶ Ɋ‰ȀŽȌ
‹ •–”‘‡ ‰”‘—’ ™Š‹…Š ™ƒ• •–ƒ–‹•–‹…ƒŽŽ› •‹‰‹ϐ‹…ƒ– ȋ’<0.001)
when compared to the control group (2.18±1.0 Ɋg/l). At the 7th
†ƒ›‘ˆŠ‘•’‹–ƒŽ‹œƒ–‹‘ǡ–Š‡•‡”—ǦͻŽ‡˜‡Ž™ƒ•‘–•‹‰‹ϐ‹-
cant lower 6.34±4.03 Ɋ‰ȀŽȋ‡š–”‡‡•ǣͳǤͻͳρ‰ȀŽ–‘ʹʹǤ͹ͶɊg/l)
–Šƒ‹–Š‡ϐ‹”•–†ƒ›‘ˆŠ‘•’‹–ƒŽ‹œƒ–‹‘ȋ’δͲǤ͵ȌǤ
One patient suffered hemorrhagic transformation of isch-
‡‹…ƒŽŽ›‹ˆƒ”…–‡†ƒ”‡ƒǡ–Š‡ǦͻŽ‡˜‡Ž™ƒ••‹‰‹ϐ‹…ƒ–Š‹‰Š‡”
–Šƒ–Š‡‡–‹”‡‰”‘—’ȋϐ‹”•–†ƒ›‘ˆŠ‘•’‹–ƒŽ‹œƒ–‹‘Ȃ͵ͶǤͺͶɊg/l,
the 7th†ƒ›‘ˆŠ‘•’‹–ƒŽ‹œƒ–‹‘ȂʹʹǤ͹ͶɊg/l).
Š‡”‡ ™ƒ• ƒ •–ƒ–‹•–‹…ƒŽŽ› •‹‰‹ϐ‹…ƒ– †‹ˆˆ‡”‡…‡ ‹ •‡”—
MMP-9 level between the patients according to stroke sub-
–›’‡ ȋƒ„Ž‡ ͳȌǤ ‡”— Ǧͻ Ž‡˜‡Ž ™‡”‡ •‹‰‹ϐ‹…ƒ–Ž› Š‹‰Š‡”
in the large-artery atherosclerosis stroke and stroke of unde-
termined etiology group than in the small-vessel occlusion
‰”‘—’Ǥ ƒ”‰‡Ǧƒ”–‡”› ƒ–Š‡”‘•…Ž‡”‘•‹• Ȃ ͳͻ ȋͶͺǤ͹ΨȌ ™ƒ• –Š‡
most common etiology of the ischemic stroke, followed by un-
†‡–‡”‹‡†‡–‹‘Ž‘‰›Ȃͻȋʹ͵ǤͲ͹ΨȌǡ‹•…Š‡‹……ƒ”†‹‘‡„‘Ž‹•
ȂͺȋʹͲǤͷΨȌƒ†•ƒŽŽǦ˜‡••‡Ž‘……Ž—•‹‘Ȃ͵ȋ͹Ǥ͹ΨȌ’ƒ–‹‡–•Ǥ
……‘”†‹‰ –Š‡ ƒˆ‘”†Ȁšˆ‘”† ȋͳͻͻͳȌ …Žƒ••‹ϐ‹…ƒ–‹‘ǡ –Š‡
serum levels of MMP-9 were similar between the groups with
partial anterior circulation infarct (7.95±6.5 μg/ml) and pos-
–‡”‹‘”…‹”…—Žƒ–‹‘‹ˆƒ”…–ȋ͸Ǥ͹͹άʹǤ͸͵ρ‰ȀŽȌƒ†™‡”‡•‹‰‹ϐ‹-
cant higher than in lacunar infarct group (4.06±1.56 μg/ml)
(Table 1).
We found a good correlation between serum MMP-9 levels
ƒ†  •…‘”‡ ƒ– ƒ†‹••‹‘ ȋ”αͲǤͶͳȌ ƒ† ‹ –Š‡ ͹th day of
ƒ ˆ‘•– •–ƒ–‹•–‹… •‡‹ϐ‹…ƒ–‹˜ ƒ‹ ƒ”‡ Á …ƒœ—Ž ’ƒ…‹‡ì‹Ž‘” …—
Š‘•’‹–ƒŽ‹œƒ–‹‘ȋ”αͲǤ͵͹Ȍȋ ‹‰—”‡ͳȌǤ
‹•…Š‡‹…†‡‘”‹‰‹‡ƒ…”‘ƒ‰‹‘’ƒ–£ç‹Žƒ’ƒ…‹‡ì‹‹…—
We divided the patients into 2 groups according to the
†‡ ‡–‹‘Ž‘‰‹‡ ‡†‡–‡”‹ƒ–£ǡ Á …‘’ƒ”ƒì‹‡ …— ‰”—’—Ž †‡ „‘Ž-
•…‘”‡ǣͳst‰”‘—’Ȃ™‹–Š‹Ž†•‡˜‡”‹–›‘ˆ•–”‘‡ƒ†ʹnd
ƒ˜‹…—†‡‘”‹‰‹‡‹…”‘ƒ‰‹‘’ƒ–£Ǥƒ…”‘ƒ‰‹‘’ƒ–‹ƒƒˆ‘•–
‰”‘—’ Ȃ ™‹–Š ‘†‡”ƒ–‡ •‡˜‡”‹–› ‘ˆ ‹•…Š‡‹… •–”‘‡Ǥ ‡”—
…‡ƒ ƒ‹ ˆ”‡…˜‡–£ …ƒ—œ£ ‡–‹‘Ž‘‰‹…£ ƒ Ǧ—Ž—‹ ‹•…Š‡‹… Ȃ ͳͻ
MMP-9 levels were compared in the two groups according to
ȋͶͺǡ͹ΨȌ’‡”•‘ƒ‡ǡ—”ƒ–£†‡†‡‡–‹‘Ž‘‰‹‡‡†‡–‡”‹ƒ–£
Ȃͻȋʹ͵ǡͲ͹ΨȌ’‡”•‘ƒ‡ǡ…ƒ”†‹‘‡„‘Ž‹…£ȂͺȋʹͲǡͷΨȌ’‡”•‘ƒ‡
ç‹‘…Ž—œ‹ƒ˜ƒ•‡Ž‘”‹…‹Ȃ͹ǡ͹Ψ†‹…ƒœ—”‹Ǥ
‘ˆ‘” …Žƒ•‹ϐ‹…£”‹‹ ƒˆ‘”†Ȁšˆ‘”† (1991), gradul de
expresie al MMP-9 seric a fost similar la grupurile de bolnavi
…—‹ˆƒ”…–…‡”‡„”ƒŽ…—ƒˆ‡…–ƒ”‡ƒ’ƒ”싃Ž£ƒ…‹”…—Žƒì‹‡‹ƒ–‡”‹‘-
ƒ”‡ȋ͹ǡͻͷά͸ǡͷɊ‰ȀŽȌç‹‹ˆƒ”…–…‡”‡„”ƒŽŽƒ‹˜‡Ž†‡…‹”…—Žƒì‹‡
Ž‘™ȋͳǦ͹Ȍƒ†‘†‡”ƒ–‡ȋε͹Ȍ‡—”‘Ž‘‰‹…ƒŽ †‡ϐ‹-
ciency (Table 2).
The group of patients with moderate stroke severity had
•‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡”•‡”—ǦͻŽ‡˜‡Žȋ’δͲǤͲͷȌȋƒ„Ž‡ʹȌǤ
‡’ƒ–‹‡–†‹‡††—”‹‰–Š‡•–—†›ǤŠ‡”‡™ƒ•ƒ•‹‰‹ϐ‹…ƒ–Ž›
higher value of serum MMP-9 level in patient who expired af-

Tabelul 1.
”ƒ†—Ž†‡‡š’”‡•‹‡ƒŽǦͻȋρ‰ȀŽȌÁˆ—…싇†‡•—„–‹’—Ž†‡‹•…Š‡‹…Ǥ
Table 1. ‹•–”‹„—–‹‘ ‘ˆ ǦͿ Ž‡˜‡Ž• ȋυ‰ȀŽȌ „› ‹•…Š‡‹… •–”‘‡ •—„–›’‡Ǥ
Žƒ•‹ϐ‹…ƒ”‡ƒȋͳͻͻ͵ȌƒŽƒ……‹†‡–—Ž—‹˜ƒ•…—Žƒ”…‡”‡„”ƒŽ‹•…Š‡‹…
›’‡ ‘ˆ ‹•…Š‡‹… •–”‘‡ —•‹‰  ȋ1ͿͿ͹Ȍ …Žƒ••‹ϔ‹…ƒ–‹‘
Macroangiopatie Microangiopatie ƒ”†‹‘‡„‘Ž‹…£ –‹‘Ž‘‰‹‡‡†‡–‡”‹ƒ–£
ƒ”‰‡ ƒ”–‡”› ƒ–Š‡”‘•…Ž‡”‘•‹• ƒŽŽǦ˜‡••‡Ž ‘……Ž—•‹‘ ƒ”†‹‘‡„‘Ž‹• †‡–‡”‹‡† ‡–‹‘Ž‘‰›
8,56±6,90 4,06±1,56 6,29±3,64 7,07±2,39
Žƒ•‹ϐ‹…ƒ”‡ƒƒˆ‘”†Ȁšˆ‘”†ȋͳͻͻͳȌƒŽƒ……‹†‡–—Ž—‹˜ƒ•…—Žƒ”…‡”‡„”ƒŽ‹•…Š‡‹…
›’‡ ‘ˆ ‹•…Š‡‹… •–”‘‡ —•‹‰ –Š‡ ƒˆ‘”†Ȁšˆ‘”† ȋ1ͿͿ1Ȍ …Žƒ••‹ϔ‹…ƒ–‹‘
ˆ‡…–ƒ”‡ƒ’ƒ”싃Ž£ƒ…‹”…—Žƒì‹‡‹ƒ–‡”‹‘ƒ”‡ ˆ‡…–ƒ”‡ƒ–‘–ƒŽ£ƒ…‹”…—Žƒì‹‡‹ƒ–‡”‹‘ƒ”‡ ˆ‡…–ƒ”‡ƒ…‹”…—Žƒì‹‡‹’‘•–‡”‹‘ƒ”‡ Infarct lacunar
ƒ”–‹ƒŽ ƒ–‡”‹‘” …‹”…—Žƒ–‹‘ ‹ˆƒ”…– ‘–ƒŽ ƒ–‡”‹‘” …‹”…—Žƒ–‹‘ ‹ˆƒ”…– ‘•–‡”‹‘” …‹”…—Žƒ–‹‘ ‹ˆƒ”…– ƒ…—ƒ” ‹ˆƒ”…–
7,95±6,50 9,39 6,77±2,53 4,06±1,56
‘–£:†ƒ–‡Ž‡•—–’”‡œ‡–ƒ–‡†”‡’–‡†‹‡ç‹†‡˜‹‡”‡•–ƒ†ƒ”†Ǥ
‘–‡: †ƒ–ƒ ƒ”‡ ’”‡•‡–‡† ƒ• ‡ƒ ƒ† •–ƒ†ƒ”† †‡˜‹ƒ–‹‘Ǥ
12 ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœƒǦͿ •‡”‹…£ ç‹ •‡˜‡”‹–ƒ–‡ƒ ƒ……‹†‡–—Ž—‹ ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‹•…Š‡‹…

Fig. 1 ‘”‡Žƒ”‡ƒ†‹–”‡‹˜‡Ž—ŽǦͻ•‡”‹…ç‹•…‘”—ŽǤ Fig. 2 —”„ƒ’‡–”—ƒ’”‡…‹‡”‡ƒ’”‘‰‘•–‹…—Ž—‹†‡‡˜‘Ž—싇ƒŽ

Fig. 1 ‘””‡Žƒ–‹‘ „‡–™‡‡ •‡”— ǦͿ Ž‡˜‡Ž ƒ†  •…‘”‡. ‹•…Š‡‹…ǡÁˆ—ì‹‡†‡‰”ƒ†—Ž†‡‡š’”‡•‹‡ƒŽǦͻȋρ‰ȀŽȌǤ
Fig. 2 Š‡  …—”˜‡ ˆ‘” ƒ••‡••‹‰ –Š‡ ’”‘‰‘•‹• ‘ˆ ‹•…Š‡‹… •–”‘‡
’”‘‰”‡••‹‘ „ƒ•‡† ‘ –Š‡ ǦͿ ‡š’”‡••‹‘ ȋυ‰ȀŽȌǤ

’‘•–‡”‹‘ƒ”£ ȋ͸ǡ͹͹άʹǡ͸͵ Ɋ‰ȀŽȌ ç‹ ƒ ˆ‘•– •–ƒ–‹•–‹… •‡‹ϐ‹…ƒ–‹˜ ter stroke than in patients who survived (10.46 μg/ml at ad-
ƒ‹ƒ”‡†‡…Ÿ–ÁŽ‘–—Ž†‡’ƒ…‹‡ì‹…—Žƒ…—ƒ”ȋͶǡͲ͸άͳǡͷ͸ ‹••‹‘ƒ†ͺǤͺͻρ‰ȀŽȂƒ––Š‡͹th day of hospitalization).
Ɋ‰ȀŽȌȋƒ„‡Ž—ŽͳȌǤ The MMP-9 can be used to predict the progression of isch-
Ǧƒ †‡–‡”‹ƒ– ‘ …‘”‡Žƒì‹‡ ’‘œ‹–‹˜£ †‹–”‡ ‹˜‡Ž—Ž •‡”‹… ƒŽ emic stroke (Figure 2). For the MMP-9, we determined the
Ǧͻ ç‹ •…‘”—Ž  ȋ ‹‰—”ƒ ͳȌǤ ‘”‡Žƒ”‡ƒ †ƒ–£ ƒ ˆ‘•– ƒ‹ Ž‡˜‡Ž ‘ˆ Ǧͻ εͳͲ Ɋ‰ȀŽǡ ”‡•’‡…–‹˜‡Ž›ǡ ˆ‘” –Š‹• ˜ƒŽ—‡ ™‡ †‡-
•–”Ÿ•£ Á œ‹—ƒ ‹–‡”£”‹‹ ȋ”αͲǡͶͳȌ ç‹ Á ƒ ͹Ǧƒ œ‹ †‡ •’‹–ƒŽ‹œƒ”‡ termined a sensitivity for unfavorable disease progression of
ȋ”αͲǡ͵͹ȌǤ ͳͲͲΨƒ†ƒ•’‡…‹ϐ‹…‹–›‘ˆͺ͸ΨǤ
ƒ…‹‡ì‹‹‰”—’—Ž—‹†‡„ƒœ£ƒ—ˆ‘•–Á’£”ì‹ì‹Áʹ•—„Ž‘–—”‹ǡ
Áˆ—…싇†‡•…‘”—Žǣ’”‹—Ž•—„Ž‘–ƒˆ‘•–…‘•–‹–—‹–†‹ Discussion
„‘Žƒ˜‹…—†‡•‡˜‡”‹–ƒ–‡—瑃”£ǡ‹ƒ”ƒŽ†‘‹Ž‡ƒȂ†‹’ƒ…‹‡ì‹ MMP-9 is such a neurochemical marker of brain damage
cu AVC ischemic de severitate medie. Nivelul seric al MMP-9 which is a major component of the cytosol, particularly in the
ƒ ˆ‘•– …‘’ƒ”ƒ– Á–”‡ …‡Ž‡ †‘—£ ‰”—’—”‹ǡ Á ˆ—…싇 †‡ •…‘”—Ž ƒ•–”‘‰Ž‹ƒŽ…‡ŽŽ•ƒ†‹•”‡Ž‡ƒ•‡†‹–Š‡…‡”‡„”‘•’‹ƒŽϐŽ—‹†ƒ†
Ǥ†‡ϐ‹…‹–‡—”‘Ž‘‰‹…—ç‘”•‡Á…ƒ†”‡ƒœ£Á–”‡˜ƒŽ‘”‹Ž‡ peripheral blood due to disruption of blood brain barrier after
 …—’”‹•‡ Á–”‡ ͳǦ͹ ’—…–‡ ç‹ …‡Ž ‘†‡”ƒ– Ȃ  ε͹ the brain damage. MMP-9 have received increasing attention
puncte (Tabelul 2). because of their use as predictive marker of improving clini-

”—’—Ž†‡’ƒ…‹‡ì‹…—•‡˜‡”‹–ƒ–‡‘†‡”ƒ–£†‡ƒ’”‡œ‡- cal management and clinical outcome of patients. The pres-
–ƒ–—‹˜‡Ž•‡‹ϐ‹…ƒ–‹˜ƒ‹ƒ”‡ƒŽǦͻ•‡”‹…‡ȋ’δͲǡͲͷȌ
‡–•–—†›’”‹ƒ”‹Ž›…‘ϐ‹”‡†–Šƒ–ǦͻŽ‡˜‡Žƒ”‡Š‹‰Š‡”‹
(Tabelul 2).
patients with stroke compared with healthy volunteers. The
Un pacient a decedat în timpul studiului. Acest pacient a
high level of MMP-9 in acute stroke was also observed with
’”‡œ‡–ƒ–‘˜ƒŽ‘ƒ”‡•‡‹ϐ‹…ƒ–‹˜ƒ‹ƒ”‡ƒ‹˜‡Ž—Ž—‹•‡”‹…ƒŽ
other studies in the literature [6-10]. Rosell A. ‡– ƒŽǤ studied
Ǧͻ†‡…Ÿ–ƒ’ƒ…‹‡ì‹Ž‘”…ƒ”‡ƒ—•—’”ƒ˜‹‡ì—‹–ȋͳͲǡͶ͸Ɋ‰ȀŽ
postmortem fresh brain tissue from 6 ischemic and 8 hemor-
Žƒ‹–‡”ƒ”‡ç‹ͺǡͺͻɊ‰ȀŽŽƒƒ͹Ǧ‡ƒœ‹†‡•’‹–ƒŽ‹œƒ”‡ȌǤ
”Šƒ‰‹…•–”‘‡’ƒ–‹‡–•™‹–Š‹–Š‡ϐ‹”•–͸Š‘—”•ƒˆ–‡”†‡ƒ–ŠǤŠ‡
•–ˆ‡Žǡ •Ǧƒ …‘•–ƒ–ƒ– …£ Ǧͻ •‡”‹… ’‘ƒ–‡ ϐ‹ —–‹Ž‹œƒ– ’‡-
study demonstrated ‹ •‹–— higher levels of MMP-9 in human
–”—ƒ’”‡œ‹…‡‡˜‘Ž—싃‹•…Š‡‹…ȋ ‹‰—”ƒʹȌǤ‡–”—Ǧͻǡ
brain tissue after ischemic and hemorrhagic stroke, suggest-
˜ƒŽ‘ƒ”‡ƒǦ’”ƒ‰†‡εͳͲɊ‰ȀŽƒ”‡‘•‡•‹„‹Ž‹–ƒ–‡†‡ͳͲͲΨç‹‘

Tabelul 2. ‹˜‡Ž—Ž•‡”‹…ƒŽǦͻȋρ‰ȀŽȌÁˆ—…싇†‡•‡˜‡”‹–ƒ–‡ƒ‹•…Š‡‹…ȋʹͶ†‡‘”‡†‡Žƒ†‡„—–ȌǤ
Table 2. ‡˜‡”‹–› ‘ˆ •–”‘‡ ȋϔ‹”•– ͸ͺ Š‘—”• ‘ˆ ‘•‡–Ȍ ƒ† •‡”— ǦͿ Ž‡˜‡Ž ȋυ‰ȀŽȌǤ
‡˜‡”‹–ƒ–‡ƒ—瑃”£ ‡˜‡”‹–ƒ–‡ƒ‘†‡”ƒ–£ p
‹Ž† •–”‘‡ •‡˜‡”‹–› ‘†‡”ƒ–‡ •–”‘‡ •‡˜‡”‹–›
5,89±2,50 10,21±7,60 0,013
‘–£ǣ–‡•–•–ƒ–‹•–‹…ƒ’Ž‹…ƒ–Ȃ–Ǧ–—†‡–„‹…ƒ—†ƒŽ‡’‡”‡…Š‡Ǥ
‘–‡: ƒ’’Ž‹‡† •–ƒ–‹•–‹…ƒŽ –‡•– Ȃ –™‘ –ƒ‹Ž‡† —’ƒ‹”‡† –Ǧ–—†‡–Ǥ
ƒ–”‹š ‡–ƒŽŽ‘’”‘–‡‹ƒ•‡ǦͿ Ž‡˜‡Ž ƒ† –Š‡ •‡˜‡”‹–› ‘ˆ •–”‘‡
•’‡…‹ϐ‹…‹–ƒ–‡ †‡ ͺ͸Ψ ’‡–”— ‡˜‘Ž—싃 ‡ˆƒ˜‘”ƒ„‹Ž£ ƒ Ǧ—Ž—‹
ischemic.
‹•…—ì‹‹
Ǧͻ”‡’”‡œ‹–£—ƒ”‡”‡—”‘…Š‹‹…ƒŽŽ‡œ‹—‹Ž‘”…‡-
”‡„”ƒŽ‡ç‹‡•–‡‘…‘’‘‡–£ƒŒ‘”£ƒ…‹–‘œ‘Ž—Ž—‹ǡÁ•’‡…‹ƒŽǡ
Á…‡Ž—Ž‡Ž‡ƒ•–”‘‰Ž‹ƒŽ‡Ǥ•–‡‡Ž‹„‡”ƒ–ÁŽ‹…Š‹†—Ž…‡ˆƒŽ‘”ƒŠ‹†‹ƒç‹
•Ÿ‰‡Ž‡’‡”‹ˆ‡”‹…†‹…ƒ—œƒ’‡”–—”„£”‹‹„ƒ”‹‡”‡‹Š‡ƒ–‘‡…‡-
ˆƒŽ‹…‡ǡ…ƒ—”ƒ”‡ƒŽ‡œ‹—‹‹…‡”‡„”ƒŽ‡†‡‘”‹‰‹‡–”ƒ—ƒ–‹…£•ƒ—
˜ƒ•…—Žƒ”£Ǥ Ǧͻ ƒ „‡‡ϐ‹…‹ƒ– †‡ ‘ ƒ–‡ì‹‡ •’‘”‹–£ Á —Ž–‹‹‹
ƒ‹ †ƒ–‘”‹–£ ’‘•‹„‹Ž‹–£ì‹‹ —–‹Ž‹œ£”‹‹ Ž—‹ …ƒ ƒ”‡” ’”‡†‹…–‹˜ †‡
Á„—£–£ì‹”‡ ƒŽ ƒƒ‰‡‡–—Ž—‹ …Ž‹‹… ç‹ ƒŽ ’”‘‰‘•–‹…—Ž—‹
‡—”‘Ž‘‰‹…Žƒ’ƒ…‹‡ì‹‹…—Ǥ–—†‹—Ž’”‡œ‡–ƒ…‘ϐ‹”ƒ–…£
‹˜‡Ž—ŽǦͻ•‡”‹…‡•–‡”‹†‹…ƒ–Žƒ’ƒ…‹‡ì‹‹…—‹•…Š‡‹…ǡ
…‘’ƒ”ƒ–‹˜…—•—„‹‡…ì‹‹•££–‘ç‹Ǥ
Nivelul ridicat al MMP-9 seric la bolnavii cu leziuni ce-
”‡„”ƒŽ‡ †‡ ‘”‹‰‹‡ ˜ƒ•…—Žƒ”£ ƒ ˆ‘•– ‘„•‡”˜ƒ– ç‹ Á …ƒœ—Ž ƒŽ–‘”
•–—†‹‹ †‹ Ž‹–‡”ƒ–—”£ ȏ͸ǦͳͲȐǤ •–ˆ‡Žǡ ‘•‡ŽŽ Ǥ ‡– ƒŽǤ, au studiat
쇕—–—Ž …‡”‡„”ƒŽ ’‘•–‘”–‡ Žƒ ͸ ’ƒ…‹‡ì‹ …—  ‹•…Š‡‹…
ç‹ Žƒ ͺ ’ƒ…‹‡ì‹ …—  Š‡‘”ƒ‰‹… Á ’”‹‡Ž‡ ͸ ‘”‡ †‡ Žƒ †‡-
ces. Studiul a demonstrat niveluri mai ridicate de MMP-9 în
쇕—–—Ž…‡”‡„”ƒŽ—ƒ‹ •‹–—†—’£Ž‡œ‹—‡…‡”‡„”ƒŽ£†‡‘”‹‰‹‡
‹•…Š‡‹…£ç‹Š‡‘”ƒ‰‹…£ǡ•—‰‡”Ÿ†…‘–”‹„—싃ǦͻÁŽ‡œ‹-
—‹Ž‡ …‡”‡„”ƒŽ‡ ‹•…Š‡‹…‡ ç‹ ‡†‡—Ž ˆ‘”ƒ– Á Œ—”—Ž Š‡ƒ–‘-
mului cerebral [8].
Zhong C. ‡– ƒŽǤǡƒ—£•—”ƒ–…‘…‡–”ƒì‹‹Ž‡•‡”‹…‡ƒŽ‡Ǧͻ
Žƒ͵Ǥͳͺ͸†‡’ƒ”–‹…‹’ƒì‹†‹Š‹ƒÁ…ƒ†”—Ž”‹ƒŽ—Ž—‹–‹Š‹’-
‡”–‡•‹˜ǡ†‡†‹…ƒ–’ƒ…‹‡ì‹Ž‘”…—‹•…Š‡‹…Áˆƒœƒƒ…—–£ǤB
…—”•—Ž…‡Ž‘”͵Ž—‹†‡…‡”…‡–ƒ”‡ǡ͹͸͹ȋʹͶǡ͸ΨȌ†‡’ƒ”–‹…‹’ƒì‹
au prezentat un handicap major sau au decedat. MMP-9 seric a
MJHS 17(3)/2018 13
ing a contribution of MMP-9 to ischemic brain injury and peri-
hematoma edema [8].
Zhong C. ‡– ƒŽǤ, measured serum MMP-9 levels in 3,186 par-
ticipants from the China Antihypertensive Trial in Acute Isch-
emic Stroke. During 3 months of follow-up, 767 participants
(24.6%) experienced major disability or died. Serum MMP-9
™ƒ• •‹‰‹ϐ‹…ƒ–Ž› ƒ••‘…‹ƒ–‡† ™‹–Š ƒ ‹…”‡ƒ•‡† ”‹• ‘ˆ †‡ƒ–Š
and major disability after adjustment for age, sex, time from
onset to randomization, current smoking, alcohol drinking,
and admission NIHSS score. So higher serum MMP-9 levels in
the acute phase of ischemic stroke were associated with in-
creased risk of mortality and major disability, suggesting that
serum MMP-9 could be an important prognostic factor for
ischemic stroke [10].
Abdelnaseer M. investigated the serum level of MMP-9
‹͵Ͳ’ƒ–‹‡–•™‹–Šƒ…—–‡‹•…Š‡‹…•–”‘‡†—”‹‰–Š‡ϐ‹”•–ʹͶ
hours of onset as predictor of stroke outcome and the relation
between the level of MMP-9 after 30 days and stroke recovery.
In this study the serum level of MMP-9 30 days after stroke
onset was positively correlated with initial stroke severity and
outcome, as well as with clinical recovery [11].
MMPs are overexpressed in the presence of some neuro-
logical diseases in which blood-brain barrier disruption ex-
ists. Abilleira S. ‡– ƒŽǤ investigated the MMP-9 concentration in
patients after acute intracerebral hemorrhage and its relation
to peri-hematomal edema. Expression of MMP-9 is raised after
acute spontaneous intracerebral hemorrhage. Among patients
with deep intracerebral hemorrhage this increase is associat-
ed with peri-hematomal edema and the development of neu-
rological worsening within the acute stage [12].
ˆ‘•–ƒ•‘…‹ƒ–…——”‹•……”‡•…—–†‡†‡…‡•ç‹‹˜ƒŽ‹†‹–ƒ–‡ƒŒ‘”£Á
—”ƒƒŒ—•–£”‹‹’‡–”—˜Ÿ”•–£ǡ•‡šǡ’‡–”—–‹’—Ž†‡Žƒ†‡„—–—Ž
ƒŽƒ†‹‡‹’Ÿ£Žƒ‹…Ž—†‡”‡ƒÁ•–—†‹—ǡ–ƒ„ƒ‰‹•ǡ…‘•—†‡ƒŽ-
cool, scor NIHSS la internare. Astfel, nivelurile serice mai mari
ƒŽ‡ǦͻÁˆƒœƒƒ…—–£ƒƒ……‹†‡–—Ž—‹˜ƒ•…—Žƒ”…‡”‡„”ƒŽ‹•…Š-
‡‹…ƒ—ˆ‘•–ƒ•‘…‹ƒ–‡…——”‹•……”‡•…—–†‡‘”–ƒŽ‹–ƒ–‡ç‹†‹œ-
ƒ„‹Ž‹–ƒ–‡ƒŒ‘”£ǡ•—‰‡”Ÿ†…£Ǧͻ•‡”‹…ƒ”’—–‡ƒϐ‹—ˆƒ…–‘”
†‡’”‘‰‘•–‹…‹’‘”–ƒ–’‡–”—‡˜‘Ž—싃‹•…Š‡‹…ȏͳͲȐǤ
Abdelnaseer M. a investigat nivelul seric al MMP-9 la 30 de
’ƒ…‹‡ì‹…—‹•…Š‡‹…ƒ…—–Á’”‹‡Ž‡ʹͶ†‡‘”‡†‡Žƒ†‡„—–
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”‡Žƒì‹ƒ†‹–”‡‹˜‡Ž—ŽǦͻ•‡”‹…’‡•–‡͵Ͳ†‡œ‹Ž‡†‡Žƒ†‡„—-
–—Ž„‘Ž‹‹ç‹‰”ƒ†—Ž†‡”‡…—’‡”ƒ”‡ˆ—…ì‹‘ƒŽ£’‘•–ǦǤBƒ…‡•–
•–—†‹—ǡ ‹˜‡Ž—Ž •‡”‹… ƒŽ Ǧͻ Žƒ ‘ Ž—£ †‡ Žƒ †‡„—–—Ž  ƒ
…‘”‡Žƒ–’‘œ‹–‹˜…—•‡˜‡”‹–ƒ–‡ƒ†‡ϐ‹…‹–—Ž—‹‡—”‘Ž‘‰‹…Žƒ†‡„—–—Ž
„‘Ž‹‹ç‹…—‰”ƒ†—Ž”‡…—’‡”£”‹‹…Ž‹‹…‡Žƒ‘Ž—£ȏͳͳȐǤ
•—–•—’”ƒ‡š’”‹ƒ–‡Á’”‡œ‡ìƒ—‘”ƒˆ‡…ì‹—‹‡—-
”‘Ž‘‰‹…‡ǡ Á …ƒ”‡ ‡š‹•–£ ‘ ’‡”–—”„ƒ”‡ ƒ „ƒ”‹‡”‡‹ Š‡ƒ–‘‡…‡-
falice. Abilleira S. ‡–Ǥ ƒŽǤǡƒ—‹˜‡•–‹‰ƒ–…‘…‡–”ƒì‹ƒǦͻŽƒ
’ƒ…‹‡ì‹‹ …ƒ”‡ ƒ— •—ˆ‡”‹– †‡ Š‡‘”ƒ‰‹‡ ‹–”ƒ…‡”‡„”ƒŽ£ ƒ…—–£
ç‹ ”‡Žƒì‹ƒ ‡‹ …— ‡†‡—Ž ˆ‘”ƒ– Á Œ—”—Ž Š‡ƒ–‘—Ž—‹Ǥ
”ƒ†—Ž levels have a positive correlation with NIHSS. Finally, we con-
†‡ ‡š’”‡•‹‡ ƒŽ Ǧͻ •‡”‹… ‡•–‡ …”‡•…—– †—’£ •—’‘”–ƒ”‡ƒ
——‹  Š‡‘”ƒ‰‹…Ǥ ƒ ’ƒ…‹‡ì‹‹ …—  Š‡‘”ƒ‰‹…ǡ ƒ…‡ƒ•–£
…”‡ç–‡”‡ ‡•–‡ ƒ•‘…‹ƒ–£ …— ˜‘Ž——Ž ‡†‡—Ž—‹ ˆ‘”ƒ– Á Œ—”—Ž
Š‡ƒ–‘—Ž—‹ ç‹ …— ‰”ƒ†—Ž ƒ‰”ƒ˜£”‹‹ †‡ϐ‹…‹–—Ž—‹ ‡—”‘Ž‘‰‹… Á
stadiul acut [12].
‘—”•–—†›•‡”—ǦͻŽ‡˜‡Ž™‡”‡•‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡”
in the large-artery atherosclerosis stroke and stroke of unde-
termined etiology group than in the small-vessel occlusion
‰”‘—’ǤǦͻŽ‡˜‡Ž™ƒ••‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡”‹–Š‡’ƒ–‹‡–™Š‘
died compared with survivors. MMP-9 has high sensitivity and
Š‹‰Š•’‡…‹ϐ‹…‹–›‹‹•…Š‡‹…•–”‘‡Ǥ
Š‡ †‡ϐ‹‹–‹‘ ‘ˆ –Š‡ ‡šƒ…– ”‘Ž‡ ‘ˆ  ƒˆ–‡” ‹•…Š‡‹…
stroke will have important diagnostic implications for stroke
and for the development of therapeutic strategies aimed at
modulating MMP [7]. MMP-9 is a possible marker for ongo-
ing brain ischemia, as well as a predictor of hemorrhage in pa-
tients treated with rt-PA.
Conclusions
‡”—ǦͻŽ‡˜‡Ž•‹‰‹ϐ‹…ƒ–Ž›”‹•‡•‹’ƒ–‹‡–™‹–Šƒ…—–‡
stroke due to ischemia. It helps in the diagnosis of stroke and
–Š‡ •‡˜‡”‹–› ‘ˆ •–”‘‡ ƒ• ‹– ‹• •‹‰‹ϐ‹…ƒ– ‹…”‡ƒ•‡• ƒ……‘”†‹‰
to the NIHSS score in patients with moderate stroke severity
compared to those with mild stroke severity. MMP-9 protein
clude that serum MMP-9 protein measurement can be used for
the prognosis of the clinical outcome in patients with acute
ischemic stroke.
14 ƒ–”‹š ‡–ƒŽ‘’”‘–‡‹ƒœƒǦͿ •‡”‹…£ ç‹ •‡˜‡”‹–ƒ–‡ƒ ƒ……‹†‡–—Ž—‹ ˜ƒ•…—Žƒ” …‡”‡„”ƒŽ ‹•…Š‡‹…

B •–—†‹—Ž ‘•–”—ǡ ‹˜‡Ž—Ž Ǧͻ •‡”‹… ƒ ˆ‘•– •‡‹ϐ‹…ƒ–‹˜ ‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‹‰‹–‡”‡•–•

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†‡‡–‹‘Ž‘‰‹‡‡†‡–‡”‹ƒ–£ǡ†‡…Ÿ–Á‰”—’—Ž†‡’ƒ…‹‡ì‹…—
†‡‘”‹‰‹‡‹…”‘ƒ‰‹‘’ƒ–£Ǥ‹˜‡Ž—ŽǦͻƒˆ‘•–•‡‹ϐ‹- Contribution of the authors
…ƒ–‹˜ ƒ‹ ƒ”‡ Žƒ ’ƒ…‹‡–—Ž …ƒ”‡ ƒ †‡…‡†ƒ– Á …‘’ƒ”ƒì‹‡ …—
Study designing (EG, DC, VC, VM), accumulation of clinical
•—’”ƒ˜‹‡ì—‹–‘”‹‹Ǥ
material (VM), data interpretation and statistical analysis (EG,
‡ϐ‹‹”‡ƒ”‘Ž—Ž—‹‡šƒ…–ƒŽ†—’£•—’‘”–ƒ”‡ƒ——‹
DC), manuscript preparation (VC, VM), critical review of man-
‹•…Š‡‹…˜ƒƒ˜‡ƒ‹’Ž‹…ƒì‹‹‹’‘”–ƒ–‡ƒ•—’”ƒ†‹ƒ‰‘•–‹…—Ž—‹
uscript (EG, DC). Final version of manuscript was read and ap-
ç‹’‡–”— †‡œ˜‘Ž–ƒ”‡ƒ •–”ƒ–‡‰‹‹Ž‘”–‡”ƒ’‡—–‹…‡ǡ ‡‹–‡ •£
proved by all authors.
‘†—Ž‡œ‡  ȏ͹ȐǤ Ǧͻ ‡•–‡ — ’‘–‡ì‹ƒŽ ƒ”‡” ’‡–”—
‹•…Š‡‹ƒ …‡”‡„”ƒŽ£ǡ ’”‡…— ç‹ — ’”‡†‹…–‘” ƒŽ –”ƒ•ˆ‘”£”‹‹
Š‡‘”ƒ‰‹…‡ ƒ ˆ‘…ƒ”—Ž—‹ ‹•…Š‡‹… Žƒ ’ƒ…‹‡ì‹‹ ‡Ž‹‰‹„‹Ž‹ ’‡–”—
tratament cu rt-PA.

‘…Ž—œ‹‹
‹˜‡Ž—ŽǦͻ•‡”‹……”‡ç–‡•‡‹ϐ‹…ƒ–‹˜Žƒ’ƒ…‹‡ì‹‹…—ƒ…-
…‹†‡–˜ƒ•…—Žƒ”…‡”‡„”ƒŽ‹•…Š‡‹…Áˆƒœƒƒ…—–£ǡ•‡”˜‹††”‡’–
biomarker pentru diagnosticarea accidentului vascular cere-
„”ƒŽç‹ƒ•‡˜‡”‹–£ì‹‹†‡ϐ‹…‹–—Ž—‹‡—”‘Ž‘‰‹…Ǥ‘…‡–”ƒì‹ƒǦͻ
…”‡ç–‡•‡‹ϐ‹…ƒ–‹˜Áˆ—…싇†‡•…‘”—ŽŽƒ’ƒ…‹‡ì‹‹…—
†‡ϐ‹…‹–‡—”‘Ž‘‰‹…‘†‡”ƒ–ǡ…‘’ƒ”ƒ–‹˜…—…‡‹…—†‡ϐ‹…‹–—ç‘”Ǥ
Nivelurile MMP-9 au corelat pozitiv cu scorul NIHSS. În cele
†‹ —”£ǡ £•—”ƒ”‡ƒ Ǧͻ •‡”‹… ’‘ƒ–‡ ϐ‹ —–‹Ž‹œƒ–£ ’‡–”—
’”‘‰‘•–‹…—Ž ‡˜‘Ž—싇‹ …Ž‹‹…‡ Žƒ ’ƒ…‹‡ì‹‹ …—  ‹•…Š‡‹… Á
ˆƒœƒƒ…—–£Ǥ

‡…Žƒ”ƒì‹ƒ†‡…‘ϐŽ‹…–†‡‹–‡”‡•‡
—–‘”‹‹†‡…Žƒ”£ƒ„•‡ìƒ…‘ϐŽ‹…–—Ž—‹†‡‹–‡”‡•Ǥ

‘–”‹„—싃ƒ—–‘”‹Ž‘”
Proiectarea studiului (EG, DC, VC, VM), acumularea mate-
”‹ƒŽ‡Ž‘”…Ž‹‹…‡ȋȌǡ‹–‡”’”‡–ƒ”‡ƒ†ƒ–‡Ž‘”狃ƒŽ‹œƒ•–ƒ–‹•–‹…£
ȋ
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ƒƒ—•…”‹•—Ž—‹ƒˆ‘•–…‹–‹–£ç‹ƒ’”‘„ƒ–£†‡–‘싃—–‘”‹‹Ǥ

‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
1. Caplan L. Basic pathology, anatomy, and pathophysiology of stro- 7. Ramos-FernandezM., Bellolio F. ‡–Ǥ ƒŽǤ Matrix Metalloproteinase-9
‡Ǥǣƒ’Žƒǯ•–”‘‡ǣƒ…Ž‹‹…ƒŽƒ’’”‘ƒ…ŠǡͶth ed. Saunders Else- ƒ•ƒƒ”‡”ˆ‘”ƒ…—–‡‹•…Š‡‹…•–”‘‡ǣƒ•›•–‡ƒ–‹…”‡˜‹‡™Ǥ ‘—”Ǧ
vier, Philadelphia 2009. p. 22. ƒŽ ‘ˆ –”‘‡ ƒ† ‡”‡„”‘˜ƒ•…—Žƒ” ‹•‡ƒ•‡•ǡʹͲͳͳǢʹͲǣͶ͹ǦͷͶǤ
ʹǤ †ƒ• Ǥǡ ‹ŽŽ‡” Ǥ Žƒ••‹ϐ‹…ƒ–‹‘ ‘ˆ •—„–›’‡• ‘ˆ ‹•…Š‡‹… •–”‘‡ 8. Rosell A., Ortega-Aznar A., Alvarez-Sabín J. ‡– ƒŽǤ Increased brain
Š‹•–‘”›‘ˆ–Š‡–”‹ƒŽ‘ˆ‘”‰ͳͲͳ͹ʹ‹ƒ…—–‡•–”‘‡–”‡ƒ–‡–…Žƒ••‹ϐ‹- expression of matrix metalloproteinase-9 after ischemic and he-
cation. –”‘‡ǡʹͲͳͷǢͶ͸ǣ‡ͳͳͶǦ‡ͳͳ͹Ǥ morrhagic human stroke. –”‘‡ǡʹͲͲ͸Ǣ͵͹ǣͳ͵ͻͻǦͳͶͲ͸Ǥ
͵Ǥ ‘‰Ǥǡ‘‰Ǥǡ‹—Ǥǡ
—‘ǤǦͻǡƒ’‘–‡–‹ƒŽ–ƒ”‰‡–ˆ‘”…‡”‡- 9. Turner R., Sharp F. Implications of MMP-9 for blood brain barrier
bral ischemic treatment. —””Ǥ ‡—”‘’Šƒ”ƒ…‘ŽǤǡʹͲͲͻǢ͹ȋͶȌǣʹ͸ͻǦ disruption and hemorrhagic transformation following ischemic
275. stroke. ”‘– ‡ŽŽ ‡—”‘•…‹ǤǡʹͲͳ͸ǢͳͲǣͷ͸Ǥ
4. Abdelnaseer M., Elfayomi N., Hassan E., Kamal M., Hamdy A., El- ͳͲǤŠ‘‰Ǥǡƒ‰ Ǥǡ—Ǥǡ—Ǥ‡– ƒŽǤ Serum matrix metalloprotei-
sawy E. Serum matrix metalloproteinase-9 in acute ischemic nase-9 levels and prognosis of acute ischemic stroke. Neurology,
stroke and its relation to stroke severity. Š‡ ‰›’–‹ƒ ‘—”ƒŽ ‘ˆ ʹͲͳ͹ǢͺͻȋͺȌǣͺͲͷǦͺͳʹǤ
‡—”‘Ž‘‰›ǡ •›…Š‹ƒ–”› ƒ† ‡—”‘•—”‰‡”›ǡʹͲͳͷǢͷʹȋͶȌǣʹ͹ͶǦʹ͹ͺǤ 11. Abdelnaseer M., Elfauomy N., Esmail E., Kamal M., Elsawy E. Ma-
5. Lakhan S., Kirchgessner A., Tepper D., Leonard A. Matrix metallo- trix metalloproteinase-9 and recovery of acute ischemic stroke.
proteinases and blood-brain barrier disruption in acute ischemic Ǥ –”‘‡ ‡”‡„”‘˜ƒ•…Ǥ ‹•ǤǡʹͲͳ͹Ǣʹ͸ȋͶȌǣ͹͵͵Ǧ͹ͶͲǤ
stroke. ”‘–Ǥ ‡—”‘ŽǤǡʹͲͳ͵ǢͶǣ͵ʹǤ 12. Abilleira S., Montaner J., Carlos A. ‡– ƒŽǤ Matrix metalloproteina-
6. Lucivero V., Prontera M., Mezzapesa D. ‡– ƒŽǤ Different roles of se-9 concentration after spontaneous intracerebral hemorrhage
matrix metalloproteinases-2 and -9 after human ischaemic stro- ‘—”ƒŽ ‘ˆ ‡—”‘•—”‰‡”›ǡʹͲͲ͵ǢͻͻȋͳȌǣ͸ͷǦ͹ͲǤ
ke. ‡—”‘ŽǤ …‹Ǥǡ ʹͲͲ͹Ǣ ʹͺǣ ͳ͸ͷǦͳ͹ͲǤ Š––’•ǣȀȀ†‘‹Ǥ‘”‰ȀͳͲǤͳͲͲ͹Ȁ
s10072-007-0814-0.
 MJHS 17(3)/2018 15

ARTICOL DE CERCETARE RESEARCH ARTICLE

Variante anatomice individuale Individual anatomical variants

ƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡ of the superior mesenteric
superioare artery
Olga Belic1ǡ‡”‰Š‡‹‘˜ƒì‡˜2ǡƒ–ƒŽ‹ƒƒœ—”—…1, Olga Belic1, Serghei Covantev2ǡƒ–ƒŽ‹ƒƒœ—”—…1,
Irina Burdeniuc1 Irina Burdeniuc1
1
ƒ–‡†”ƒ †‡ ƒƒ–‘‹‡ ƒ ‘—Ž—‹ǡ ‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ è‹ ƒ”ƒ…‹‡ 1
Šƒ‹” ‘ˆ Š—ƒ ƒƒ–‘›ǡ ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‡†‹…ƒŽ ƒ† Šƒ”ƒ…‡—–‹Ǧ
ǡǡ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ Š‹è‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǢ …ƒŽ ‹˜‡”•‹–›ǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǢ
͸
ƒ„‘”ƒ–‘”—Ž †‡ ƒŽ‡”‰‘Ž‘‰‹‡ è‹ ‹—‘Ž‘‰‹‡ …Ž‹‹…£ǡ ‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹Ǧ ͸
ƒ„‘”ƒ–‘”› ‘ˆ ƒŽŽ‡”‰‘Ž‘‰› ƒ† …Ž‹‹…ƒŽ ‹—‘Ž‘‰›ǡ ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡
…‹£ è‹ ƒ”ƒ…‹‡ ǡǡ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ Š‹è‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǤ ‡†‹…ƒŽ ƒ† Šƒ”ƒ…‡—–‹…ƒŽ ‹˜‡”•‹–›ǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǤ

Data primirii manuscrisului: 22.06.2018 Manuscript received on: 22.06.2018

ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣͲ͵ǤͲͻǤʹͲͳͺ ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣͲ͵ǤͲͻǤʹͲͳͺ

Autor corespondent: Corresponding author:

Ž‰ƒ ‡Ž‹…ǡ †”Ǥ Šƒ„Ǥ è–Ǥ ‡†Ǥǡ …‘ˆǤ —‹˜Ǥ Ž‰ƒ ‡Ž‹…ǡ Šǡ ƒ••‘…Ǥ ’”‘ˆǤ
ƒ–‡†”ƒ †‡ ƒƒ–‘‹‡ ƒ ‘—Ž—‹ Šƒ‹” ‘ˆ Š—ƒ ƒƒ–‘›
‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ è‹ ƒ”ƒ…‹‡ ǡǡ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dz ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‡†‹…ƒŽ ƒ† Šƒ”ƒ…‡—–‹…ƒŽ ‹˜‡”•‹–›
„†Ǥ f–‡ˆƒ …‡Ž ƒ”‡ ç‹ ˆŸ–ǡ 1ͼͻǡ Š‹è‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ 1ͼͻǡ –‡ˆƒ …‡Ž ƒ”‡ •‹ ˆƒ– ƒ˜‡Ǥǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ‘Ž‰ƒǤ„‡Ž‹…̻—•ˆǤ† ‡Ǧƒ‹Ž: ‘Ž‰ƒǤ„‡Ž‹…̻—•ˆǤ†

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

…–—ƒŽ‡Ž‡ …‡”…‡–£”‹ ƒ— †”‡’– •…‘’ ‡Ž—…‹†ƒ”‡ƒ —‘” The current research aims to elucidate the individual
’”‘’”‹‡–£ì‹‹†‹˜‹†—ƒŽ‡ǡÁˆ—…싇†‡•‡šǡ†‡˜Ÿ”•–£ç‹†‡”ƒ‹- properties, taking into account sex, age and branching of the
ϐ‹…ƒ”‡ǡƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡Žƒ‘Ǥ superior mesenteric artery in humans.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
–—†‹‡”‡ƒ ’ƒ”–‹…—Žƒ”‹–£ì‹Ž‘” •–”—…–—”ƒŽ‡ ‹†‹˜‹†—ƒŽ‡ǡ †‡
”ƒ‹ϐ‹…ƒ”‡ǡƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡Žƒ‘Á”‡Žƒì‹‡
…—•‡š—Žç‹˜Ÿ”•–ƒ•—„‹‡…ì‹Ž‘”ƒ”’—–‡ƒϐ‹Ž—ƒ–‡Á…‘•‹†‡”ƒì‹‡
Á‹–‡”˜‡ì‹‹Ž‡…Š‹”—”‰‹…ƒŽ‡Ǥ
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
—ˆ‘•–‹†‡–‹ϐ‹…ƒ–‡†‹ˆ‡”‡ì‡•‡‹ϐ‹…ƒ–‹˜‡Á‘†ƒŽ‹–ƒ–‡ƒ
ƒ’ƒ”‹ì‹‡‹ ˜ƒ•‡Ž‘” ’”‹ƒ”‡ †‡ ”ƒ‹ϐ‹…ƒì‹‡ Á ˆ—…싇 †‡ •‡š ç‹
†‡˜Ÿ”•–£Ǥ‡œ—Ž–ƒ–‡Ž‡‘„싐—–‡’‘–ƒ˜‡ƒ˜ƒŽ‘ƒ”‡Á…Š‹”—”‰‹ƒ
’”ƒ…–‹…£ǡ‹…Ž—•‹˜ǡÁŽ‡œ‹—‹Ž‡–”ƒ—ƒ–‹…‡Ǥ
‡œ—ƒ–
Introducere. Nivelul înalt de dezvoltare al chirurgiei abdo-
‹ƒŽ‡è‹…”‡è–‡”‡ƒ—£”—Ž—‹‹–‡”˜‡ì‹‹Ž‘”‘’‡”ƒ–‘”‹‹‡…‡•‹-
–£‹ˆ‘”ƒì‹‹ƒ’Ž‡’”‹˜‹†‘”ˆ‘Ž‘‰‹ƒ˜ƒ•‡Ž‘”‹–‡•–‹‡Ž‘”Á
…‘–‡š–—Ž˜ƒ”‹ƒ„‹Ž‹–£ì‹‹‹†‹˜‹†—ƒŽ‡Ǥ‹ƒ…‡•–‡…‘•‹†‡”‡–‡ǡƒ
ˆ‘•–”‡ƒŽ‹œƒ–—•–—†‹—†‡‹†‡–‹ϐ‹…ƒ”‡ƒ˜ƒ”‹ƒ–‡Ž‘”•–”—…–—”ƒŽ‡
è‹–‘’‘‰”ƒϐ‹…‡‹†‹˜‹†—ƒŽ‡ƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡Ǥ
ƒ–‡”‹ƒŽ è‹ ‡–‘†‡Ǥ –ƒ„‹Ž‹”‡ƒ ˜ƒ”‹ƒ–‡Ž‘” –”ƒ‹‡…–—Ž—‹ è‹
£”‹‹‹—‰Š‹—”‹Ž‘”†‡”ƒ‹ϐ‹…ƒ”‡ƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—-
’‡”‹‘ƒ”‡Žƒ‘ǡÁ”‡Žƒì‹‡…—˜Ÿ”•–ƒè‹•‡š—Žǡƒ—ˆ‘•–•–—†‹ƒ–‡’‡
ͳͲ͸ ’ƒƒ‘”–‘‰”ƒ‡ è‹ ’‡ ’‹‡•‡Ž‡ …‘ˆ‡…ì‹‘ƒ–‡ ’”‹ †‹•‡…싇
Research hypothesis
To study of the individual structural particularities of
branching of the superior mesenteric artery in humans
in relation to the sex and age of the subjects that could be
considered in surgical interventions.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
‹‰‹ϐ‹…ƒ– †‹ˆˆ‡”‡…‡• Šƒ˜‡ „‡‡ ‹†‡–‹ϐ‹‡† ‹ –Š‡ ƒ-
ner of occurrence of primary vessels as well as the branching
pattern by gender and age. The established results may have
importance in practical surgery, including traumatic injuries.
Abstract
Introduction. The high level of development of abdominal
surgery and the increase in the number of operative interven-
tions, requires extensive information on intestinal morphol-
ogy in the context of individual variability. For these reasons,
a study was conducted to identify individual structural and
topographical variants.
Material and methods. The variants of the trajectory and
the angles of branching of the superior mesenteric artery in
humans in relation to age and sex were studied on 106 aor-
–Š‘‰”ƒ•ƒ†‘‹–‡”ƒŽ‘”‰ƒ•„›ϐ‹‡ƒƒ–‘‹…ƒŽ†‹••‡…–‹‘
16
ƒƒ–‘‹…£ϐ‹£’”‹‡–‘†‡ƒ…”‘•…‘’‹…‡†—’£ǤǤ‘”‘„‹‘˜
è‹ǤǤ‡”Ž‹Ǥ
‡œ—Ž–ƒ–‡Ǥ ‡ˆ‡”‹–‘” Žƒ ƒ”–‡”ƒ ‡œ‡–‡”‹…£ •—’‡”‹‘ƒ”£ǡ au
ˆ‘•–•–ƒ„‹Ž‹–‡ǣ‹˜‡Ž—Ž‡‡”‰‡ì‡‹‡‹ǡ•‡†‹—Ž‘•–‹——Ž—‹ƒ”–‡”‹ƒŽǡ
–”ƒ‹‡…–—Ž’‘”ì‹—‹‹‹…‹’‹‡–‡ƒ˜ƒ•—Ž—‹Ǥ—ˆ‘•–•–—†‹ƒ–‡…ƒœ—”‹-
Ž‡Á…ƒ”‡ƒ”–‡”ƒ‡œ‡–‡”‹…£•—’‡”‹‘ƒ”£ǡŽƒ…Ÿì‹˜ƒ…‡–‹‡–”‹
†‡Žƒ†‡•’”‹†‡”‡ƒ‡‹†‡ƒ‘”–ƒƒ„†‘‹ƒŽ£ǡ‡•–‡•—’—•£”ƒ‹-
ϐ‹…£”‹‹†‡–‹’†‹•’‡”•ƒ–Ǥ
‘…Ž—œ‹‹Ǥƒƒ‘”–‘‰”ƒϐ‹ƒǡ…ƒè‹‡–‘†‡Ž‡ƒ…”‘•…‘’‹…‡†‡
…‘ˆ‡…ì‹‘ƒ”‡ƒ’‹‡•‡Ž‘”ǡ’—‡Á‡˜‹†‡ì£˜ƒ”‹ƒ„‹Ž‹–ƒ–‡ƒ‹†‹-
˜‹†—ƒŽ£ƒ–”ƒ‹‡…–—Ž—‹è‹”ƒ‹ϐ‹…£”‹‹ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹-
oare.
Cuvinte cheie: ƒ”–‡”£‡œ‡–‡”‹…£•—’‡”‹‘ƒ”£ǡ˜ƒ”‹ƒ„‹Ž‹–ƒ-
–‡‹†‹˜‹†—ƒŽ£Ǥ
Introducere
Variabilitatea vaselor sangvine ale organelor interne pre-
œ‹–£‹–‡”‡•ƒ–Ÿ–Á‹–‡”˜‡ì‹‹Ž‡…Š‹”—”‰‹…ƒŽ‡—”‰‡–‡ǡ…Ÿ–è‹Á
…‡Ž‡’”‘‰”ƒƒ–‡ǡÁ•’‡…‹ƒŽǡÁ’”‡œ‡–ǡ…Ÿ†ˆ”‡…˜‡ìƒŽ‡œ‹—‹-
Ž‘”–”ƒ—ƒ–‹…‡‡•–‡Á…‘–‹—£…”‡è–‡”‡Ǥ
‡ƒƒ‹˜ƒŽ‘”‘ƒ•£•—’Ž‹‡–ƒ”‡ƒ•–—†‹‹Ž‘”ˆ—†ƒ‡–ƒŽ‡ǡ
”‡ƒŽ‹œƒ–‡’”‹†‹•‡…싇ƒƒ–‘‹…£ǡ•—–”‡œ—Ž–ƒ–‡Ž‡‹˜‡•–‹‰ƒì‹-
ilor intravitale. În cazul vizat, este vorba despre panaortogra-
ϐ‹‡ǤB…‡”…‡–£”‹Ž‡‡†‹…‘Ǧ„‹‘Ž‘‰‹…‡‡—”‘˜ƒ•…—Žƒ”‡ǡ†‡’”‹£
‹’‘”–ƒì£ •—– ’‹‡•‡Ž‡ ƒ…”‘•…‘’‹…‡ …‘ˆ‡…ì‹‘ƒ–‡ ’”‹ †‹-
•‡…싇ƒƒ–‘‹…£ϐ‹£ǤŽ‡’‘–ϐ‹˜‡”‹ϐ‹…ƒ–‡ǡ’”‡…‹œƒ–‡†‡‡—-
ƒ”‹ƒ–‡ ƒƒ–‘‹…‡ ‹†‹˜‹†—ƒŽ‡ ƒŽ‡ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡
with the use of macroscopic methods developed by V. P. Voro-
biov and B. Z. Perlin.
Results. We evaluated the superior mesenteric artery, re-
garding the level of its emergence, the arterial ostium, the inci-
dence of the beginning portion of the vessel. Special attention
was drawn to cases in which the superior mesenteric artery
a few centimeters from its origin from the abdominal aortais
subjected to the dispersed type of branching.
Conclusions. Panaortography, as well as macroscopic
methods of dissection, highlights the individual variability of
the trajectory and branching of the superior mesenteric artery.
Key words: superior mesenteric artery, individual vari-
ability.
Introduction
The variability of blood vessels of internal organs is of
interest in both emergency and planned interventions, espe-
cially, at the current stage, taking into account the increasing
frequency of traumatic injuries.
The most valuable addition to the fundamental studies,
made by anatomical dissection, are the results of investiga-
tions during lifetime. In this case it is possible by panaorthog-
raphy. In the neurovascular medical-biological research, the
ƒ…”‘•…‘’‹…•’‡…‹‡•ǡƒ†‡„›ϐ‹‡ƒƒ–‘‹…ƒŽ†‹••‡…–‹‘ǡ
”‡ƒ‹ –Š‡ „ƒ•‹… ‡–Š‘†Ǥ Š‡› …ƒ „‡ ˜‡”‹ϐ‹‡†ǡ ƒ› –‹‡•
£”ƒ–‡‘”‹Ȃ†‡Žƒ‘”‹‰‹‹’Ÿ£Žƒ‡š–”‡ƒ–‡”‹ƒŽ£è‹‹˜‡”•Ǥ
Interpretarea imaginilor intravitale, indiferent de modalitatea
‘„싐‡”‹‹Ž‘”ȋ”ƒ†‹‘‰”ƒϐ‹…ǡ—Ž–”ƒ•‘‹…ǡ…‘’—–‡”Ǧ–‘‘‰”ƒϐ‹…ǡŽƒ-
’ƒ”‘Ǧ•ƒ—‡†‘•…‘’‹…‡–…ǤȌǡ‡…‡•‹–£‘’”‡‰£–‹”‡ƒ‹’”‘ˆ—†£ǡ
„ƒœƒ–£’‡…‡”…‡–£”‹ˆ—†ƒ‡–ƒŽ‡ǡƒŽ‹ƒ•ǡ’‡ƒ–‡”‹ƒŽ…ƒ†ƒ˜‡”‹…Ǥ
g‹–‘–—è‹ǡŽ—…”Ÿ†…—’ƒ…‹‡ì‹‹ǡ’ƒ”–‹…—Žƒ”‹–£ì‹Ž‡•–”—…–—”ƒŽ‡ƒŽ‡
•—„•–”ƒ–—Ž—‹‘”ˆ‘Ž‘‰‹…–”‡„—‹‡…‘ˆ”—–ƒ–‡…—‹ˆ‘”ƒì‹ƒ•‹-
‹Žƒ”£ǡ‘„싐—–£’‡ƒ–‡”‹ƒŽ…ƒ†ƒ˜‡”‹…Ǥ‡Ž‡‡ì‹‘ƒ–‡•‡”‡-
ˆ‡”£è‹Žƒ‹˜‡•–‹‰ƒì‹‹Ž‡’ƒƒ‘”–‘‰”ƒϐ‹…‡Ǥ‡ƒ…‡•–ˆƒ’–•Ǧƒ싐—–
…‘–Áƒ…–—ƒŽ‡Ž‡…‡”…‡–£”‹Ǥ
ƒ–‡”‹ƒŽç‹‡–‘†‡
–—†‹—Žƒˆ‘•–‡ˆ‡…–—ƒ–’‡—Ž‘–†‡ͳͲ͸’ƒƒ‘”–‘‰”ƒ‡è‹
’‡’‹‡•‡Ž‡…‘ˆ‡…ì‹‘ƒ–‡’”‹†‹•‡…싇ƒƒ–‘‹…£ϐ‹£ǡ’”‹‡-
–‘†‡ƒ…”‘•…‘’‹…‡ǡ†—’£ǤǤ‘”‘„‹‘˜è‹ǤǤ‡”Ž‹Ǥ
— ˆ‘•– •–ƒ„‹Ž‹–‡ •—”•‡Ž‡ǡ —£”—Žǡ –”ƒ•‡—Žǡ ‘†ƒŽ‹–£ì‹Ž‡
”ƒ‹ϐ‹…£”‹‹ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡Ǥˆ‘•–•–ƒ„‹Ž‹–£‹-
…‹†‡ìƒ ˜ƒ”‹ƒ–‡Ž‘” †‡ ”ƒ‹ϐ‹…ƒ”‡ è‹ £”‹‡ƒ —‰Š‹—”‹Ž‘” †‡
”ƒ‹ϐ‹…ƒ”‡Ǥ
Repartizarea materialului investigat conform perioadelor
‘–‘‰‡‡œ‡‹ ƒ”‡ Žƒ „ƒœ£ ’‡”‹‘†‹œƒ”‡ƒ †‡ ˜Ÿ”•–£ǡ ƒ†‘’–ƒ–£ Žƒ
Ȃˆ”‘–Š‡‘”‹‰‹•–‘–Š‡–‡”‹ƒŽ’ƒ”–ǡƒ†˜‹…‡˜‡”•ƒǤ–‡”-
pretation of imaging, regardless of how they are obtained (ra-
diographic, ultrasonic, computer tomography, laparoscopic,
endoscopic etc.), requires deeper training, based on funda-
mental research, and on cadaveric material. Nevertheless,
while working with patients, the structural particularities of
the morphological substrate must be confronted with similar
information obtained on cadaveric material. The above men-
–‹‘‡† ƒŽ•‘ ”‡ˆ‡”• –‘ ’ƒƒ‘”–‘‰”ƒ’Š‹… ‹˜‡•–‹‰ƒ–‹‘• Ȃ ™Š‹…Š
has been taken into account in the current research.
Material and methods
The study included 106 aortographies and a specimen
ƒ†‡„›ϐ‹‡ƒƒ–‘‹…ƒŽ†‹••‡…–‹‘„›ƒ…”‘•…‘’‹…‡–Š‘†•
by V. P. Vorobiov and B. Z. Perlin.
We analyzed the sources, number, route, and ways of
branching of the superior mesenteric artery. The center of
attention was the superior mesenteric artery, with the deter-
mination of the incidence of the branching variants and the
values of the angles of branching.
The distribution of the investigated material according to
‹’‘œ‹‘—Ž•–‹–—–—Ž—‹†‡ ‹œ‹‘Ž‘‰‹‡ƒŸ”•–‡‹ƒŽgƒŽ
ȋ†—’£ʏǤʏǤƒ”‘•‹ƒǡͳͻ͸ͻȌǡ’”‡…—è‹…‡ƒ’”‘’—•£†‡Ǥ‘-
„ƒ•‹ȋǤg–‡ˆƒ‡ìè‹…‘ƒ—–ǤǡʹͲͲͲȌǤ
‡œ—Ž–ƒ–‡
”–‡”ƒ ‡œ‡–‡”‹…£ •—’‡”‹‘ƒ”£ ‡•–‡ —ƒ †‹–”‡ ”ƒ—”‹Ž‡
principale impare ale aortei abdominale. Ea se desprinde la cca
1,2-1,8 cm inferior de trunchiul celiac, ceea ce, scheletotopic,
periods of ontogenesis is based on the age periodization ad-
opted at the Symposium of the Institute of Physiology of the
‰‡ǡ  ǡ ƒ• ™‡ŽŽ ƒ• –Šƒ– ’”‘’‘•‡† „› ʏǤ ʏǤ ƒ”‘•‹ƒ
(1969) and R. Robaski (M. Stefanets and coworkers, 2000).
Results
The superior mesenteric artery is one of the main unpaired
branches of the abdominal aorta. It branches about 1.2-1.8 cm
†‹˜‹†—ƒŽ ƒƒ–‘‹…ƒŽ ˜ƒ”‹ƒ–• ‘ˆ –Š‡ •—’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”›
mai frecvent, corespunde primei vertebre lombare. Sintopic,
‡ƒ Áè‹ …”‘‹‡è–‡ …ƒŽ‡ ’”‹–”‡ …ƒ’—Ž ’ƒ…”‡ƒ•—Ž—‹ ȋ†‹ ƒ–‡”‹‘”Ȍ
è‹ ’ƒ”–‡ƒ ‘”‹œ‘–ƒŽ£ ‹ˆ‡”‹‘ƒ”£ ƒ †—‘†‡—Ž—‹ (din posterior).
‡ƒ ‘‘‹£ǡ …‡ Á•‘ì‡è–‡ ƒ”–‡”ƒ ‡œ‡–‡”‹…£ •—’‡”‹‘ƒ”£ǡ
‡•–‡’‘œ‹ì‹‘ƒ–£†‹†”‡ƒ’–ƒƒ”–‡”‡‹˜‹œƒ–‡ǤBƒèƒ‘†ǡƒ„‡Ž‡
ˆ‘”ƒì‹—‹˜ƒ•…—Žƒ”‡ǡ’‡—ƒ—‹––”ƒ•‡—ǡ•—–’‘œ‹ì‹‘ƒ–‡Á
‰”‘•‹‡ƒ ‡œ‡–‡”—Ž—‹ ‹–‡•–‹—Ž—‹ •—„ì‹”‡Ǥ ”–‡”ƒ ‡œ‡–‡-
”‹…£•—’‡”‹‘ƒ”£ƒ•‹‰—”£è‹˜ƒ•…—Žƒ”‹œƒ”‡ƒ‹–‡•–‹—Ž—‹‰”‘•ǡ…—
‡š…‡’싃—Ž–‹‡Ž‘”†‘—£•‡‰‡–‡Ȃ•‹‰‘‹†è‹”‡…–ƒŽǤ
‘ˆ‘”ƒϐ‹”ƒì‹‹Ž‘”—Ž–‘”ƒ—–‘”‹ǡ‘•–‹——Žƒ”–‡”‡‹‡œ-
‡–‡”‹…‡•—’‡”‹‘ƒ”‡•‡ƒϐŽ£’‡ˆƒìƒƒ–‡”‹‘ƒ”£ƒƒ‘”–‡‹ƒ„†‘‹-
ƒŽ‡Ǥ ƒƒŽ‹œ£ ƒ‹‹—ì‹‘ƒ•£ǡ ‹…Ž—•‹˜ǡƒ’ƒƒ‘”–‘‰”ƒ‡Ž‘”
abdominale, impune deplasarea accentului. Sediul ostiumului
”‡•’‡…–‹˜ǡ‹…‘–‡•–ƒ„‹Žǡ‡•–‡Ž‡‰ƒ–†‡•‡‹…‹”…—ˆ‡”‹ìƒƒ–‡-
”‹‘ƒ”£ƒƒ‘”–‡‹Ǥ
—’£…—•Ǧƒ•–ƒ„‹Ž‹–Áƒ…–—ƒŽ—Ž•–—†‹—ǡ–‹’—Ž—‹‡†‹ƒ†‡
localizare a ostiumului arterei mezenterice superioare i-au re-
˜‡‹–……ƒǤͷͲΨ†‹…ƒœ—”‹ǣͷ͹ǡͺͻΨȋ͵͵†‡‘„•‡”˜ƒì‹‹ȌŽƒ„£”„ƒì‹
è‹ͶʹǡͳͳΨȋʹͲ†‡…ƒœ—”‹ȌŽƒˆ‡‡‹ǤB”‡•–—Ž…ƒœ—”‹Ž‘”ȋͷ͵†‡’ƒ-
…‹‡ì‹Ȍǡƒ”–‡”ƒ‡œ‡–‡”‹…£•—’‡”‹‘ƒ”£•‡†‡•’”‹†‡ƒ†‡Žƒˆƒìƒ
ƒ–‡”‹‘ƒ”£ ƒ ƒ‘”–‡‹ƒ„†‘‹ƒŽ‡ǡ Á•£ǡ ƒ‹ ƒ’”‘ƒ’‡ †‡ƒ”‰‹-
‡ƒ‡‹•–Ÿ‰£Ȃ͵ͳȋʹͻǡʹͷΨȌ’ƒ…‹‡ì‹†‹–‘–ƒŽ‹–ƒ–‡ƒŽ‘–—Ž—‹ǣͳͶ
„£”„ƒì‹è‹ͳ͹ˆ‡‡‹ǤƒƒŽì‹ʹʹȋʹͲǡ͹ͷΨȌ†‡’ƒ…‹‡ì‹ȋͳʹ„£”„ƒì‹
è‹ͳͲˆ‡‡‹Ȍǡƒ”–‡”ƒ”‡•’‡…–‹˜£•‡†‡•’”‹†‡ƒƒ‹ƒ’”‘ƒ’‡†‡
ƒ”‰‹‡ƒ†”‡ƒ’–£ƒƒ‘”–‡‹ƒ„†‘‹ƒŽ‡Ǥ‡ˆ‡”‹–‘”Žƒ–‹’—Ž‡-
dian (anterior) al ostiumului arterei mezenterice superioare,
”ƒ’‘”–—Ž„£”„ƒì‹Ȁˆ‡‡‹ƒˆ‘•–‹˜‡”•Ȃ͵͵˜‡”•—• 20.
‡Žƒ‹ƒ”‡—£”†‡…ƒœ—”‹•–—†‹ƒ–‡‹Ǧƒ”‡˜‡‹–‰”—’—Ž—‹
MJHS 17(3)/2018 17
below the celiac trunk, which, scheletotopically, more often
…‘””‡•’‘†•–‘–Š‡ϐ‹”•–Ž—„ƒ”˜‡”–‡„”ƒǤ‹–‘’‹…ƒŽŽ›ǡ‹–Šƒ•‹–•
path between the pancreas head (anteriorly) and the horizon-
tal part of the inferior duodenum (posteriorly). The homonym
vein, which accompanies the superior mesenteric artery, is
positioned on the right side of the artery. Thus, both vascular
formations, on a particular route, are positioned in the thick-
ness of the small intestine mesentery. The superior mesenter-
ic artery also provides vascular supply to the large intestine,
‡š…‡’–ˆ‘”–Š‡Žƒ•––™‘•‡‰‡–•Ȃ•‹‰‘‹†ƒ†”‡…–ƒŽǤ
According to many authors, the ostium of the superior mes-
enteric artery is on the anterior part of the abdominal aorta. A
more thorough analysis, including abdominal aortographies,
demonstrates that the emphasis should be shifted. The osti-
um, indisputably, is related to the anterior semicircumference
of the aorta.
As established in the current study, medial type of ostium
localization was seen in 50% of the cases, including 57.89%
(33 observations) in males and 42.11% (20 cases) in women.
In the rest of the cases (53 patients), the superior mesen-
teric artery branched from the front of the abdominal aorta,
but closer to its left margin in 31 (29.25%) patients of the
whole group, including 14 males and 17 females. In another
22 (20.75%) patients, the artery was delineated closer to the
right edge of the abdominal aorta. Moreover, in this variation,
–Š‡ˆ”‡“—‡…›‘ˆ–Š‡…ƒ•‡•™ƒ••Ž‹‰Š–Ž›Š‹‰Š‡”Ȃͳʹ˜‡”•—•ͳͲ
Ȃ‹ˆ‡ƒŽ‡•Ǥ‡‰ƒ”†‹‰–Š‡‡†‹ƒȋƒ–‡”‹‘”Ȍ–›’‡‘ˆ•—’‡”‹‘”
‡•‡–‡”‹…‘•–‹—ǡ–Š‡ƒŽ‡Ȁˆ‡ƒŽ‡”ƒ–‹‘™ƒ•‹˜‡”•‡Ȃ͵͵
†‡˜Ÿ”•–£2Ȃƒ†‘—ƒ’‡”‹‘ƒ†£ƒ˜Ÿ”•–‡‹ƒ–—”‡Ǥ…‡•–‰”—’ versus 20.
ƒÁ–”—‹–ͷͲȋͶ͹ǡͳ͹ΨȌ†‡’ƒ…‹‡ì‹ǣʹͻ†‡•‡šƒ•…—Ž‹è‹ʹͳ The highest number of cases was in the age group VIII2Ȃ
†‡•‡šˆ‡‹‹Ǥ—”ƒ–‰”—’—Ž†‡˜Ÿ”•–£1Ȃ’”‹ƒ’‡”‹‘ƒ- the second maturity period. The group had 50 (47.17%) pa-
†£ƒ˜Ÿ”•–‡‹ƒ–—”‡Ǥ
”—’—Ž”‡•’‡…–‹˜ƒ‹…Ž—•ʹͻȋʹ͹ǡ͵͸ΨȌ†‡ tients, including 29 male and 21 female. As expected, accord-
’ƒ…‹‡ì‹ǣͳͶ„£”„ƒì‹è‹ͳͷˆ‡‡‹ǤB‰”—’—Ž†‡˜Ÿ”•–£Ȃƒ†‘- ing to the number of cases, age group VIII1Ȃ–Š‡ϐ‹”•–’‡”‹‘†‘ˆ
Ž‡•…‡ì‹Á–”‡ͳ͸è‹ʹͳ†‡ƒ‹Ȃƒ—ˆ‘•–ͳ͸ȋͳͷǡͲͻΨȌ’ƒ…‹‡ì‹ǣ ƒ–—”‡ƒ‰‡Ȃ™ƒ•ʹͻȋʹ͹Ǥ͵͸ΨȌ‘ˆ’ƒ–‹‡–•ǡ‹…Ž—†‹‰ͳͶ‡
ͻ†‡•‡šƒ•…—Ž‹è‹͹†‡•‡šˆ‡‹‹ǤŸ”•–‹…‹Ž‘”ȋ‰”—’—Ž—‹
ƒ†ͳͷ™‘‡Ǥ–™ƒ•Ž‡••Ž‹‡Ž›–Šƒ––Š‡ƒ‰‡‰”‘—’Ȃƒ†‘-
†‡ ˜Ÿ”•–£ Ȍ Ž‡Ǧƒ— ”‡˜‡‹– ͳͳ ȋͳͲǡ͵ͺΨȌ …ƒœ—”‹ǣ ͷ ’ƒ…‹‡ì‹ è‹
͸ ’ƒ…‹‡–‡Ǥ ‡‡ϐ‹…‹ƒ”‹ †‡ ƒ‘”–‘Ǧƒ”–‡”‹‘‰”ƒϐ‹‡ ƒ„†‘‹ƒŽ£ †‡
˜Ÿ”•–£•‡‹Ž£Ȃ͹ͷǦͻͲ†‡ƒ‹ȋ‰”—’—Ž†‡˜Ÿ”•–£ȌȂÁŽ‘–—Ž•–—-
diat nu au fost.
‡ͳͲ͸’ƒƒ‘”–‘‰”ƒ‡•Ǧƒˆ£…—–‘ƒƒŽ‹œ£ƒ•‡†‹—Ž—‹‘•–‹-
——Ž—‹ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡è‹ƒ’‘œ‹ì‹‘£”‹‹–”—-
…Š‹—Ž—‹ ‡‹ Á ”ƒ’‘”– …— ƒ‘”–ƒ ƒ„†‘‹ƒŽ£ Ȃ †‹ ƒ–‡”‹‘”ǡ †‹
dreapta sau din stânga vasului magistral. Conform datelor
’”‘’”‹‹ǡ Á †‘ƒ” Œ—£–ƒ–‡ †‹ …ƒœ—”‹ ‘•–‹——Ž ƒ”–‡”‡‹ ”‡•’‡…-
tive a fost de tip median. Alte variante au fost concretizate în
„ƒœƒ’ƒƒ‘”–‘‰”ƒ‡Ž‘”ƒ„†‘‹ƒŽ‡Ǥ‡è‹‘•–‹——”‹Ž‡•—–Ž‘-
…ƒŽ‹œƒ–‡’‡•‡‹…‹”…—ˆ‡”‹ìƒƒ–‡”‹‘ƒ”£ƒ˜ƒ•—Ž—‹ƒ‰‹•–”ƒŽǡ
ostiumul arterei vizate este deplasat mai spre stânga sau mai
•’”‡†”‡ƒ’–ƒ†‡ƒš—ŽŽ‘‰‹–—†‹ƒŽƒŽƒ‘”–‡‹ǡ†‡—†‡—”‡ƒœ£
’‘”ì‹—‡ƒ ‹…‹’‹‡–£ ƒ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡Ǥ ‡ƒ
†‹—”£ǡÁŽ‹–‡”ƒ–—”ƒ†‹†‘‡‹—ǡ‡•–‡†‡•…”‹•£•—„ˆ‘”£
ƒ”…—ƒ–£ǡ…—ˆƒìƒ…‘˜‡š£ǡÁ†”‡’–ƒ–£•’”‡•–Ÿ‰ƒǤǤǤ‘”‘„‹‘˜
è‹…‘ƒ—–ǤȋͳͻͶͺȌǡ’”‡…—è‹ƒŽì‹ƒ—–‘”‹ǡ•‡Ž‹‹–‡ƒœ£Žƒƒ…‡ƒ•–£
˜ƒ”‹ƒ–£ǤB•£ǡ†—’£…—•Ǧƒ•–ƒ„‹Ž‹–ǡ–”ƒ‹‡…–—Ž’‘”ì‹—‹‹‹…‹’‹-
‡–‡ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡’‘ƒ–‡ƒ˜‡ƒè‹ƒŽ–‡ˆ‘”‡Ǥ
‘ˆ‘”†ƒ–‡Ž‘”’”‘’”‹‹ǡˆƒìƒ…‘˜‡š£ƒ’‘”ì‹—‹‹‹…‹’‹‡–‡
ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡‡”ƒÁ†”‡’–ƒ–£•’”‡•–Ÿ‰ƒŽƒ
Ž‡•…‡–•ȋͳ͸Ǧʹͳ›‡ƒ”•‘Ž†Ȍ™‘—Ž†Šƒ˜‡•—…Šƒˆ”‡“—‡…›Ȃͳ͸
(15.09%) cases, nine of which were males and seven females.
Elderly (age group IX) represented 11 (10.38%) cases, includ-
‹‰ ϐ‹˜‡ ƒŽ‡• ƒ† •‹š ˆ‡ƒŽ‡•Ǥ ‘‰ –Š‘•‡ —†‡”‰‘‹‰ ƒ„-
dominal aorto-arteriography we did not have cases of senile
ƒ‰‡Ȃ͹ͷǦͻͲ›‡ƒ”•ȋƒ‰‡‰”‘—’ȌǤ
The analysis 106 aortography of the superior mesenteric
artery and the positioning of its trunk with respect to the ab-
†‘‹ƒŽƒ‘”–ƒ™‡”‡ƒ†‡Ȃˆ”‘–Š‡ƒ–‡”‹‘”ǡ”‹‰Š–‘”Ž‡ˆ–‘ˆ
the magistral vessel. According to the data, as mentioned, only
half of the cases are median. Other variants were concretized
on the basis of abdominal panaortograms. Although the ostiu-
mis located on the anterior semi circumference of the aorta,
it can be moved somewhat to the left or to the right of the
longitudinal axis of the aorta, from where the superior mes-
enteric artery begins. The latter, in the literature, is describe-
das arcuate shaped, with the convex part turned to the left. V.
P. Vorobiov and coworkers (1948), as well as other authors,
also describe this type. However, as has been established, the
trajectory of the beginning portion of the superior mesenteric
artery may have other shapes.
18
Fig. 1 ƒƒ‘”–‘‰”ƒ£ƒ„†‘‹ƒŽ£Ǥ ƒìƒ…‘˜‡š£ƒ’‘”ì‹—‹‹‹…‹’‹-
‡–‡ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡‡•–‡Á†”‡’–ƒ–£•’”‡•–Ÿ‰ƒǤ
„•‡”˜ƒì‹ƒ”ǤʹͶǢ„£”„ƒ–ǡ͵ͻ†‡ƒ‹Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ ͹ Ȃ ƒǤ ƒ……‡••‘”‹ƒ ”‡ƒŽ‹•
ȋ†‡ Žƒ ƒ”–‡”ƒ Ž‹‡ƒŽ‹•ȌǢ ͺ Ȃ ƒǤ Š‡’ƒ–‹…ƒ …‘—‹•Ǣ ͻ Ȃ ƒǤ ”‡ƒŽ‹• †‡š–”ƒǢ
ͼ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ ͽ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒ ƒ……‡••‘”‹ƒǢ ; Ȃ ƒǤ ‡•‡–‡Ǧ
”‹…ƒ •—’‡”‹‘”Ǥ
Fig. 1 „†‘‹ƒŽ ’ƒƒ‘”–‘‰”ƒǤ Š‡ …‘˜‡š ’ƒ”– ‘ˆ –Š‡ „‡‰‹‹‰
’‘”–‹‘ ‘ˆ –Š‡ •—’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”› ‹• †‹”‡…–‡† –‘ –Š‡ Ž‡ˆ–Ǥ
„•‡”˜ƒ–‹‘ ‘Ǥ ͸ͺǢ ƒŽ‡ǡ ͹Ϳ ›‡ƒ”• ‘Ž†Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ ͹ Ȃ ƒǤ ƒ……‡••‘”‹ƒ ”‡ƒŽ‹•
ȋˆ”‘ –Š‡ ƒ”–‡”ƒ Ž‹‡ƒŽ‹•ȌǢ ͺ Ȃ ƒǤ Š‡’ƒ–‹…ƒ …‘—‹•Ǣ ͻ Ȃ ƒǤ ”‡ƒŽ‹•
†‡š–”ƒǢ ͼ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ ͽ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒ ƒ……‡••‘”‹ƒǢ
; Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǥ
Ͷͳȋ͵ͺǡ͸ͺΨȌ†‹–”‡’ƒ…‹‡ì‹ǣʹʹ†‡•‡šƒ•…—Ž‹è‹ͳͻȂ†‡•‡š
ˆ‡‹‹ȋ ‹‰—”ƒͳȌǤBˆ—…싇†‡‰”—’—”‹Ž‡†‡˜Ÿ”•–£ǡ…ƒœ—”‹Ž‡
ƒ”‹ƒ–‡ ƒƒ–‘‹…‡ ‹†‹˜‹†—ƒŽ‡ ƒŽ‡ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡
Fig. 2 ƒƒ‘”–‘‰”ƒ£ƒ„†‘‹ƒŽ£Ǥ—”„—”£•‘Ž‹–ƒ”£…—‹’Ž‹…ƒ”‡ƒ
•‡‰‡–‡Ž‘”•—’”ƒǦç‹‹ˆ”ƒ”‡ƒŽǤ‘”ì‹—‡ƒ‹…‹’‹‡–£ƒƒ”–‡”‡‹
‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡‡•–‡Á†”‡’–ƒ–£•’”‡†”‡ƒ’–ƒǤ
„•‡”˜ƒì‹ƒ”ǤͶ͸Ǣˆ‡‡‹‡ǡ͵ͳ†‡ƒ‹Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹• ƒ……‡••‘”‹ƒǢ ͹ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ
ͺ Ȃ ƒǤ Š‡’ƒ–‹…ƒ …‘—‹•Ǣ ͻ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ ͼ Ȃ ƒǤ ”‡ƒŽ‹•
†‡š–”ƒǢ ͽ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒ ƒ……‡••‘”‹ƒǢ ; Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ
Ϳ Ȃ ƒǤ ‹Ž‡‘…‘Ž‹…ƒǢ 1Ͷ Ȃ ƒǤ …‘Ž‹…ƒ †‡š–”ƒǢ 11 Ȃ ””Ǥ ‹–‡•–‹ƒŽ‡•Ǣ
1͸ Ȃ •‡‰‡– ƒ”…—ƒ– ƒŽ ƒ”–‡”‡‹ Ž‹‡ƒŽ‡Ǣ 1͹ Ȃ …—”„—”£ ƒ ƒ”–‡”‡‹ Ž‹‡ƒŽ‡Ǥ
Fig. 2 „†‘‹ƒŽ ’ƒƒ‘”–‘‰”ƒǤ ‘Ž‹–ƒ”› …—”˜‡ ‹˜‘Ž˜‹‰ –Š‡ •—’”ƒǦ
ƒ† ‹ˆ”ƒ”‡ƒŽ •‡‰‡–•Ǥ Š‡ „‡‰‹‹‰ ’‘”–‹‘ ‘ˆ –Š‡ •—’‡”‹‘”
‡•‡–‡”‹… ƒ”–‡”› ‹• †‹”‡…–‡† –‘ –Š‡ ”‹‰Š–Ǥ
„•‡”˜ƒ–‹‘ ‘Ǥ ͺͼǢ ˆ‡ƒŽ‡ǡ ͹1 ›‡ƒ”• ‘Ž†Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹• ƒ……‡••‘”‹ƒǢ ͹ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ
ͺ Ȃ ƒǤ Š‡’ƒ–‹…ƒ …‘—‹•Ǣ ͻ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ ͼ Ȃ ƒǤ ”‡ƒŽ‹•
†‡š–”ƒǢ ͽ Ȃ ƒǤ ”‡ƒŽ‹ ••‹‹•–”ƒ ƒ……‡••‘”‹ƒǢ ; Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ
Ϳ Ȃ ƒǤ ‹Ž‡‘…‘Ž‹…ƒǢ 1Ͷ Ȃ …‘Ž‹…ƒ †‡š–”ƒǢ 11 Ȃ ””Ǥ ‹–‡•–‹ƒŽ‡•Ǣ 1͸ Ȃ ƒ”… •‡‰Ǧ
‡– ‘ˆ –Š‡ •’Ž‡‹… ƒ”–‡”›Ǣ 1͹ Ȃ …—”˜ƒ–—”‡ ‘ˆ –Š‡ •’Ž‡‹… ƒ”–‡”›Ǥ
ƒ—ˆ‘•–†‹•–”‹„—‹–‡Áˆ‡Ž—Ž—”£–‘”ǣ‰”—’—Ž‹…Ž—†‡ƒͶ„£”-
„ƒì‹è‹͵ˆ‡‡‹Ǣ‰”—’—Ž1Ȃ͸„£”„ƒì‹è‹ͷˆ‡‡‹Ǣ‰”—’—Ž2 According to our data, the convex part of the beginning
ȂͳͲ„£”„ƒì‹è‹ͻˆ‡‡‹Ǣ‰”—’—Ž†‡˜Ÿ”•–£ƒˆ‘•–”‡’”‡œ‡–ƒ–
†‡ʹ„£”„ƒì‹è‹ʹˆ‡‡‹Ǥ”‹—”ƒ”‡ǡÁƒŒ‘”‹–ƒ–‡ƒ…ƒœ—”‹Ž‘”ǡ
ˆƒìƒ…‘˜‡š£ƒ’‘”ì‹—‹‹‹…‹’‹‡–‡ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡-
”‹‘ƒ”‡‡•–‡‘”‹‡–ƒ–£•’”‡’ƒ”–‡ƒ•–Ÿ‰£ƒ…‘”’—Ž—‹Ǥ
B•£ǡ†—’£…—•Ǧƒ‘„•‡”˜ƒ–ǡˆƒìƒ…‘˜‡š£ȋ•ƒ—…‘˜‡š‹–ƒ-
portion of the superior mesenteric artery was directed to the
left in 41 (38.68%) patients, among whom 22 were males and
19 were females (Figure 1). Depending on the age groups, cas-
es were distributed as following. The age group VII includes
4 men and 3 women; group VIII1Ȃ͸ƒ†ͷ’ƒ–‹‡–•ǡ”‡•’‡…-
–‡ƒȌ ƒ ’‘”ì‹—‹‹ ‹…‹’‹‡–‡ ƒ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡ tively; group VIII2ȂͳͲƒŽ‡•ƒ†ͻˆ‡ƒŽ‡•Ǣ–Š‡ƒ‰‡‰”‘—’
’‘ƒ–‡ϐ‹Á†”‡’–ƒ–£è‹•’”‡†”‡ƒ’–ƒȋ ‹‰—”ƒʹȌǤƒ”‹ƒ–‡‹Á…ƒ- was represented by 2 men and 2 women. Therefore, in most
—œ£‹Ǧƒ—”‡˜‡‹–͵͸ȋ͵͵ǡͻ͸ΨȌ†‡…ƒœ—”‹†‹–‘–ƒŽ‹–ƒ–‡ƒŽ‘–—Ž—‹Ǥ cases, the convex part of the beginning portion of the superior
‡’ƒ”–‹œƒ”‡ƒ’‡‰”—’—”‹†‡˜Ÿ”•–£è‹•‡š‡ƒˆ‘•–—”£–‘ƒ”‡ƒǣ mesenteric artery is oriented toward the left side of the body.
‰”—’—Ž  ƒ ˆ‘•– ˆ‘”ƒ– †‹ ͷ ’ƒ…‹‡ì‹ǣ ͵ „£”„ƒì‹ è‹ ʹ ˆ‡‡‹Ǣ However, as it can be seen, the convex part (or convexity)
grupul VIII1Ȃ†‹ͳͳ’ƒ…‹‡ì‹ǣ͸„£”„ƒì‹è‹ͷˆ‡‡‹Ǣ‰”—’—Ž2 of the beginning portion of the superior mesenteric artery can
Ȃ†‹ͳͻ’ƒ…‹‡ì‹ǣͳͲ„£”„ƒì‹è‹ͻˆ‡‡‹Ǣ‰”—’—Ž—‹‹Ǧƒ”‡˜‡‹– be oriented to the right (Figure 2). The type was encountered
un singur pacient. in 36 (33.96%) cases of the whole group. The division by age
ˆ‘”ƒì‹ƒ‘„싐—–£’‡ƒ…‡Žƒè‹Ž‘–†‡’ƒ…‹‡ì‹†‡‘•–”‡ƒ- and sex was as following. The age group VII was represented
œ£ …£ ’‘”ì‹—‡ƒ ‹…‹’‹‡–£ ƒ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡ „›ͷ’ƒ–‹‡–•Ȃ͵ƒŽ‡•ƒ†ʹˆ‡ƒŽ‡•Ǣ‰”‘—’1Ȃͳͳ’ƒ–‹‡–•ǡ
†‹˜‹†—ƒŽ ƒƒ–‘‹…ƒŽ ˜ƒ”‹ƒ–• ‘ˆ –Š‡ •—’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”› MJHS 17(3)/2018 19

’‘ƒ–‡ ƒ˜‡ƒ — –”ƒ‹‡…– ”‡…–‹Ž‹‹— ȋ ‹‰—”ƒ ͵ȌǤ ƒ”‹ƒ–ƒ Á …ƒ—œ£ respectively 6 males and 5 females; group VIII2Ȃͳͻ’ƒ–‹‡–•ǡ
ƒˆ‘•–•–ƒ„‹Ž‹–£Žƒʹͻȋʹ͹ǡ͵͸ΨȌ†‡’ƒ…‹‡ì‹ǣͳ͵„£”„ƒì‹è‹ͳ͸ˆ‡- including 10 men and 9 women; group IX had a single patient.
‡‹Ǥ
”—’—Ž†‡˜Ÿ”•–£‡”ƒ”‡’”‡œ‡–ƒ–†‡ͷ’‡”•‘ƒ‡ǣʹ„£”- The results obtained on the same group of patients dem-
„ƒì‹è‹͵ˆ‡‡‹Ǣ‰”—’—Ž1 Ȃ†‡ͻ’‡”•‘ƒ‡ǣͶ†‡•‡šƒ•…—Ž‹ onstrate that the beginning portion of the superior mesenteric
è‹ͷȂ†‡•‡šˆ‡‹‹Ǥ”£–‘ƒ”‡Ž‡ͳͶ‘„•‡”˜ƒì‹‹•Ǧƒ—”‡ˆ‡”‹–Žƒ artery can have a rectilinear trajectory (Figure 3). This variant
‰”—’—Ž†‡˜Ÿ”•–£2ǡ…ƒ”‡‹…Ž—†‡ƒ͹„£”„ƒì‹è‹͹ˆ‡‡‹ǡè‹Žƒ was established in 29 (27.36%) of patients, including 13 men
‰”—’—Žǡ”‡’”‡œ‡–ƒ–†‡‘•‹‰—”£’ƒ…‹‡–£Ǥ and 16 women. The age group VII was represented in 5 people
‡”‡ƒ”…ƒ–ˆƒ’–—Ž…£ǡÁ—‡Ž‡…ƒœ—”‹ǡ’‘”ì‹—‡ƒ‹…‹’‹‡–£
ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡ǡŽƒ…Ÿì‹˜ƒ…‡–‹‡–”‹†‡Žƒ‘•-
–‹—ǡ‡”ƒ•—’—•£–‹’—Ž—‹†‹•’‡”•ƒ–†‡”ƒ‹ϐ‹…ƒ”‡Ǥ†‹–‡…£è‹
ƒ…‡ƒ•–£˜ƒ”‹ƒ–£ǡ†—’£—•–—†‹—ƒ‹”‹‰—”‘•ǡƒ”‡”‹–ƒƒ–‡ì‹‡
è‹—Ž‘…ƒŽ‡‹’”‹–”‡˜ƒ”‹ƒ–‡Ž‡‡ì‹‘ƒ–‡Ǥ
Ȃʹ‡ƒ†͵™‘‡Ǣ‰”‘—’1Ȃͻ’ƒ–‹‡–•ǡ”‡•’‡…–‹˜‡Ž›ǡͶ
male and 5 females. The following 14 observations were of the
age group VIII2, which includes 7 men and 7 women; group IX
was represented by a single female patient.
It should be noted that in some cases, the beginning por-
†‹ˆ‡”‡–†‡•‡†‹—Ž‘•–‹——Ž—‹ǡ†‡–”ƒ‹‡…–—Ž’‘”ì‹—‹‹‹…‹-
’‹‡–‡ƒŽƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡ǡ†ƒ…£—‡Ž‡”ƒ‹ϐ‹…£”‹
ƒŽ‡‡‹ǡ…——†‹ƒ‡–”—”‡Žƒ–‹˜‹…ǡ’ƒ”–‹…‹’£Žƒ˜ƒ•…—Žƒ”‹œƒ”‡ƒ
complexului spleno-ligamentar, apoi în câteva cazuri, a fost
’‘•‹„‹Ž†‡—”£”‹–—ƒǦ†‘—£”ƒ—”‹†‡Žƒƒ”–‡”ƒ‡œ‡–‡”‹…£
•—’‡”‹‘ƒ”£ǡ …ƒ”‡ ’ƒ”–‹…‹’ƒ— Žƒ ˜ƒ•…—Žƒ”‹œƒ”‡ƒ ’‘Ž—Ž—‹ ‹ˆ‡”‹‘”
al splinei.
•–ˆ‡ŽǡÁ„ƒœƒ’ƒƒ‘”–‘‰”ƒϐ‹‡‹ƒ„†‘‹ƒŽ‡ǡƒ—ˆ‘•–‡Ž—…‹†ƒ-
–‡ƒ‹—Ž–‡ƒ•’‡…–‡•–”—…–—”ƒŽǦ•’ƒì‹ƒŽ‡ƒŽ‡˜ƒ•‡Ž‘”ƒ‰‹•–”ƒ-
‹‰Ǥ͵ƒƒ‘”–‘‰”ƒ£ƒ„†‘‹ƒŽ£Ǥ”ƒ‹‡…–”‡…–‹Ž‹‹—ƒŽ–”—-
…Š‹—Ž—‹ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡Ǥ”–‡”ƒŽ‹‡ƒŽ£‡•–‡
—ç‘”‘†—Žƒ–£Ǥ„•‡”˜ƒì‹ƒ”ǤͶǢ„£”„ƒ–ǡͶ͹†‡ƒ‹Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ ͹ Ȃ ƒǤ Š‡’ƒ–‹…ƒ
…‘—‹•Ǣ ͺ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ ͻ Ȃ ƒǤ ”‡ƒŽ‹• †‡š–”ƒǢ
ͼ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ ͽ Ȃ „‹ˆ—”…ƒ–‹‘ ƒ‘”–ƒ‡Ǥ
Fig. 3 „†‘‹ƒŽ ’ƒƒ‘”–‘‰”ƒ’Š›Ǥ –”ƒ‹‰Š– –”ƒŒ‡…–‘”› ‘ˆ –Š‡
•—’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”› –”—Ǥ Š‡ •Ž‹‰Š–Ž› …—”Ž› •’Ž‡‹… ƒ† Žƒ”‰‡ ‹–‡•–‹‡Ǥ ƒ…”‘•’‡…‹‡Ǥ „•‡”˜ƒ–‹‘ ‘Ǥ ͼǢ
ƒ”–‡”›Ǥ „•‡”˜ƒ–‹‘ ‘Ǥ ͺǢ ƒŽ‡ǡ ͺͽ ›‡ƒ”• ‘Ž†Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ Ž‹‡ƒŽ‹•Ǣ ͹ Ȃ ƒǤ Š‡’ƒ–‹…ƒ
…‘—‹•Ǣ ͺ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ ͻ Ȃ ƒǤ ”‡ƒŽ‹• †‡š–”ƒǢ
ͼ Ȃ ƒǤ ”‡ƒŽ‹• •‹‹•–”ƒǢ ͽ Ȃ „‹ˆ—”…ƒ–‹‘ ƒ‘”–ƒ‡Ǥ
tion of the superior mesenteric artery to a few centimeters
from the ostium had dispersed type of branching. We admit
that this variant, after a more rigorous study, would deserve
attention, taking its place among the variants thatwere men-
tioned above.
Regardless of the location of the ostium, the trajectory of
the beginning portion of the superior mesenteric artery, if
some of its branches are of relatively small diameter partici-
pate in the vasculature of the ligamental splenic complex. In
‹‰ǤͶƒ”‹ƒ„‹Ž‹–ƒ–‡ƒ”ƒ‹ϐ‹…£”‹‹ƒ”–‡”‡Ž‘”‹–‡•–‹‡Ž‘”•—„ì‹”‡è‹
‰”‘•Ǥƒ…”‘’”‡’ƒ”ƒ–Ǥ„•‡”˜ƒì‹‡”Ǥ͸Ǣˆ‡‡‹‡ǡ͸͵†‡ƒ‹Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ
͹ Ȃ ƒƒǤ Œ‡Œ—ƒŽ‡• ‡– ‹Ž‡ƒŽ‡•Ǣ ͺ Ȃ ƒǤ ‹Ž‡‘…‘Ž‹…£Ǣ ͻ Ȃ ƒǤ ‡•‡–‡”‹…ƒ
‹ˆ‡”‹‘”Ǣ ͼ Ȃ –”—…—• •—’‡”‹‘” ȋƒǤ ‡•‡–‡”‹…ƒ ‹ˆ‡”‹‘”ȌǢ
ͽ Ȃ –”—…—• ‹ˆ‡”‹‘” ȋƒǤ ‡•‡–‡”‹…ƒ ‹ˆ‡”‹‘”ȌǤ
Fig. 4 ƒ”‹ƒ„‹Ž‹–› ‘ˆ „”ƒ…Š‹‰ ‘ˆ –Š‡ ƒ”–‡”‹‡• –‘ –Š‡ •ƒŽŽ
ˆ‡ƒŽ‡ǡ ͼ͹ ›‡ƒ”• ‘Ž†Ǥ
1 Ȃ ’ƒ”• ƒ„†‘‹ƒŽ‹• ƒ‘”–ƒ‡Ǣ ͸ Ȃ ƒǤ ‡•‡–‡”‹…ƒ •—’‡”‹‘”Ǣ
͹ Ȃ ƒƒǤ Œ‡Œ—ƒŽ‡• ‡– ‹Ž‡ƒŽ‡•Ǣ ͺ Ȃ ƒǤ ‹Ž‡‘…‘Ž‹…Ǣ ͻ Ȃ ƒǤ ‡•‡–‡”‹…ƒ ‹ˆ‡Ǧ
”‹‘”Ǣ ͼ Ȃ –”—…—• •—’‡”‹‘” ȋƒǤ ‡•‡–‡”‹…ƒ ‹ˆ‡”‹‘”ȌǢ
ͽ Ȃ –”—…—• ‹ˆ‡”‹‘” ȋƒǤ ‡•‡–‡”‹…ƒ ‹ˆ‡”‹‘”ȌǤ
20 ƒ”‹ƒ–‡ ƒƒ–‘‹…‡ ‹†‹˜‹†—ƒŽ‡ ƒŽ‡ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡

Ž‡ƒŽ‡…ƒ˜‹–£ì‹‹ƒ„†‘‹ƒŽ‡Ǥ‡Ž‡†‹—”£ǡƒ—ˆ‘•–•–ƒ„‹Ž‹–‡’‡ a few cases, one or two branches of the superior mesenteric

——Žè‹ƒ…‡Žƒè‹Ž‘–†‡’ƒ…‹‡ì‹Ǥ”‹–”‡‡‹ǡ’”‡˜ƒŽƒ—”‡’”‡œ‡–ƒ- artery participate in the vascularization of the lower pole of
싋‰”—’—Ž—‹†‡˜Ÿ”•–£2Ȃƒ†‘—ƒ’‡”‹‘ƒ†£ƒ˜Ÿ”•–‡‹ƒ–—”‡ǡ the spleen.
—”ƒì‹ǡ†‡”‡‰—Ž£ǡ†‡‰”—’—Ž1Ȃ’”‹ƒ’‡”‹‘ƒ†£ƒ˜Ÿ”•–‡‹
ƒ–—”‡ǡƒ’‘‹†‡ƒŽ–‡…ƒ–‡‰‘”‹‹†‡˜Ÿ”•–£Ǥ
B „ƒœƒ †ƒ–‡Ž‘” ‡†‹…ƒŽ‡ ’—–‡ ƒϐ‹”ƒ …£ǡ Á Ž‹‹‹ ƒ”‹ǡ
ƒ…‡ƒ•–£ •‹–—ƒì‹‡ ‡•–‡ Œ—•–‹ϐ‹…ƒ–£Ǥ ‡è‹ǡ ‡ …—‘•…—– ˆƒ’–—Ž …£ǡ
‘†ƒ–£…—Áƒ‹–ƒ”‡ƒÁ˜Ÿ”•–£ǡ—£”—Žƒˆ‡…ì‹—‹Ž‘”…”‡è–‡ǡ’ƒ-
…‹‡ì‹‹‹…Ž—è‹ÁŽ‘–—Ž†ƒ–ƒ—ˆ‘•–ƒƒŽ‹œƒì‹ˆ£”£•£•‡싐£…‘–
†‡ƒ…‡ƒ•–£”‡ƒŽ‹–ƒ–‡ǤB…ƒœ—Žƒ‘”–‘Ǧƒ”–‡”‹‘‰”ƒϐ‹‡‹ƒ„†‘‹ƒŽ‡ǡ
‡š‹•–£‘ƒŽ–£‡š’Ž‹…ƒì‹‡Ȃƒ‹’—싐‹’ƒ…‹‡ì‹†‡˜Ÿ”•–£Áƒ‹–ƒ-
–£•‡†‡…‹†•£ϐ‹‡•—’—è‹‹˜‡•–‹‰ƒì‹‡‹”‡•’‡…–‹˜‡ǡ†‡‘ƒ”‡…‡—
‡•–‡ —ƒ †‹–”‡ …‡Ž‡ ƒ‹ —è‘” •—’‘”–ƒ„‹Ž‡ǡ …— ƒ–Ÿ– ƒ‹ —Ž–ǡ
’‡ˆ—†ƒŽ—Ž”‡ƒ‹‡”‡Ž‘”‹˜‘Ž—–‹˜‡è‹ƒŽ——‹—£”…”‡•…—–
ȋÁ”ƒ’‘”–…—‰”—’—”‹Ž‡†‡˜Ÿ”•–£’”‡…‡†‡–‡Ȍ†‡ƒˆ‡…ì‹—‹…‡
‡˜‘Ž—‡ƒœ£ƒ‹”ƒ’‹†Ǥ
”‹–”Ǧ‘†‹•‡…싇ƒƒ–‘‹…£ϐ‹£ƒ…‘’Ž‡š—Ž—‹†‡‘”‰ƒ‡ƒŽ
…ƒ˜‹–£ì‹‹ƒ„†‘‹ƒŽ‡ȋˆ‡‡‹‡ǡ͸͵†‡ƒ‹Ȍǡƒˆ‘•–†‡’‹•–ƒ–£‘˜ƒ-
”‹ƒ–£”ƒ”Á–ŸŽ‹–£†‡˜ƒ•…—Žƒ”‹œƒ”‡ƒ‹–‡•–‹‡Ž‘”ȋ ‹‰—”ƒͶȌǤ
Trunchiul arterei mezenterice superioare, în cazul nostru,
•‡†‡•’”‹†‡†‡Žƒƒ‘”–ƒƒ„†‘‹ƒŽ£…—Ͳǡͷ…ƒ‹•—•†‡ƒ”-
–‡”‡Ž‡”‡ƒŽ‡è‹’£–”—†‡Á”£†£…‹ƒ‡œ‡–‡”—Ž—‹‹–‡•–‹—-
Ž—‹•—„ì‹”‡ǡ—†‡†£ƒè–‡”‡ƒ”–‡”‡Ž‘”Œ‡Œ—ƒŽ‡ǡ‹Ž‡ƒŽ‡è‹ƒ”–‡”‡‹
ileocolice. Colonul ascendent, transvers, descendent, sigmoid
è‹•‡‰‡–‡Ž‡•—’‡”‹‘”苏‡†‹—ƒŽ”‡…–—Ž—‹’”‹‡•…”ƒ—”‹Ž‡
ƒ”–‡”‹ƒŽ‡†‡Žƒ–”—…Š‹—”‹Ž‡•—’‡”‹‘”è‹‹ˆ‡”‹‘”ƒŽ‡ƒ”–‡”‡‹‡œ-
enterice inferioare.
‹•…—ì‹‹
‹•–‡—Ž˜ƒ•…—Žƒ”ƒŽ‹–‡•–‹‡Ž‘”’‘ƒ–‡ϐ‹‡šƒ‹ƒ–è‹’”‹
’ƒƒ‘”–‘‰”ƒϐ‹‡Ǥƒ’‡”‹–‡•–ƒ„‹Ž‹”‡ƒ•—”•‡Ž‘”’”‹…‹’ƒŽ‡è‹•‡-
…—†ƒ”‡†‡˜ƒ•…—Žƒ”‹œƒ”‡ƒ‹–‡•–‹‡Ž‘”ǡ–”ƒ‹‡…–—Ž—‹ǡ‘†—Ž—‹è‹
Thus, based on abdominal panaortography, several struc-
tural and spatial aspects of the abdominal cavity vessels were
elucidated. The latter were established on the same group of
patients. Among them, were prevalent the representatives of
the age group VIII2 Ȃ–Š‡•‡…‘†’‡”‹‘†‘ˆƒ–—”‡ƒ‰‡ǡ—•—ƒŽŽ›
followed by group VIII1Ȃ–Š‡ϐ‹”•–’‡”‹‘†‘ˆƒ–—”‡ƒ‰‡ǡ–Š‡
by other age groups.
ƒ•‡†‘–Š‡‡†‹…ƒŽ’”ƒ…–‹…‡ǡ–Š‹••‹–—ƒ–‹‘‹•Œ—•–‹ϐ‹‡†ǡƒŽ-
though with aging the incidence of diseases increases, but the
patients included in the given group have been analyzed with-
out considering this fact. In the case of abdominal aorto-arte-
”‹‘‰”ƒ’Š›ǡ–Š‡”‡‹•ƒ‘–Š‡”‡š’Žƒƒ–‹‘Ȃˆ‡™‡”‘Ž†‡”’ƒ–‹‡–•
decide to undergo this investigation, which is not one of the
easiest to undergo, even more so, taking into accountinvolu-
tion processes and an increased number (relative to previous
age groups) of diseases with progressive evolution.
Fine anatomical dissection of the organs of the abdominal
cavity (female, 63 years), allowed us to demonstrate a rare oc-
currence of intestinal vascularization (Figure 4).
The trunk of the superior mesenteric artery, in our case,
branched from the abdominal aorta 0.5 cm above the renal
arteries and penetrated into the root of the mesentery of the
small intestine where it gave jejunal, ileal and ileocolic arter-
ies. The ascending, transverse, descending, sigmoid colon and
upper and middle segments of the rectum received the arte-
rial branches from the upper and lower trunks of the inferior
mesenteric artery.
Discussion
Ž‘…—Ž—‹ †‡ ”ƒ‹ϐ‹…ƒ”‡ ƒŽ ƒ”–‡”‡Ž‘” ‡œ‡–‡”‹…‡Ǥ ˆ‘”ƒì‹ƒ †‡
ƒ…‡•– ‰‡ ’”‡œ‹–£ — ‹–‡”‡• ƒ’Ž‹…ƒ–‹˜ Žƒ •–ƒ„‹Ž‹”‡ƒ †‹ˆ‡”‹–‘”
’”‘…‡•‡ ’ƒ–‘Ž‘‰‹…‡ ƒŽ‡ ‹–‡•–‹‡Ž‘”Ǥ ‘”–‘Ǧƒ”–‡”‹‘‰”ƒϐ‹ƒ ƒ„-
†‘‹ƒŽ£ ‡•–‡ ‘ ‡–‘†£ ‡ϐ‹…‹‡–£ ’‡–”— ƒ ‘„싐‡ ‘ ‹ƒ‰‹‡
‹–‡‰”ƒŽ£ Á …‡‡ƒ …‡ ’”‹˜‡è–‡ ’‘”ì‹—‡ƒ ƒ„†‘‹ƒŽ£ ƒ ƒ‘”–‡‹ǡ
”ƒ—”‹Ž‡‡‹˜‹•…‡”ƒŽ‡’”‹…‹’ƒŽ‡è‹˜ƒ”‹ƒ–‡Ž‡Ž‘”†‡•–”—…–—”£ǡ
†‡‘ƒ”‡…‡ǡ’”‹†‹•‡…싇ƒƒ–‘‹…£ǡƒ•‡‡‡ƒ–ƒ„Ž‘—”‹ǡ’”ƒ…–‹…ǡ
—•‡’‘–‘„싐‡Ǥ
ƒ–‡Ž‡ ƒ…–—ƒŽ‡ ‹†‹…£ Žƒ ˆƒ’–—Ž …£ ƒ”–‡”ƒ ‡œ‡–‡”‹…£ •—-
’‡”‹‘ƒ”£ ‹”‹‰£ǡ †‡ ‘„‹…‡‹ǡ ‹–‡•–‹—Ž •—„ì‹”‡ǡ ’ƒ…”‡ƒ•—Žǡ ʹȀ͵
•–Ÿ‰‹ ƒŽ‡ …‘Ž‘—Ž—‹ –”ƒ•˜‡”• è‹ …‡…—ŽǤ ”–‡”‡Ž‡ ‹–‡•–‹—Ž—‹
‰”‘••‡…ƒ”ƒ…–‡”‹œ‡ƒœ£’”‹–”Ǧ—‰”ƒ†ÁƒŽ–†‡˜ƒ”‹ƒ„‹Ž‹–ƒ–‡ǤB
Ͷǡ͵Ǧʹ͵Ψ†‹…ƒœ—”‹ǡƒ”–‡”ƒ…‘Ž‹…£†”‡ƒ’–£è‹ƒ”–‡”ƒ…‘Ž‹…£‹Œ-
Ž‘…‹‡Á…‡’Á’”‡—£…ƒ—–”—…Š‹…‘—ȏͳǡʹȐǤ”–‡”ƒ…‘Ž‹…£
†”‡ƒ’–£‡•–‡’”‡œ‡–£—ƒ‹ÁͳͲǦ͸͵Ψ†‹…ƒœ—”‹ǡÁ–‹’…‡
ƒ”–‡”ƒ…‘Ž‹…£‹ŒŽ‘…‹‡‡•–‡’”‡œ‡–£Áͻͻǡ͵Ψè‹Á͹ǡʹΨ‡š‹•–£
arterele colice mijlocii accesorii [3, 4].
—è‹…‘ƒ—–‘”‹‹’”‘’—‘…Žƒ•‹ϐ‹…ƒ”‡ƒ˜ƒ”‹ƒ–‡Ž‘”†‡†‡œ-
The vascular system of the intestine can also be examined
through panaortography. It allows establishing the main and
secondary sources of vascularization of the intestine, the tra-
jectory, the way and the branching pattern of the mesenteric
arteries. Such information is of interest in determining the
various pathological processes of the intestine. Abdominal
aortic arteriography is an effective method of obtaining an in-
tegral picture of the abdominal part of the aorta, its main vis-
ceral branches and their structural variants, because, during
anatomical dissection, such demonstration, practically, cannot
be obtain.
Current data indicate that the superior mesenteric artery
usually supplies the small intestine, the pancreas, the left 2/3
of the transverse colon and the caecum. The large intestine
arteries are characterized by a high degree of variability. In
4.3-23% of cases, the right colonic artery and the middle colic
artery begin together as a common trunk [1, 2]. The right colic
artery is present only in 10-63% of cases, while the middle
˜‘Ž–ƒ”‡ƒƒ”–‡”‡Ž‘”‡œ‡–‡”‹…‡ǣ–‹’—ŽȂ‘”ƒŽǡƒ”–‡”ƒ‡œ- colic artery is present in 99.3%, and in 7.2% there are middle
‡–‡”‹…£•—’‡”‹‘ƒ”£è‹…‡ƒ‹ˆ‡”‹‘ƒ”£Á…‡’•‡’ƒ”ƒ–†‡Žƒƒ‘”–£Ǣ accessory colic arteries [3, 4].
–‹’—ŽȂ˜ƒ”‹ƒ–‡†‡ˆ‡…–‹˜‡ƒŽ‡ƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡ǡ — ƒ† …‘™‘”‡”•ǡ †‡•…”‹„‡• …Žƒ••‹ϐ‹…ƒ–‹‘ „ƒ•‡† ‘ –Š‡
Ž‹’•ƒ–‘–ƒŽ£•ƒ—’ƒ”싃Ž£Ǣ–‹’—ŽȂ˜ƒ”‹ƒ–‡†‡ˆ‡…–‹˜‡ƒŽ‡ƒ”–‡- ˜ƒ”‹ƒ–• ‘ˆ †‡˜‡Ž‘’‡– ‘ˆ –Š‡ ‡•‡–‡”‹… ƒ”–‡”‹‡•ǣ –›’‡ 
”‡‹‡œ‡–‡”‹…‡‹ˆ‡”‹‘ƒ”‡ǡŽ‹’•ƒ–‘–ƒŽ£•ƒ—’ƒ”싃Ž£Ǣ–‹’—ŽȂ (normal, upper and lower mesenteric artery starting from the
’”‡œ‡ìƒƒ”–‡”‡Ž‘”‡œ‡–‡”‹…‡‡†‹‹ƒ„‡”ƒ–‡ȏͷȐǤ aorta), type II (defective variants of superior mesenteric ar-
†‹˜‹†—ƒŽ ƒƒ–‘‹…ƒŽ ˜ƒ”‹ƒ–• ‘ˆ –Š‡ •—’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”›
‹•–‡—Ž ƒ”–‡”‹ƒŽ ƒŽ –”ƒ…–—Ž—‹ ‰ƒ•–”‘‹–‡•–‹ƒŽ ‡•–‡ ‹‹ì‹ƒŽ
•‡‰‡–ƒ–Ǥ…‡•–ƒ†‡”‹˜£†‹…Ÿ–‡˜ƒ’‡”‡…Š‹†‡ƒ”–‡”‡•’ŽƒŠ-
‹…‡ ˜‡–”ƒŽ‡ǡ …ƒ”‡ ƒ— — ‘†‡Ž •‡‰‡–ƒ” è‹ ‘ ”ƒ‹ϐ‹…ƒì‹‡
†‹ƒ‘”–ƒ†‘”•ƒŽ£’ƒ”‹ƒ–£Ǥ—’£ˆ—œ‹—‡ƒƒ‘”–‡‹†‘”•ƒŽ‡ǡƒ…‡•-
–‡˜ƒ•‡•‡—‡•…苈‘”‡ƒœ£–”—…Š‹—”‹‹’ƒ”‡ǡ…ƒ”‡ƒ•‹‰—”£
ƒŽ‹‡–ƒ”‡ƒƒ”–‡”‹ƒŽ£ƒ–—„—Ž—‹†‹‰‡•–‹˜’”‹‹–‹˜Ǥ”—…Š‹—”‹Ž‡
sunt legate între ele prin anastomoze longitudinale. În cele din
—”£ǡƒ…‡•–•‹•–‡‡•–‡•‹’Ž‹ϐ‹…ƒ–’”‹”‡†—…‡”‡ƒ—£”—Ž—‹
†‡˜ƒ•‡ǡƒ•–ˆ‡ŽǡÁ…Ÿ–”£Ÿ†‘ƒ”–”‡‹ǣ–”—…Š‹—Ž…‡Ž‹ƒ…苃”–‡-
”‡Ž‡‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”£è‹‹ˆ‡”‹‘ƒ”£ȏ͸ȐǤ”‡•—’—‡…£
orice schimbare în acest proces poate cauza majoritatea ano-
ƒŽ‹‹Ž‘”˜ƒ•…—Žƒ”‡…ƒ”‡’‘–•£ϐ‹‡‰£•‹–‡Žƒƒ…‡•–‹˜‡ŽǤ
‰Š‹—Ž †‡ ”ƒ‹ϐ‹…ƒì‹‡ ƒŽ ƒ”–‡”‡‹ ‡œ‡–‡”‹…‡ •—’‡”‹‘ƒ”‡
ƒ”‡è‹‡Ž‹’‘”–ƒì£…Ž‹‹…£Ǥˆ‘•–†‡‘•–”ƒ–…£Žƒ’ƒ…‹‡ì‹‹…—
†‹•‡…싇‹œ‘Žƒ–£ƒƒ”–‡”‡‹‡œ‡–‡”‹…‡•—’‡”‹‘ƒ”‡ǡ…‘’ƒ”ƒ–‹˜
cu cei din grupul de control, ea are un unghi aortic mediu mai
mare (73,0±19,8° versus 50,0±18,8°, p<0,001). Unghiul mai
ƒ”‡‡•–‡ƒ•‘…‹ƒ–…——•–”‡•ƒ‹ƒ”‡’‡’‡”‡–‡Ž‡ƒ”–‡”‹ƒŽè‹
un indice de forfecare oscilatorie mai mare în lumenul vasu-
lui la nivelul convexului arterei mezenterice superioare, unde,
ƒ†‡•‡ƒǡƒ’ƒ”‡†‹•‡…싃ȏ͹ǡͺȐǤ
‘…Ž—œ‹‹
ͳȌ —ˆ‘•–•–ƒ„‹Ž‹–‡ǣ‹˜‡Ž—Ž‡‡”‰‡ì‡‹ƒ”–‡”‡‹‡œ‡–‡”‹…‡
superioare, sediul ostiumului arterial.
ʹȌ ”ƒ‹‡…–—Ž’‘”ì‹—‹‹‹…‹’‹‡–‡ƒ˜ƒ•—Ž—‹ƒˆ‘•–Á–ŸŽ‹–ǣ…—
…‘˜‡š‹–ƒ–‡ƒ •’”‡ •–Ÿ‰ƒ Ȃ Á ͵ͺǡ͸ͺΨ †‹ …ƒœ—”‹ǡ •’”‡
†”‡ƒ’–ƒȂÁ͵͵ǡͻ͸Ψ†‹…ƒœ—”‹ǡ…—–”ƒ‹‡…–”‡…–‹Ž‹‹—ȂÁ
27,36% din cazuri.
͵Ȍ ‡Ž‡”ƒ—”‹è‹”ƒ—•…—Ž‡…—‘”‹‰‹‡ƒÁƒ”–‡”ƒ‡œ‡Ǧ
–‡”‹…£•—’‡”‹‘ƒ”£’ƒ”–‹…‹’£Žƒ˜ƒ•…—Žƒ”‹œƒ”‡ƒ…‘’Ž‡š—Ž—‹
spleno-ligamentar, în special, al polului lienal inferior.
‡…Žƒ”ƒì‹ƒ†‡…‘ϐŽ‹…–†‡‹–‡”‡•‡
Nimic de declarat.
‘–”‹„—싃ƒ—–‘”‹Ž‘”
MJHS 17(3)/2018 21
tery, total or partial absence), type III defective inferior mes-
enteric artery, total or partial absence), type IV (presence of
aberrant medium mesenteric arteries) [5].
The arterial system of the gastrointestinal tract is, ini-
tially, segmented. It is derived from a number of pair ventral
splanchnic arteries. All of these have a segmental model and
branch from the paired dorsal aortas. Following the fusion of
the dorsal aortas, these vessels combine and form unpaired
trunks that provide the arterial supply of the primitive diges-
tive tract. Trunks are linked together by longitudinal anasto-
‘•‡•Ǥ ‹ƒŽŽ›ǡ–Š‹••›•–‡‹••‹’Ž‹ϐ‹‡†„›”‡†—…‹‰–Š‡—-
„‡”‘ˆ˜‡••‡Ž•ǡ•‘‘Ž›–Š”‡‡”‡ƒ‹ǣ…‡Ž‹ƒ…–”—ƒ†•—’‡”‹‘”
and inferior mesenteric arteries [6]. We can suppose that any
changes in this process can cause most of the vascular abnor-
malities that can be found at this level.
The branching angle of the superior mesenteric artery
also has clinical importance. It has been shown that in pa-
tients with isolated mesenteric artery dissection compared
with those in the control group they have a higher mean aortic
angle (73.0±19.8° versus 50.0±18.8°, p<0.001). Higher angle
is associated with a higher stress on the arterial wall and a
higher oscillatory shear index in the lumen of the vessel at the
convex level of the superior mesenteric artery where dissec-
tion often occurs [7, 8].
Conclusions
1) We have established the level of the superior mesenteric
artery and the location of arterial ostium.
2) The trajectory of the beginningportion of the vessel was
with convexity to the left (38.68% of cases), to the right
(33.96% of cases), straight tract (27.36% of cases).
3) Some branches that originate from the superior mesen-
teric artery participate in the vasculature of the spleno-
ligament complex, especially the lower pole of the spleen.
‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‹‰‘ˆ‹–‡”‡•–•
Nothing to declare.
‘…‡’–苆‡•‹‰ȋǡȌǤ…Š‹œ‹ì‹ƒ†‡†ƒ–‡ȋǡȌǤƒ-
Ž‹œ£è‹‹–‡”’”‡–ƒ”‡ȋǡȌǤ…”‹‡”‡ƒ—•…”‹•ȋǡȌǤ‡˜‹-
Author’s contribution
zuire (OB, SC, NM, IB). Concept and design (OB, NM). Acquisition (OB, IB). Analy-
sis and interpretation (OB, SC). Drafting (OB, SC). Reviewing
(OB, SC, NM, IB).
‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
1. Gamo E., Jimenez C., Pallares E. ‡– ƒŽǤ The superior mesenteric ar- ͷǤ —Ǥǡ‡‰Ǥǡ—ǤǡŠ‡
ǤǡŠ—
Ǥǡ‹‰Ǥ„•‡…‡‘ˆ–Š‡•—-
tery and the variations of the colic patterns. A new anatomical ’‡”‹‘” ‡•‡–‡”‹… ƒ”–‡”› ‹ ƒ ƒ†—Ž– ƒ† ƒ ‡™ …Žƒ••‹ϐ‹…ƒ–‹‘
ƒ† ”ƒ†‹‘Ž‘‰‹…ƒŽ …Žƒ••‹ϐ‹…ƒ–‹‘ ‘ˆ –Š‡ …‘Ž‹… ƒ”–‡”‹‡•Ǥ —”‰Ǥ ƒ†‹‘ŽǤ method for superior-inferior mesenteric arterial variations. —”‰Ǥ
ƒ–ǤǡʹͲͳ͸Ǣ͵ͺȋͷȌǣͷͳͻǦʹ͹Ǥ ƒ†‹‘ŽǤ ƒ–ǤǡʹͲͳͶǢ͵͸ȋͷȌǣͷͳͳǦͷǤ
2. Cheng B., Chang S., Huang J. ‡– ƒŽǤ Surgical anatomy of the colic 6. Kitamura S., Nishiguchi T., Sakai A., Kumamoto K. Rare case of the
˜‡••‡Ž•‹Š‹‡•‡ƒ†‹–•‹ϐŽ—‡…‡‘–Š‡‘’‡”ƒ–‹‘‘ˆ‡•‘’Šƒ- inferior mesenteric artery arising from the superior mesenteric
geal replacement with colon. Š‘‰Š—ƒ ‹ —‡ ƒ Š‹, 2006; 86 artery. ƒ–Ǥ ‡…Ǥǡͳͻͺ͹Ǣʹͳ͹ȋͳȌǣͻͻǦͳͲʹǤ
ȋʹͳȌǣͳͶͷ͵Ǧ͸Ǥ ͹Ǥ —Ǥǡ‹
Ǥǡ—Ǥǡ
—‘Ǥǡƒ‰ǤǡŠ‡Ǥǡ‹‘‰
ǤŠ‡•‹‰‹ϐ‹-
͵Ǥ Ž•ƒ„‹ŽƒŠ
Ǥǡ‹Ǥǡ‹Ǥƒ•…—Žƒ”•–”—…–—”‡•‘ˆ–Š‡”‹‰Š–…‘Ž‘ǣ cance of the angle between superior mesenteric artery and aorta
incidence and variations with their clinical implications. …ƒ†Ǥ
Ǥ in spontaneous isolated superior mesenteric artery dissection.
—”‰ǡʹͲͳ͹ǢͳͲ͸ȋʹȌǣͳͲ͹ǦͳͳͷǤ  ƒ•…Ǥ —”‰ǤǡʹͲͳ͹ǢͶͷǣͳͳ͹Ǧͳʹ͸Ǥ
4. Nesgaard J., Stimec B., Bakka A., Edwin B., Ignjatovic D. Navigating ͺǤ ʙˑ˅˃ːˑ˅ʑǤʑǤǡʏːˋˍˋː˃ʡǤʗǤʤˋ˓˖˓ˆˋ˚ˈ˔ˍ˃ˢ˃ː˃˕ˑˏˋˢ˃˓˕ˈ˓ˋˌ
–Š‡‡•‡–‡”›ǣƒ…‘’ƒ”ƒ–‹˜‡’”‡Ǧƒ†’‡”‘’‡”ƒ–‹˜‡˜‹•—ƒŽ‹œƒ–‹‘ ˚ˈˎˑ˅ˈˍ˃Ǥʛˑ˔ˍ˅˃ǡͳͻ͹ͶǤ
of the vascular anatomy. ‘Ž‘”‡…–ƒŽ ‹•ǤǡʹͲͳͷǢͳ͹ȋͻȌǣͺͳͲǦͺǤ
22

ARTICOL DE CERCETARE RESEARCH ARTICLE

‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ƒ…‘’‹‹Ž‘” Physical development of

狃†‘Ž‡•…‡ì‹Ž‘”†‹…‡–”—Ž children and adolescents in
‡’—„Ž‹…‹‹‘Ž†‘˜ƒÁ…‘”‡Žƒì‹‡ the center of the Republic of
…—ˆƒ…–‘”—ŽƒŽ‹‡–ƒ”ç‹…ƒ†”—Ž Moldova in correlation with the
Ž‡‰‹•Žƒ–‹˜Á˜‹‰‘ƒ”‡ food factor and the legislative
Alexandru Voloc1, Natalia Bivol2 framework in force
1
‡’ƒ”–ƒ‡–—Ž †‡ ’‡†‹ƒ–”‹‡ǡ ‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ ç‹ ƒ”ƒ…‹‡
Ƿ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ Š‹ç‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǢ Alexandru Voloc1*, Natalia Bivol2
͸
ƒ–‡†”ƒ †‡ ‹‰‹‡£ ‰‡‡”ƒŽ£ǡ ‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ ç‹ ƒ”ƒ…‹‡ 1
‡’ƒ”–‡– ‘ˆ ’ƒ‡†‹ƒ–”‹…•ǡ ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‹˜‡”•‹–› ‘ˆ ‡†‹…‹‡
Ƿ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ Š‹ç‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǤ ƒ† Šƒ”ƒ…›ǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǢ
͸
Šƒ‹” ‘ˆ ‰‡‡”ƒŽ Š›‰‹‡‡ǡ ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‹˜‡”•‹–› ‘ˆ ‡†‹…‹‡ ƒ†
Data primirii manuscrisului: 12.02.2018 Šƒ”ƒ…›ǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǤ
ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣʹͺǤͲͻǤʹͲͳͺ
Manuscris received on: 12.02.2018
Autor corespondent: ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣʹͺǤͲͻǤʹͲͳͺ
Ž‡šƒ†”— ‘Ž‘…ǡ †”Ǥ Šƒ„Ǥ ç–Ǥ ‡†Ǥǡ …‘ˆǤ —‹˜Ǥ
‡’ƒ”–ƒ‡–—Ž †‡ ’‡†‹ƒ–”‹‡ Corresponding author:
‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹…‹£ ç‹ ƒ”ƒ…‹‡ Ƿ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dz Ž‡šƒ†”— ‘Ž‘…ǡ ǡ Šǡ 
„†Ǥ f–‡ˆƒ …‡Ž ƒ”‡ ç‹ ˆŸ–ǡ 1ͼͻǡ Š‹ç‹£—ǡ ‡’—„Ž‹…ƒ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ ‡’ƒ”–‡– ‘ˆ ’‡†‹ƒ–”‹…•
‡Ǧƒ‹Ž: ƒŽ‡šƒ†”—Ǥ˜‘Ž‘…̻—•ˆǤ† ‹…‘Žƒ‡ ‡•–‡‹–ƒ— –ƒ–‡ ‹˜‡”•‹–› ‘ˆ ‡†‹…‹‡ ƒ† Šƒ”ƒ…›
1ͼͻǡ –‡ˆƒ …‡Ž ƒ”‡ •‹ ˆƒ– ƒ˜‡Ǥǡ Š‹•‹ƒ—ǡ ‡’—„Ž‹… ‘ˆ ‘Ž†‘˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ƒŽ‡šƒ†”—Ǥ˜‘Ž‘…̻—•ˆǤ†

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

—싐‡ •–—†‹‹ 疋‹ì‹ϐ‹…‡ †‡•…”‹— •‹–—ƒì‹ƒ ƒŽ‹‡–ƒ”£ ’”‹ ‡™•…‹‡–‹ϐ‹…•–—†‹‡•†‡•…”‹„‡–Š‡ˆ‘‘†•‹–—ƒ–‹‘‹–‡”•
’”‹•ƒ Ž‡‰‹•Žƒì‹‡‹ ƒì‹‘ƒŽ‡ ç‹ ‹–‡”ƒì‹‘ƒŽ‡ Žƒ …ƒ’‹–‘Ž—Ž of national and international legislation on the balanced and
ƒŽ‹‡–ƒì‹‡‹‡…Š‹Ž‹„”ƒ–‡ç‹”ƒì‹‘ƒŽ‡ƒ…‘’‹‹Ž‘”狃†‘Ž‡•…‡ì‹Ž‘” rational diet of institutionalized children and adolescents
‹•–‹–—ì‹‘ƒŽ‹œƒì‹Á…‘’ƒ”ƒì‹‡…—…‡‹…‡˜‹†‹ˆƒ‹Ž‹‹Ǥ compared to those coming from families.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
š‹•–£ †‹ˆ‡”‡ì‡ …—ƒ–‹ϐ‹…ƒ„‹Ž‡ Á–”‡ •–ƒ–—–—Ž —–”‹ì‹‘ƒŽ ƒŽ
…‘’‹‹Ž‘” ‹•–‹–—ì‹‘ƒŽ‹œƒì‹ ˆƒì£ †‡ …‘’‹‹‹ ’”‘˜‡‹ì‹ †‹ ˆƒ‹Ž‹‹
complete.
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
‡œ—Ž–ƒ–‡Ž‡‘„싐—–‡†‡‘•–”‡ƒœ£…£Ž‡‰‹•Žƒì‹ƒ’”‹˜‹†•‡-
…—”‹–ƒ–‡ƒƒŽ‹‡–ƒ”£ç‹ƒŽ‹‡–ƒì‹ƒƒ†‡…˜ƒ–£Á…‘ˆ‘”‹–ƒ–‡…—
‘”ƒ–‹˜‡Ž‡Á˜‹‰‘ƒ”‡—‡•–‡”‡•’‡…–ƒ–£Á‡’—„Ž‹…ƒ‘Ž†‘-
˜ƒǤB”‡œ—Ž–ƒ–ǡ•Ǧƒ…‘•–ƒ–ƒ–—”‡–ƒ”†Á†‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ƒ
…‘’‹‹Ž‘” ç‹ ƒ†‘Ž‡•…‡ì‹Ž‘” ‹•–‹–—ì‹‘ƒŽ‹œƒì‹ǡ Á …‘’ƒ”ƒì‹‡ …—
cei care provin din familii complete.
‡œ—ƒ–
Introducere.B…ƒ†”—Žƒ…‡•–—‹•–—†‹—ǡƒˆ‘•–‡˜ƒŽ—ƒ–£•–ƒ”‡ƒ
†‡ —–”‹ì‹‡ ƒ …‘’‹‹Ž‘” è‹ ƒ†‘Ž‡•…‡ì‹Ž‘” †‹ †‘—£ ‹•–‹–—ì‹‹ †‹
샔£’”‹’”‹•ƒ•–ƒ–—–—Ž—‹†‡…‘’‹‹‹•–‹–—ì‹‘ƒŽ‹œƒì‹è‹’”‘˜‡-
‹ì‹†‹•Ÿ—Žˆƒ‹Ž‹‹Ž‘”…‘’Ž‡–‡Ǥ
ƒ–‡”‹ƒŽè‹‡–‘†‡ǤStudiul a inclus 2 cohorte de 297 de
•—„‹‡…ì‹Ǥ‘–—Ž†‡•–—†‹—ȋ0Ȍǡ’”‘˜‡‹–†‹腑ƒŽƒ‹–‡”ƒ–†‹
Research hypothesis
Š‡”‡ƒ”‡“—ƒ–‹ϐ‹ƒ„Ž‡†‹ˆˆ‡”‡…‡•„‡–™‡‡–Š‡—–”‹–‹‘ƒŽ
status of institutionalized children and children from comple-
te families.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
The results obtained show that the legislation on food se-
curity and adequate nutrition according to the norms in force
is not observed in the Republic of Moldova. As a result, there
has been a slowdown in the physical development of instituti-
onalized children and adolescents, as compared to those from
complete families.
Abstract
Introduction. In this study, the state of nutrition of chil-
dren and adolescents in two institutions in the country was as-
sessed in terms of the status of institutionalized children and
of the families.
Material and methods. The study included 2 cohorts of
297 subjects. The study group (L0), coming from the boarding
Š›•‹…ƒŽ †‡˜‡Ž‘’‡–ǡ ˆ‘‘† ˆƒ…–‘” ƒ† ”‡‰—Žƒ–‘”› ˆ”ƒ‡™‘”
”Š‡‹ǡƒ‹…Ž—•ͻ͹ȋͶ͵ΨȌ†‡ˆ‡–‡è‹ͳʹͻȋͷ͹ΨȌ†‡„£‹‡ì‹ǤŸ”•–ƒ
‡†‹‡ƒˆ‡–‡Ž‘”ƒˆ‘•–†‡ͳͳǡͷάͲǡ͹ƒ‹ǤŸ”•–ƒ‡†‹‡ƒ„£‹‡ì‹Ž‘”
a fost de 11,4±0,1 ani. Lotul martor (L1) a cuprins 33 (47%)
ˆ‡–‡ è‹ ͵ͺ ȋͷ͵ΨȌ †‡ „£‹‡ì‹ǡ •’‹–ƒŽ‹œƒì‹ Á ’‹–ƒŽ—Ž Ž‹‹… —‹-
…‹’ƒŽ†‡‘’‹‹”Ǥͳ†‹Š‹è‹£—…—‹ˆ‡…싇”‡•’‹”ƒ–‘”‹‡˜‹”ƒŽ£
ƒ…—–£ǤŸ”•–ƒ‡†‹‡ƒˆ‡–‡Ž‘”ƒˆ‘•–†‡ͻǡʹάͲǡͶƒ‹ǤŸ”•–ƒ‡†‹‡
ƒ„£‹‡ì‹Ž‘”ƒˆ‘•–†‡ͺǡͻάͲǡ͵ƒ‹Ǥ
‡œ—Ž–ƒ–‡Ǥƒì‹‘—ŽƒŽ‹‡–ƒ”†‹0 a fost evaluat în baza
MJHS 17(3)/2018 23
school in Orhei, included 97 (43%) girls and 129 (57%) boys.
The average age of the girls was 11.5±0.7 years. The average
age of boys was 11.4±0.1 years. The control group (L1) com-
prised 33 (47%) girls and 38 (53%) boys, hospitalized in the
Municipal Children’s Clinic Hospital no. 1 in Chisinau with acu-
te viral respiratory infection. The average age of the girls was
9.2±0.4 years. The average age of boys was 8.9±0.3 years.
Results. The food ration of L0 was evaluated on the basis
–ƒ„‡Ž—Ž—‹  ƒŽ …‘’‘œ‹ì‹‡‹ —–”‹–‹˜‡ǡ •–ƒ„‹Ž‹† —”£–‘ƒ-
”‡Ž‡ǣ ’”‘–‡‹‡ –‘–ƒŽ‡ Ȃ ͹ͷ ‰ ȋʹǡͷάͲǡͶ ‰Ȁ‰Ȁœ‹ è‹ ͳǡͺάͲǡ͵ ‰Ȁ‰Ȁ
œ‹ ’‡–”— ƒ†‘Ž‡•…‡ì‹ǡ ‹…Ž—•‹˜ǡ †‡ ‘”‹‰‹‡ ƒ‹ƒŽ‹‡”£ Ȃ ʹͶ ‰Ǣ
‡‡”‰‹‡ʹͺͶʹ…ƒŽǢȂͻʹͳ‰Ǣ‰Ȃʹͷͷ‰Ǥ’‘”–—Ž†‡ƒƒ
constituit 493 mg/zi, inclusiv, 69 mg din produse lactate, iar
cel al vit. D a fost de 1,23 g. Ingredientele din L1ǣ’”‘–‡‹‡Ȃͺͻ
‰ȋʹǡ͸άͲǡͳʹ‰Ȁ‰Ȁœ‹’‡–”—…‘’‹‹è‹ʹǡ͵άͲǡͶ‰Ȁ‰Ȁœ‹’‡–”—ƒ†‘-
Ž‡•…‡ì‹ǡ‹…Ž—•‹˜ǡ†‡‘”‹‰‹‡ƒ‹ƒŽ‹‡”£ȂͶͺ‰ǡ‡‡”‰‹‡Ȃ͵ͳ͸ʹ
…ƒŽǡȂͳͲ͵Ͳ‰ǡ‰Ȃʹ͹͵ǡͺ‰ǡƒȂͻ͵Ͳ‰Ȁœ‹ǡ‹…Ž—•‹˜ǡͷͷͲ
‰ †‹ ’”‘†—•‡ Žƒ…–ƒ–‡Ǥ †‘Ž‡•…‡ì‹‹ †‡ ƒ„‡Ž‡ •‡š‡ †‹ 0
ƒ˜‡ƒ—‘Á£Žì‹‡ƒ‹‹…£Á…‘’ƒ”ƒì‹‡…—…‡‹†‹1, precum
è‹…‘ˆ‘”…—”„‡Ž‘”†‡”‡ˆ‡”‹ì£ƒŽ‡ǤB…‘’ƒ”ƒì‹‡…—1,
ƒŒ—•–ƒ–†—’£˜Ÿ”•–£ǡ’ƒ”–‹…‹’ƒì‹‹†‹0 aveau valori serice mai
Œ‘ƒ•‡ƒŽ‡ƒǡ‰ǡ„è‹…”‡ƒ–‹‹‡‹Ǥ
‘…Ž—œ‹‹Ǥ Ž‹‡–ƒì‹ƒ ’”‡…ƒ”£ǡ †‡ †—”ƒ–£ǡ ‹ϐŽ—‹‡ì‡ƒœ£
‡‰ƒ–‹˜ ƒ•—’”ƒ †‡œ˜‘Ž–£”‹‹ ϐ‹œ‹…‡ ƒ …‘’‹‹Ž‘” è‹ ƒ†‘Ž‡•…‡ì‹Ž‘”Ǥ
Valorile joase ale creatininei serice ar putea pleda în favoarea
—‡‹ƒ•‡—•…—Žƒ”‡•Žƒ„†‡œ˜‘Ž–ƒ–‡ǡ…ƒ—”ƒ”‡ƒƒŽ‹‡–ƒì‹‡‹
‡”ƒì‹‘ƒŽ‡è‹‡‡…Š‹Ž‹„”ƒ–‡†‡Ž—‰£†—”ƒ–£Ǥ
Cuvinte cheie: †‡œ˜‘Ž–ƒ”‡ϐ‹œ‹…£ǡƒŽ—–”‹ì‹‡ǡ…‘’‹‹ǡƒ†‘Ž‡•-
…‡ì‹‹•–‹–—ì‹‘ƒŽ‹œƒì‹Ǥ
Introducere
”‡’–—ŽƒŽ‹‡–ƒ”‡•–‡—†”‡’–˜‹–ƒŽ’‡–”—–‘ƒ–‡ϐ‹‹ì‡Ž‡
—ƒ‡ǡ‹ƒ”ƒŽ‹‡–ƒì‹ƒǡ†‡”Ÿ†…—•‡…—”‹–ƒ–‡ƒƒŽ‹‡–ƒ”£ǡ…‘-
•–‹–—‹‡ ‡Ž‡‡–‡Ž‡ ‡•‡ì‹ƒŽ‡ ’‡–”— •—’”ƒ˜‹‡ì—‹”‡ƒ ‹†‹˜‹œ‹Ž‘”Ǥ
‡…Žƒ”ƒì‹ƒ ‹˜‡”•ƒŽ£ ƒ ”‡’–—”‹Ž‘” —Ž—‹ ƒ ˆ‘•– ’”‹—Ž ‹-
•–”—‡–‹–‡”ƒì‹‘ƒŽ…ƒ”‡”‡…—‘ƒè–‡‘ϐ‹…‹ƒŽ†”‡’–—ŽŽƒŠ”ƒ£
ca pe un drept uman, în contextul dreptului la un nivel de trai
†‡…‡–ȋƒ”–ǤʹͷȌǤ•–ˆ‡ŽǡÁƒ…‡ƒ•–£†‡…Žƒ”ƒì‹‡ǡƒ”–ǤʹͷǤͳ”‡‹–‡”‡ƒ-
œ£…£Ƿ”‹…‡ ’‡”•‘ƒ£ ƒ”‡ †”‡’–—Ž Žƒ — ‹˜‡Ž †‡ –”ƒ‹ ƒ†‡…˜ƒ– ’‡Ǧ
–”— •££–ƒ–‡ƒǡ „—£•–ƒ”‡ƒ ’”‘’”‹‡ è‹ ƒ ˆƒ‹Ž‹‡‹ •ƒŽ‡ǡ ‹…Ž—•‹˜ǡ Žƒ
ƒŽ‹‡–ƒì‹‡ǡ Á„”£…£‹–‡ǡ Ž‘…—‹ì£ǡ Á‰”‹Œ‹”‹ ‡†‹…ƒŽ‡ è‹ •‡”˜‹…‹‹
•‘…‹ƒŽ‡ ‡…‡•ƒ”‡̺ȏͳȐǤ”‡’–—Ž†‡ƒϐ‹Ž‹’•‹–†‡ˆ‘ƒ‡‡•–‡†”‡’-
–—Ž•–”‹…–Žƒ˜‹ƒì£è‹…‘•‹†‡”ƒ–‘‘”£ƒ„•‘Ž—–£ǣ‹˜‡Ž—Ž‹‹
–”‡„—‹‡•£ϐ‹‡‰ƒ”ƒ–ƒ––—–—”‘”ǡ‹†‹ˆ‡”‡–†‡‹˜‡Ž—Ž†‡†‡œ˜‘Ž-
–ƒ”‡ƒŽ죔‹‹Ǥ‡†‡ƒŽ–£’ƒ”–‡ǡ†”‡’–—ŽŽƒƒŽ‹‡–‡ƒ†‡…˜ƒ–‡‡•–‡
—…‘…‡’–…ƒ”‡ƒ…‘’‡”£‘†‹‡•‹—‡—Ž–ƒ‹ƒ”‡ǡ†‡‘ƒ”‡-
…‡‹’Ž‹…£‡š‹•–‡ìƒ——‹‡†‹—‡…‘‘‹…ǡ’‘Ž‹–‹…è‹•‘…‹ƒŽ…ƒ”‡
of the CIQUAL table of the nutritional composition, establi-
•Š‹‰–Š‡ˆ‘ŽŽ‘™‹‰ǣ–‘–ƒŽ’”‘–‡‹Ȃ͹ͷ‰ȋʹǤͷάͲǤͶ‰Ȁ‰Ȁ†ƒ›ƒ†
1.8±0.3 g/kg/day for adolescents including those of animal
‘”‹‰‹ȂʹͶ‰ǡ‡‡”‰›ʹͺͶʹ…ƒŽǡȂͻʹͳ‰ǡ‰Ȃʹͷͷ‰ǡƒ
ȂͶͻ͵‰Ȁ†ƒ›ǡ‹…Ž—†‹‰͸ͻ‰‘ˆ†ƒ‹”›’”‘†—…–•ƒ†˜‹–ƒ‹
D was 1.23 g. Ingredients from L1ǣͺͻ‰’”‘–‡‹ȋʹǤ͸άͲǤͳʹ‰Ȁ
kg/day for children and 2.3±0.4 g/kg/day for adolescents, in-
…Ž—†‹‰ƒ‹ƒŽ‘”‹‰‹ȂͶͺ‰ǡ‡‡”‰›Ȃ͵ͳ͸ʹ…ƒŽǡȂͳͲ͵Ͳ‰ǡ
‰Ȃʹ͹͵Ǥͺ‰ǡƒȂͻ͵Ͳ‰Ȁ†ƒ›ǡ‹…Ž—†‹‰ͷͷͲ‰‘ˆ†ƒ‹”›
products. Compared with those in L1 as well as according to
the WHO reference curves. Compared to age-adjusted L1, L0
participants had lower serum, Ca, Mg, Hb and creatinine va-
lues.
Conclusions. Lasting, poor nutrition has a negative impact
on the physical development of children and adolescents. Low
serum creatinine levels may advocate a poorly developed mus-
cle mass as a result of long-term irrational and unbalanced nu-
trition.
Key words: physical development, malnutrition, children,
institutionalized teenagers.
Introduction
Food law is a vital right for all human beings, and food,
along with food security, is essential to the survival of individu-
ƒŽ•ǤŠ‡‹˜‡”•ƒŽ‡…Žƒ”ƒ–‹‘‘ˆ—ƒ‹‰Š–•™ƒ•–Š‡ϐ‹”•–‹-
–‡”ƒ–‹‘ƒŽ‹•–”—‡––‘‘ˆϐ‹…‹ƒŽŽ›”‡…‘‰‹œ‡–Š‡”‹‰Š––‘ˆ‘‘†
as a human right, in the context of the right to a decent living
standard (Article 25). Thus, in this statement, art. 25.1 reite-
rates that Ƿ˜‡”›‘‡ Šƒ• –Š‡ ”‹‰Š– –‘ ƒ ƒ†‡“—ƒ–‡ •–ƒ†ƒ”† ‘ˆ
Ž‹˜‹‰ ˆ‘” Š‹• ‘” Š‡” ‘™ Š‡ƒŽ–Šǡ ™‡ŽŽǦ„‡‹‰ ƒ† ˆƒ‹Ž›ǡ ‹…Ž—†‹‰
ˆ‘‘†ǡ …Ž‘–Š‹‰ǡ Š‘—•‹‰ǡ …ƒ”‡ ƒ† •‘…‹ƒŽ •‡”˜‹…‡•dz [1]. hunger is
–Š‡•–”‹…–”‹‰Š––‘Ž‹ˆ‡ƒ†…‘•‹†‡”‡†ƒƒ„•‘Ž—–‡”—Ž‡ǣ–Š‡‹-
nimum level must be guaranteed to all, irrespective of the level
of development of the country. On the other hand, the right to
adequate food is a concept that covers a much larger dimensi-
on, the existence of an economic, political and social environ-
ment that allows everyone to guarantee the food security and
•‡ŽˆǦ•—ˆϐ‹…‹‡…›–Šƒ––Š‡Š—ƒ„‡‹‰‡‡†•ȏͳȐǤ
•£’‡”‹–£–—–—”‘”‰ƒ”ƒì‹ƒ•‡…—”‹–£ì‹‹ƒŽ‹‡–ƒ”‡è‹•ƒ–‹•ˆƒ…싃
’”‘’”‹‡†‡…ƒ”‡ƒ”‡‡˜‘‹‡ϐ‹‹ìƒ—ƒ£ȏͳȐǤ
În articolul 11 al ƒ…–—Ž—‹ ‹–‡”ƒì‹‘ƒŽ ’”‹˜‹† †”‡’–—”‹Ž‡
•‘…‹ƒŽ‡ è‹ …—Ž–—”ƒŽ‡ ‡…Š‹–ƒ„‹Ž‡ǡ‡•–‡’”‡˜£œ—–…ƒ•–ƒ–‡Ž‡ǡ…ƒ’£”ì‹
ƒ†‡”‡–‡ Žƒ ‡Žǡ •£ ”‡…—‘ƒ•…£ †”‡’–—Ž ˆ—†ƒ‡–ƒŽ ƒŽ ϐ‹‡…£”‡‹
’‡”•‘ƒ‡†‡ƒϐ‹Ž‹„‡”‡†‡ˆ‘ƒ‡ǡƒ†‘’–Ÿ†ǡ‹†‹˜‹†—ƒŽè‹Ȁ•ƒ—
’”‹ ‹–‡”‡†‹—Ž …‘‘’‡”£”‹‹ ‹–‡”ƒì‹‘ƒŽ‡ǡ £•—”‹ ‡…‡•ƒ”‡ǡ
‹…Ž—•‹˜ǡ’”‘‰”ƒ‡…‘…”‡–‡’‡–”—ƒˆƒ…‡ˆƒì£’”‘„Ž‡‡Ž‘”ǤB
‘•–‹–—싃 ‡’—„Ž‹…‹‹ ‘Ž†‘˜ƒǡ …‹–ƒ–£ †‡ …£–”‡ ƒ‹ —Ž–‡ ‘”-
Article 11 of the –‡”ƒ–‹‘ƒŽ ‘˜‡ƒ– ‘ “—‹–ƒ„Ž‡ ‘…‹ƒŽ
ƒ† —Ž–—”ƒŽ ‹‰Š–• states that States as adhering to it should
recognize the fundamental right of everyone to be free from
hunger by adopting, individually and / or through internatio-
nal cooperation, measures necessary, including, concrete pro-
grams to deal with the problems. The Constitution of the Re-
public of Moldova, quoted by several international reference
organizations in human rights, explicitly mentions the right to
ˆ‘‘† ‹ –Š‡ …‘–‡š– ‘ˆ ƒ ‘”‡ ‰‡‡”ƒŽ Š—ƒ ”‹‰Š–ǣ –Š‡ ”‹‰Š–
24
‰ƒ‹œƒì‹‹ ‹–‡”ƒì‹‘ƒŽ‡ †‡ ”‡ˆ‡”‹ì£ Á †”‡’–—Ž ‘—Ž—‹ǡ ‡•–‡
‡ì‹‘ƒ–ǡÁ‘†‡š’Ž‹…‹–ǡ†”‡’–—ŽŽƒŠ”ƒ£ǡÁ…‘–‡š–—Ž——‹
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‡–‡Ž‡ϐ‹‹†——Ž†‹–”‡ˆƒ…–‘”‹‹†‡–‡”‹ƒì‹ȏʹȐǤŽ‹‡–ƒì‹ƒ
’”‡˜‡†‡†”‡’–—Žϐ‹‡…£”—‹„£”„ƒ–ǡˆ‡‡‹‡è‹…‘’‹ŽŽƒƒŽ‹‡–‡†‡
„—£…ƒŽ‹–ƒ–‡ǡ…ƒ”‡‹…Ž—†‡—”£–‘ƒ”‡Ž‡Ͷƒ•’‡…–‡‹’‘”–ƒ–‡ǣ
ȋͳȌ †‹•’‘‹„‹Ž‹–ƒ–‡ Ȃ ƒŽ‹‡–‡Ž‡ –”‡„—‹‡ •£ ϐ‹‡ Á …ƒ–‹–£ì‹ •—-
ϐ‹…‹‡–‡ ’‡–”— Á–”‡ƒ‰ƒ ’‘’—Žƒì‹‡Ǣ ȋʹȌ ƒ……‡•‹„‹Ž‹–ƒ–‡ Ȃ ϐ‹‡…ƒ”‡
’‡”•‘ƒ£ –”‡„—‹‡ •£ ϐ‹‡ …ƒ’ƒ„‹Ž£ •£ ‘„싐£ ƒŽ‹‡–‡ǡ ϐ‹‡ ’”‹
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•–ƒ„‹Ž‹–ƒ–‡è‹†—”ƒ„‹Ž‹–ƒ–‡ȂƒŽ‹‡–‡Ž‡–”‡„—‹‡•£ϐ‹‡†‹•’‘‹„‹Ž‡
苃……‡•‹„‹Ž‡Á–‘ƒ–‡…‹”…—•–ƒì‡Ž‡ȋ”£œ„‘‹ǡ…ƒŽƒ‹–£ì‹ƒ–—”ƒ-
Ž‡ǤǤǤȌǢȋͶȌ•‹‰—”ƒì£Ȃ•£ϐ‹‡…‘•—ƒ„‹Ž‡è‹‹‰‹‡‹…‡ȏͳǡʹȐǤ
•–ˆ‡Žǡ …‘’‹‹‹ †‡ –‘ƒ–‡ ˜Ÿ”•–‡Ž‡ è‹ ƒ†‘Ž‡•…‡ì‹‹ –”‡„—‹‡ǡ ‡-
ƒ’£”ƒ–ǡ •£ †‹•’—£ †‡ ‘ †‹‡–£ ‡…Š‹Ž‹„”ƒ–£ è‹ ”ƒì‹‘ƒŽ£ǡ ƒ…‡ƒ•–ƒ
…‘•–‹–—‹† — †”‡’– ˜‹–ƒŽ ’‡–”— †‡œ˜‘Ž–ƒ”‡ƒ ƒ”‘‹‘ƒ•£ ƒ
‰‡‡”ƒì‹‡‹ Á …”‡è–‡”‡Ǥ ”‹ —”ƒ”‡ǡ ƒŽ‹‡–‡Ž‡ –”‡„—‹‡ •£ ϐ‹‡
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•ƒ–‹•ˆ£…£–‘ƒ”‡ƒ†‡œ˜‘Ž–£”‹‹ϐ‹œ‹…‡è‹‹–‡Ž‡…–—ƒŽ‡Ǥ†‹‡–£‡…Š‹-
Ž‹„”ƒ–£ è‹ ”ƒì‹‘ƒŽ£ ‹’Ž‹…£ ‡…Š‹Ž‹„”ƒ”‡ƒ ’”‘’‘”ì‹‹Ž‘” ‡…‡•ƒ”‡
†‡—–”‹‡–‹ǡ…ƒ”„‘Š‹†”ƒ–‹ǡ’”‘–‡‹‡ǡ‰”£•‹‹ǡ‹‡”ƒŽ‡ǡ˜‹–ƒ‹-
‡ǡϐ‹„”‡è‹ƒ’£Ǥ‘ƒ”Áƒèƒ‘†’—–‡‡˜‹–ƒƒŽ—–”‹ì‹ƒȀ•—„-
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†‡‡š…‡•—ŽŽ‘”ǤB죔‹Ž‡ÁƒŽ–‹†—•–”‹ƒŽ‹œƒ–‡ǡ’‡’ƒ”…—”•—Žƒœ‡…‹
è‹ œ‡…‹ †‡ ƒ‹ǡ •‡…—”‹–ƒ–‡ƒ ƒŽ‹‡–ƒ”£ ƒ ˆ‘•– Á ’‡”ƒ‡ì£ Á
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†—•‡Ž‘” ƒŽ‹‡–ƒ”‡Ǥ ‘–—è‹ǡ ’‡–”— ƒ…‡•–‡ 죔‹ǡ Š”ƒƒ Á ‡š…‡•
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•££–£ì‹‹…‘’‹‹Ž‘”ǡƒ†‘Ž‡•…‡ì‹Ž‘”è‹ǡƒ‹ƒŽ‡•ǡƒŽƒ†—Žì‹Ž‘”Ǥ…‡•–‡
excese pot duce, în special, la probleme de obezitate, diabet,
„‘Ž‹…ƒ”†‹‘˜ƒ•…—Žƒ”‡è‹ƒŽ–‡ƒˆ‡…ì‹—‹Ǥ‘–”ƒ”ƒ…‡•–‡‹ƒǡÁ죔‹Ž‡
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ƒ‹Ž‹‹Ž‡ Ž‘” — †‹•’— †‡ ”‡•—”•‡ •—ϐ‹…‹‡–‡ ’‡–”— ƒ •‡ ƒŽ‹-
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ϐ‹…‹ƒœ£ †‡ •—„•–ƒì‡Ž‡ —–”‹–‹˜‡ ‡•‡ì‹ƒŽ‡ ’‡–”— †‡œ˜‘Ž–ƒ”‡ƒ
Ž‘”è‹•—–ǡƒ•–ˆ‡Žǡ‡š’—è‹—‘”’”‘„Ž‡‡‰”ƒ˜‡†‡•££–ƒ–‡ǤB
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‡’—„Ž‹…ƒ‘Ž†‘˜ƒǡ…‡ƒƒ‹…‘—£•–ƒ”‡†‡ƒŽ—–”‹ì‹‡‡•–‡
†‡ϐ‹…‹–—Ž†‡—–”‹‡ì‹•ƒ—•—„—–”‹ì‹ƒǤ’”‘ƒ’‡‘–”‡‹‡†‹–”‡
…‘’‹‹‹•—„˜Ÿ”•–ƒ†‡ͷƒ‹ƒ—”‡–ƒ”†Á†‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ȋ–ƒŽ‹‡
苉”‡—–ƒ–‡‹…£Á”ƒ’‘”–…—˜Ÿ”•–ƒȌǡ—‹–£†‡…£–”‡ƒ‰Ž‘ˆ‘‹
•–—–‡† ‰”‘™–Š ȏͳȐǤ’‡…‹ƒŽ‹è–‹‹Á†‡œ˜‘Ž–ƒ”‡ƒ…‘’‹Ž—Ž—‹ƒ—‡•–‹-
ƒ–…£ƒ’”‘š‹ƒ–‹˜ʹͲͲ†‡‹Ž‹‘ƒ‡†‡…‘’‹‹†‡’‡‰Ž‘„•—ˆ‡”£
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solute [1, 2].
Bƒ…‡ƒ•–£‘”†‹‡†‡‹†‡‹ǡ•…‘’—Ž acestui studiu a constat în
ƒ’”‡…‹‡”‡ƒ‹˜‡Ž—Ž—‹†‡œ˜‘Ž–£”‹‹ϐ‹œ‹…‡ƒ…‘’‹‹Ž‘”苃†‘Ž‡•…‡ì‹Ž‘”
‹•–‹–—ì‹‘ƒŽ‹œƒì‹˜‡”•—•…‡Ž‘”’”‘˜‡‹ì‹†‹ˆƒ‹Ž‹‹…‘’Ž‡–‡ǡÁ
”ƒ’‘”–…—•–ƒ”‡ƒŽ‘”†‡—–”‹ì‹‡ǡ’”‡…—è‹‹’ƒ…–—Ž’”‘†—•†‡
Ž‡‰‹•Žƒì‹ƒ‹–‡”ƒì‹‘ƒŽ£†‡•‡…—”‹–ƒ–‡ƒŽ‹‡–ƒ”£Ǥ
ƒ–‡”‹ƒŽç‹‡–‘†‡
–—†‹—Ž ƒ ‹…Ž—• ʹ …‘Š‘”–‡ †‡ ʹͻ͹ †‡ •—„‹‡…ì‹ǡ Á’£”ì‹ì‹ Á
2 loturi. Lotul de studiu (L0), provenit din Gimnaziul Internat
†‹”Š‡‹ǡƒ‹…Ž—•ʹʹ͸†‡…‘’‹‹è‹ƒ†‘Ž‡•…‡ì‹ƒ’ƒ”‡–•££–‘è‹
Ȃͻ͹ȋͶ͵ΨȌ†‡ˆ‡–‡è‹ͳʹͻȋͷ͹ΨȌ†‡„£‹‡ì‹Ȃ…ƒ”‡‡”ƒ—ƒŽ‹‡-
–ƒì‹Á’‡”ƒ‡ì£Á‹…‹–ƒ‰‹ƒœ‹—Ž—‹ǤŸ”•–ƒˆ‡–‡Ž‘”ȋ‡†‹‡
‡œ˜‘Ž–ƒ”‡ƒ ϔ‹œ‹…£ǡ ˆƒ…–‘”—Ž ƒŽ‹‡–ƒ” ç‹ …ƒ†”—Ž ‘”ƒ–‹˜
to an adequate standard of living; food being one of the deter-
mining factors [2]. Food provides for the right of every male,
female and child to good quality food, which includes the fol-
Ž‘™‹‰Ͷ‹’‘”–ƒ–ƒ•’‡…–•ǣȋͳȌƒ˜ƒ‹Žƒ„‹Ž‹–›Ȃˆ‘‘†—•–„‡‹
•—ˆϐ‹…‹‡–“—ƒ–‹–‹‡•ˆ‘”–Š‡‡–‹”‡’‘’—Žƒ–‹‘ǢȋʹȌƒ……‡••‹„‹Ž‹–›
Ȃ‡˜‡”›’‡”•‘—•–„‡ƒ„Ž‡–‘‘„–ƒ‹ˆ‘‘†‡‹–Š‡”„›’”‘†—…‹‰
‹–‘”„›’—”…Šƒ•‹‰•—ˆϐ‹…‹‡–’‘™‡”Ǣȋ͵Ȍ•–ƒ„‹Ž‹–›ƒ†•—•–ƒ‹ƒ-
„‹Ž‹–›Ȃˆ‘‘†—•–„‡ƒ˜ƒ‹Žƒ„Ž‡ƒ†ƒ……‡••‹„Ž‡‹ƒŽŽ…‹”…—•–ƒ-
…‡•ȋ™ƒ”ǡƒ–—”ƒŽ†‹•ƒ•–‡”•ǤǤǤȌǢȋͶȌ•ƒˆ‡–›Ȃ„‡…‘•—ƒ„Ž‡ƒ†
hygienic [1, 2].
Thus, children of all ages and adolescents must necessarily
have a balanced and rational diet, which is a vital right for the
harmonious development of the growing generation. There-
fore, food must be nutritionally appropriate for satisfactory
physical and intellectual development. A balanced and rational
diet involves balancing the necessary proportions of nutrients,
…ƒ”„‘Š›†”ƒ–‡•ǡ’”‘–‡‹•ǡˆƒ–•ǡ‹‡”ƒŽ•ǡ˜‹–ƒ‹•ǡϐ‹„‡”ƒ†™ƒ-
ter. Only in this way can we avoid malnutrition / subutrition
and problems of food shortages or, conversely, of their excess.
In high-industrialized countries, for decades and decades, food
security has always been the focus of state authorities. Their
populations have never had problems with the availability and
ƒ……‡••‹„‹Ž‹–›‘ˆˆ‘‘†Ǥ‘™‡˜‡”ǡˆ‘”–Š‡•‡…‘—–”‹‡•ǡ‘˜‡”ϐ‹•Š‹‰
is becoming more and more common and poses a threat to the
health of children, adolescents and, above all, adults. These ex-
cesses may in particular lead to problems of obesity, diabetes,
cardiovascular disease and other conditions. Contrary to this,
many children are undernourished in developing countries.
Their families do not have enough resources to feed and / or
†‹˜‡”•‹ˆ› –Š‡‹” ‡ƒŽ•Ǥ ‘•‡“—‡–Ž›ǡ …Š‹Ž†”‡ †‘ ‘– „‡‡ϐ‹–
from the essential nutrients for their development and are thus
exposed to serious health problems. In developing and transi-
tion countries, as is the Republic of Moldova, the most common
ƒŽ—–”‹–‹‘‹•—–”‹–‹‘ƒŽ†‡ϐ‹…‹‡…›‘”—†‡”—–”‹–‹‘Ǥ‡ƒ”-
ly one-third of children under the age of 5 have a slowing-down
in physical development (waist and low weight in relation to
age), called by anglophones stunted growth [1]. Child develop-
ment specialists have estimated that around 200 million chil-
dren globally suffer from retardation in physical development
and live below absolute poverty [1, 2].
In this context, the purpose of this study was to assess the
level of physical development of institutionalized children and
adolescents versus those of complete families in relation to
their nutritional status as well as the impact of international
food safety legislation.
Material and methods
The study included 2 cohorts of 297 subjects, divided into
2 batches. The study group (L0), coming from the Orhei Gym-
nasium, included 226 apparently healthy children and ado-
Ž‡•…‡–• Ȃ ͻ͹ ȋͶ͵ΨȌ ‰‹”Ž• ƒ† ͳʹͻ ȋͷ͹ΨȌ „‘›• Ȃ ™Š‘ ™‡”‡
permanently fed into the gymnasium. The age of girls (mean
± standard deviation) was 11.5±0.7 years, the extremes being
7.7 to 17.3 years. The age of the boys was 11.4±0.1 years, with
extremes between 7.9 and 15.1 years.
Š›•‹cƒŽ †‡˜‡Ž‘’‡n–ǡ ˆ‘‘† ˆƒc–‘” ƒn† ”‡‰—Žƒ–‘”› ˆ”ƒ‡™‘”
ά†‡˜‹‡”‡•–ƒ†ƒ”†Ȍƒˆ‘•–†‡ͳͳǡͷάͲǡ͹ƒ‹ǡ‡š–”‡‡Ž‡ϐ‹‹††‡
͹ǡ͹Ȃͳ͹ǡ͵ƒ‹ǤŸ”•–ƒ„£‹‡ì‹Ž‘”ƒˆ‘•–†‡ͳͳǡͶάͲǡͳƒ‹ǡ…—‡š–”‡‡
Á–”‡͹ǡͻè‹ͳͷǡͳƒ‹Ǥ
Lotul martor (L1Ȍƒ…—’”‹•͹ͳ†‡…‘’‹‹ǣ͵͵ȋͶ͹ΨȌ†‡ˆ‡–‡è‹
͵ͺ ȋͷ͵ΨȌ †‡ „£‹‡ì‹ǡ •’‹–ƒŽ‹œƒì‹ Á ’‹–ƒŽ—Ž Ž‹‹… —‹…‹’ƒŽ †‡
‘’‹‹”Ǥͳȋ”ǤͳȌ†‹Š‹è‹£—…—„‘Ž‹”‡•’‹”ƒ–‘”‹‹ƒ…—–‡ǡ
…ƒ”‡’”‘˜‡‡ƒ—†‹ˆƒ‹Ž‹‹…‘’Ž‡–‡è‹…‘•‹†‡”ƒì‹•‘ƒ–‹…•£-
£–‘è‹ǤŸ”•–ƒˆ‡–‡Ž‘”ƒˆ‘•–†‡ͻǡʹάͲǡͶƒ‹ǡ‡š–”‡‡Ž‡ϐ‹‹††‡
ʹǡͷǦͳͷǡͲƒ‹ǤŸ”•–ƒ„£‹‡ì‹Ž‘”ƒˆ‘•–†‡ͺǡͻάͲǡ͵ƒ‹ǡ…—‡š–”‡‡
Á–”‡͵ǡ͵è‹ͳͶǡͳƒ‹Ǥ
Testele biochimice de laborator au fost realizate în SCMC
”Ǥͳ苃—‹…Ž—•…ƒŽ…‹—Ž•‡”‹…ǡˆ‘•ˆƒì‹‹ǡƒ‰‡œ‹—Žǡ’”‘–‡‹ƒǡ…”‡-
ƒ–‹‹ƒǡŠ‡‘‰Ž‘„‹ƒǡ‰Ž—…‘œƒǡˆ‘•ˆƒ–ƒœƒƒŽ…ƒŽ‹£è‹ƒ…–‹˜‹–ƒ–‡ƒ
–”ƒ•ƒ‹ƒœ‡Ž‘”  è‹ Ǥ ‹˜‡Ž—Ž •‡”‹… †‡ ʹͷȋȌ ƒ ˆ‘•–
determinat în probele de ser conservate la temperatura de
ǦʹͲιŽƒ’‹–ƒŽ—Žƒ‹–‹…‡–†‡ƒ—Žȋƒ”‹•ǡ ”ƒìƒȌǡ—–‹Ž‹œŸ†
–‡•–‡Ž‡…”‘ƒ–‘‰”ƒϐ‹…‡†‡Ž‡‰ƒ”‡…‘’‡–‹–‹˜£ƒ’”‘–‡‹‡Ž‘”ǡ…—
‡˜ƒŽ—ƒ”‡ƒ…‘–‹—£‡š–‡”£ƒ…ƒŽ‹–£ì‹‹ƒ–‡•–‡Ž‘”’‡–”—
ʹͷȋȌ ȏ͵ͲȐǤ ”‘„‡Ž‡ ƒ— ˆ‘•– ƒƒŽ‹œƒ–‡ Á’”‡—£ …— ʹͲ †‡
…‘–”‘ƒŽ‡ȋ‹–‡”˜ƒŽǣͻǦ͹ͻ‘ŽȀŽȌǤƒŽ‘”‹Ž‡ȋ‡†‹ƒά†‡-
˜‹‡”‡ƒ•–ƒ†ƒ”†Ȍƒ—ˆ‘•–†‡ͲǡͳͳάͲǡ͹ʹ—‹–£ì‹†‹–‘ƒ–‡‡†‹‹Ž‡
†‡Žƒ„‘”ƒ–‘”’‡–”—ϐ‹‡…ƒ”‡…‘–”‘ŽǤ
ƒ”ƒ–Š‘”‘—Žè‹ƒ”‡”‹‹‘•‘苐—ƒ—ˆ‘•–†‡–‡”‹ƒì‹ǡ†‡-
‘ƒ”‡…‡–‡•–‡Ž‡—ƒ—ˆ‘•–†‹•’‘‹„‹Ž‡’‡’ŽƒŽ‘…ƒŽè‹—ƒˆ‘•–
’‘•‹„‹Ž•£•‡•–ƒ„‹Ž‡ƒ•…£†ƒ…£’”‘„‡Ž‡†‡•‡”ƒ—ˆ‘•–’£•–”ƒ–‡Á
…‘†‹ì‹‹‘’–‹‡Á–‹’—Ž…‘•‡”˜£”‹‹è‹–”ƒ•’‘”–£”‹‹Á ”ƒìƒǤ
Variabilele distribuite în mod normal sunt raportate drept me-
die ± deviere standard. Testul t-Student a fost folosit pentru a
compara variabilele continui, distribuite în mod normal, pe pe-
”‡…Š‹Ǥ‹ˆ‡”‡ì‡Ž‡•‡‹ϐ‹…ƒ–‹˜‡Á–”‡‰”—’—”‹Ž‡ƒ‹‹…‹†‡͵Ͳ
†‡•—„‹‡…싃—ˆ‘•–˜‡”‹ϐ‹…ƒ–‡’”‹ƒ’Ž‹…ƒ”‡ƒ–‡•–—Ž—‹‘Ǧ’ƒ”ƒ-
‡–”‹…ƒǦŠ‹–‡›Ǥ‘’ƒ”ƒ”‡ƒ’”‡˜ƒŽ‡ì‡‹Á–”‡‰”—’—”‹
ƒˆ‘•–‡ˆ‡…–—ƒ–£…—ƒŒ—–‘”—Ž–‡•–—Ž—‹Š‹Ǧ’£–”ƒ–Ǥ‘ƒ–‡ƒƒŽ‹œ‡Ž‡
au fost efectuate cu ajutorul programului Statview 5.0 („ƒc—•
‘nc‡’–• Inc., Berkeley, CA, SUA). Valoarea ’<0,05 a fost consi-
†‡”ƒ–£•–ƒ–‹•–‹…•‡‹ϐ‹…ƒ–‹˜£Ǥ
‡œ—Ž–ƒ–‡
Copiii din Gimnaziul Internat (L0Ȍǡ‡”ƒ—ƒŽ‹‡–ƒì‹…‘ˆ‘”
——‹ ‡‹— •’‡…‹ƒŽǡ ‹…Ž—•‹˜ǡ Á œ‹Ž‡Ž‡ †‡ ‘†‹Š£Ǥ ƒì‹‘—Ž Ž‘”
MJHS 17(3)/2018 25
The control group (L1Ȍ…‘’”‹•‡†͹ͳ…Š‹Ž†”‡ǣ͵͵ȋͶ͹ΨȌ‰‹”-
ls and 38 (53%) boys, hospitalized in the Municipal Children’s
Clinic Hospital no. 1 (MCCH no. 1) from Chisinau with acute
respiratory diseases, coming from complete families and con-
sidered healthy somatic. The girls’ age was 9.2±0.4 years, the
extremes being 2.5 to 15.0 years. Boys’ age was 8.9±0.3 years,
with extremes between 3.3 and 14.1 years.
Laboratory biochemical tests were performed in MCCH
no. 1 and included serum calcium, phosphates, magnesium,
protein, creatinine, hemoglobin, glucose, alkaline phosphata-
se, and the activity of ALT and AST transaminases. The serum
level of 25(OH)D was determined in serum samples preserved
at -20°C at Saint Vincent de Paul Hospital (Paris, France) using
competitive protein binding assays with continuous external
quality assessment DEQAS tests for 25(OH)D [30]. The sam-
’Ž‡•™‡”‡ƒƒŽ›œ‡†ƒŽ‘‰™‹–ŠʹͲ…‘–”‘Ž•ȋ”ƒ‰‡ǣͻǦ͹ͻ
nmol/l). Values (mean ± standard deviation) were 0.11±0.72
units of all laboratory media for each control.
Parathyroid hormone and bone markers were not determi-
ned because the tests were not available locally and it was not
possible to determine whether the serum samples were kept in
optimal conditions during preservation and transport in Fran-
ce. The normally distributed variables are reported as mean ±
standard deviations. The t-Student test was used to compare
…‘–‹——˜ƒ”‹ƒ„Ž‡•ǡ‘”ƒŽŽ›†‹•–”‹„—–‡†‹’ƒ‹”•Ǥ‹‰‹ϐ‹…ƒ–
differences between groups of less than 30 subjects were ve-
”‹ϐ‹‡† „› ƒ’’Ž›‹‰ –Š‡ ‘Ǧ’ƒ”ƒ‡–”‹…  ƒǦŠ‹–‡› –‡•–Ǥ
Comparison of prevalence among groups was performed using
the Chi-square test. All analyzes were performed with the Stat-
view 5.0 program (Abacus Concepts Inc., Berkeley, CA, USA).
The ’δͲǤͲͷ˜ƒŽ—‡™ƒ•…‘•‹†‡”‡†•–ƒ–‹•–‹…ƒŽŽ›•‹‰‹ϐ‹…ƒ–Ǥ
Results
Children in Gymnasium Intern (L0) were fed a special
menu, including on rest days. Their food ration was based on
cereals and low consumption of meat, milk and dairy products.
Food intake was evaluated based on the CIQUAL table of the
—–”‹–‹‘ƒŽ …‘’‘•‹–‹‘ ‘ˆ ˆ‘‘†• ȋŠ––’ǣȀȀ™™™Ǥƒˆ••ƒǤˆ”Ȁƒ„Ž‡-
ƒŽ‹‡–ƒ”‡”ƒ„ƒœƒ–’‡…‡”‡ƒŽ‡è‹’‡—…‘•—”‡†—•†‡…ƒ”- ȌǤ ƒ‹Ž› ƒ˜‡”ƒ‰‡ ‹–ƒ‡ ™ƒ• ƒ• ˆ‘ŽŽ‘™•ǣ –‘–ƒŽ ’”‘–‡‹ Ȃ
‡ǡŽƒ’–‡è‹’”‘†—•‡Žƒ…–ƒ–‡Ǥ’‘”–—ŽƒŽ‹‡–ƒ”ƒˆ‘•–‡˜ƒŽ—ƒ–Á 75 g (2.5±0.4 g/kg/day and 1.8±0.3 g/kg/day for adolescents,
„ƒœƒ –ƒ„‡Ž—Ž—‹  ƒŽ …‘’‘œ‹ì‹‡‹ —–”‹–‹˜‡ ƒ ƒŽ‹‡–‡Ž‘”
(Š––’:ȀȀ™™™Ǥƒˆ••ƒǤˆ”Ȁƒ„Ž‡I). Aportul mediu zilnic a fost
—”£–‘”—Žǣ’”‘–‡‹‡–‘–ƒŽ‡Ȃ͹ͷ‰ȋʹǡͷάͲǡͶ‰Ȁ‰Ȁœ‹è‹ͳǡͺάͲǡ͵‰Ȁ
‰Ȁœ‹’‡–”—ƒ†‘Ž‡•…‡ì‹ǡ‹…Ž—•‹˜ǡ’”‘–‡‹‡†‡‘”‹‰‹‡ƒ‹ƒŽ‹-
‡”£ȂʹͶ‰Ǣ‡‡”‰‹‡ʹͺͶʹ…ƒŽǢȂͻʹͳ‰Ǣ‰Ȃʹͷͷ‰Ǥ’‘”–—Ž
œ‹Ž‹…†‡ƒƒˆ‘•–‹…ȋͶͻ͵‰ǡ‹…Ž—•‹˜ǡ͸ͻ‰Ȃ’”‹Žƒ’–‡è‹
produse lactate, iar cel al vit. D a fost de 1,23 g. Aportul zilnic
la copiii din lotul martor (L1Ȍƒˆ‘•–…ƒŽ…—Žƒ–†‡…£–”‡†‹‡–‹…‹ƒ—Ž
‹•–‹–—싇‹ǡ…‘•–‹–—‹†’”‘–‡‹‡–‘–ƒŽ‡Ȃͺͻ‰ȋʹǡ͸άͲǡͳʹ‰Ȁ‰Ȁ
œ‹’‡–”—…‘’‹‹è‹ʹǡ͵άͲǡͶ‰Ȁ‰Ȁœ‹’‡–”—ƒ†‘Ž‡•…‡ì‹ǡ‹…Ž—•‹˜ǡ
’”‘–‡‹‡†‡‘”‹‰‹‡ƒ‹ƒŽ‹‡”£ȂͶͺ‰ǡ‡‡”‰‹‡Ȃ͵ͳ͸ʹ…ƒŽǡ
ȂͳͲ͵Ͳ‰ǡ‰Ȃʹ͹͵ǡͺ‰Ǥ’‘”–—Žœ‹Ž‹…†‡ƒƒˆ‘•–†‡ͻ͵Ͳ
‰ǡ‹…Ž—•‹˜ǡͷͷͲ‰Ȃ†‹Žƒ’–‡è‹’”‘†—•‡Žƒ…–ƒ–‡Ǥ‡‹ʹʹ͸†‡
copii din L0è‹͹ͳ†‡…‘’‹‹†‹1 aveau parametri antropome-
–”‹…‹…‘’ƒ”ƒ„‹Ž‹Žƒƒè–‡”‡è‹Áƒ‹–‡†‡’—„‡”–ƒ–‡ȋƒ„‡Ž—ŽͳȌǤ
‘–—è‹ǡƒ†‘Ž‡•…‡ì‹‹†‡ƒ„‡Ž‡•‡š‡†‹Ž‘–—Ž†‡•–—†‹—ƒ˜‡ƒ—‘
including 24 g animal protein. The daily intake of Ca was small
ȋͶͻ͵ ‰ǡ ‹…Ž—†‹‰ ͸ͻ ‰ Ȃ ‹ ‹Ž ƒ† †ƒ‹”› ’”‘†—…–•ǡ ƒ†
vitamin D was 1.23 g). The daily intake in children in the con-
trol group (L1) was calculated by the dietitian of the institution,
…‘•–‹–—–‹‰ –‘–ƒŽ ’”‘–‡‹ Ȃ ͺͻ ‰ ȋʹǤ͸άͲǤͳʹ ‰Ȁ‰Ȁ†ƒ› ˆ‘” …Š‹Ž-
dren and 2.3±0.4 g/kg/day for adolescents, including animal
’”‘–‡‹ȂͶͺ‰ǡ‡‡”‰›Ȃ͵ͳ͸ʹ…ƒŽǡȂͳͲ͵‰ǡ‰Ȃʹ͹͵Ǥͺ‰Ǥ
ƒ‹Ž›‹–ƒ‡‘ˆƒ™ƒ•ͻ͵Ͳ‰ǡ‹…Ž—†‹‰ͷͷͲ‰Ȃ‘ˆ‹Žƒ†
dairy products.The 226 children in L0 and 71 children in L1 had
comparable anthropometric parameters at birth and before
puberty (Table 1), however, the teenagers of both sexes in the
study group had a lower height compared to the control group
as well as WHO growth curves. Compared to the age-adjusted
control group, participants in the study group had lower serum
calcium, magnesium and hemoglobin levels. Lower blood se-
26 ‡œ˜‘Ž–ƒ”‡ƒ ϔ‹œ‹c£ǡ ˆƒc–‘”—Ž ƒŽ‹‡n–ƒ” ç‹ cƒ†”—Ž n‘”ƒ–‹˜

Á£Žì‹‡ƒ‹‹…£ǡ…‘’ƒ”ƒ–‹˜…—…‡‹†‹Ž‘–—Žƒ”–‘”ǡ’”‡…—
è‹ …‘ˆ‘” …—”„‡Ž‘” †‡ …”‡è–‡”‡ Ǥ B …‘’ƒ”ƒì‹‡ …— Ž‘–—Ž
ƒ”–‘”ǡ ƒŒ—•–ƒ– †—’£ ˜Ÿ”•–£ǡ ’ƒ”–‹…‹’ƒì‹‹ †‹ Ž‘–—Ž †‡ •–—†‹—
ƒ˜‡ƒ—˜ƒŽ‘”‹•‡”‹…‡ƒ‹Œ‘ƒ•‡ƒŽ‡…ƒŽ…‹—Ž—‹ǡƒ‰‡œ‹—Ž—‹è‹Š‡-
moglobinei. La copiii din lotul de studiu s-au înregistrat valori
ƒ‹Œ‘ƒ•‡ƒŽ‡…”‡ƒ–‹‹‡‹•‡”‹…‡Áƒ‹–‡†‡’—„‡”–ƒ–‡è‹‘ƒ…–‹-
˜‹–ƒ–‡ƒ‹ÁƒŽ–£ƒˆ‘•ˆƒ–ƒœ‡‹ƒŽ…ƒŽ‹‡Á’‡”‹‘ƒ†ƒ†‡’—„‡”–ƒ–‡ǡ
comparativ cu lotul martor (Tabelul 2).
‘’‹‹‹†‹ƒ„‡Ž‡Ž‘–—”‹ƒ˜‡ƒ—‘•££–ƒ–‡†‡–ƒ”£’”‡…ƒ”£
è‹‘’”‡˜ƒŽ‡ì£…”‡•…—–£ƒ•‹’–‘‡Ž‘”‰ƒ•–”‘‹–‡•–‹ƒŽ‡ǡ’”‡-
’‘†‡”‡–—Ž–‹’Ž‡Ǥ‹’–‘‡‹œ‘Žƒ–‡†‡‰”‡ƒì£ƒ—’”‡œ‡–ƒ–
ͳ͹Ψ†‹–”‡…‘’‹‹ǡ†—”‡”‹ƒ„†‘‹ƒŽ‡‹œ‘Žƒ–‡ȂʹͲΨǤ
Bƒ„‡Ž‡Ž‘–—”‹•ǦƒÁ”‡‰‹•–”ƒ–‘’”‡˜ƒŽ‡ì£Œ‘ƒ•£ƒ•…‘Ž‹‘-
œ‡‹è‹ƒ†—”‡”‹Ž‘”†‡‘ƒ•‡ȋ<ͳͲΨȌǡÁ•£‰‡n— ˜ƒ”—Ȁ‰‡n— ˜ƒŽǦ
‰— ƒ— ˆ‘•– Á”‡‰‹•–”ƒ–‡ …— ‘ ˆ”‡…˜‡ì£ ƒ‹ ÁƒŽ–£ Á Ž‘–—Ž †‡
•–—†‹—ȋͳͷΨȌǡ…‘’ƒ”ƒ–‹˜…—Ž‘–—Žƒ”–‘”ȋ͹ΨȌǡÁ•£†‹ˆ‡”‡ìƒ
”‡•’‡…–‹˜£—‡•–‡•–ƒ–‹•–‹…•‡‹ϐ‹…ƒ–‹˜£Ǥ
‹•…—ì‹‹
”‹œƒ ‡…‘‘‹…£ ’‡ …ƒ”‡ •‘…‹‡–ƒ–‡ƒ ‘ƒ•–”£ ‘ –”ƒ˜‡”•‡ƒœ£
†‡ƒ‹—Žì‹ƒ‹ƒ•…£œ—–…‘•‹†‡”ƒ„‹Ž‹˜‡Ž—Ž†‡˜‹ƒì£ƒŽ’‘’—-
Žƒì‹‡‹ǡ…‡‡ƒ…‡‹ϐŽ—‹‡ì‡ƒœ£‡‰ƒ–‹˜ƒ–Ÿ–…Ž‹ƒ–—Ž’•‹Š‘Ž‘‰‹…†‹
ˆƒ‹Ž‹‡ǡ…Ÿ–苏‘†—Ž†‡ƒŽ‹‡–ƒì‹‡ƒ‡„”‹Ž‘”‡‹ǤB…‘•‡-
rum creatinine values were recorded in the study group before
puberty and higher alkaline phosphatase activity in the puber-
tal period compared to the control group (Table 2).
The children in both groups had poor dental health and
increased prevalence of predominantly gastrointestinal symp-
toms. Symptoms isolated from nausea showed 17% of chil-
†”‡ǡ‹•‘Žƒ–‡†ƒ„†‘‹ƒŽ’ƒ‹ȂʹͲΨǤ
In both groups there was a low prevalence of scoliosis and
bone pain (<10%), but the varum / genu valgum gene was re-
corded at a higher frequency in the study group (15%), compa-
red to the control group (7%), but the difference is not statis-
–‹…ƒŽŽ›•‹‰‹ϐ‹…ƒ–Ǥ
Discussion
The economic crisis that our society has been going thro-
ugh for many years has considerably reduced the standard of
Ž‹˜‹‰‘ˆ–Š‡’‘’—Žƒ–‹‘ǡ™Š‹…Š‡‰ƒ–‹˜‡Ž›‹ϐŽ—‡…‡•„‘–Š–Š‡
psychological climate of the family and the way of feeding its
‡„‡”•Ǥ • ƒ ”‡•—Ž–ǡ ‡˜‡”›‘‡ǯ• Š‡ƒŽ–Š •—ˆˆ‡”•ǡ „—–ǡ ϐ‹”•– ‘ˆ
all, pregnant women and institutionalized children of all ages.
Based on the results of the study, we want to challenge all de-
cision-makers that the violation of the ƒ™ ‘n –Š‡ ‹‰Š–• ‘ˆ –Š‡

Tabelul 1.ƒ”ƒ…–‡”‹•–‹…‹Ž‡…Ž‹‹…‡…‘’ƒ”ƒ–‹˜‡ƒŽ‡…‘’‹‹Ž‘”‹•–‹–—ì‹‘ƒŽ‹œƒì‹ȋ1Ȍ˜•Ǥ…‡Ž‘”’”‘˜‡‹ì‹†‹ˆƒ‹Ž‹‹…‘’Ž‡–‡ȋ0).
Table 1. ‘’ƒ”ƒ–‹˜‡ cŽ‹n‹cƒŽ cŠƒ”ƒc–‡”‹•–‹c• ‘ˆ ‹n•–‹–—–‹‘nƒŽ‹œ‡† cŠ‹Ž†”‡n ȋ1Ȍ ˜•Ǥ –Š‘•‡ ˆ”‘ c‘’Ž‡–‡ ˆƒ‹Ž‹‡• ȋͶȌǤ

Lotul /
”‘—’ L1ȋαʹʹ͸Ȍ L0ȋα͹ͳȌ p
Date generale / ‰‡n‡”ƒŽ †ƒ–ƒ
Vârsta, ani / ƒ‰‡ǡ ›Ǥ‘Ǥ 11,4±1,8 11,1±2,4 ns
Prepubertar / prepubertar, % 52 46 ns
‡š—ŽǡΨ„£‹‡ì‹Ȁ‰‡n†‡”ǡ ά „‘›• 57 52 ns
ƒ”ƒ‡–”‹‹Žƒƒç–‡”‡Ȁ ’ƒ”ƒ‡–‡”• ƒ– „‹”–Š
‡”‡ǡ•£’–£Ÿ‹Ȁ–‡”, weeks 39,4±0,8 39,2±1,6 ns
Greutatea / ™‡‹‰Š–, kg 3,11±0,42 3,08±0,56 ns
B£Žì‹‡ƒȀŠ‡‹‰Š–, cm 50,5±2,3 50,4±2,1 ns
Antropometria
ȋ•…‘”—Žœ†—’£ȌȀI ȋœ •c‘”‡ ƒcc‘”†‹n‰ –‘ Ȍ -0,205±1,041 -0,471±1,141 ns
ƒ la copii / ‹n cŠ‹Ž†”‡n -0,325±1,107 -0,261±1,228 ns
ƒ Žƒƒ†‘Ž‡•…‡ì‹Ȁ‹n ƒ†‘Ž‡•c‡n–• -0,440±0,898 -0,682±1,023 ns
B£Žì‹‡ƒȋ•…‘”—Žœ†—’£ȌȀŠ‡‹‰Š– ȋœ •c‘”‡ ƒcc‘”†‹n‰ –‘ Ȍ -0,721±1,054 -0,024±1,051 <0,0001
ƒ la copii / ‹n cŠ‹Ž†”‡n -0,088±0,964 -0,155±1,101 ns
-1,009±1,126 -0,106±1,000 <0,0001
ƒ Žƒƒ†‘Ž‡•…‡ì‹Ȁ‹n ƒ†‘Ž‡•c‡n–•
Semne clinice / cŽ‹n‹cƒŽ •‹‰n•

‡n— ˜ƒ”—Ȁ˜ƒŽ‰—ǡ % 15 7 ns
…‘Ž‹‘œ£Ȁ •c‘Ž‹‘•‹•ǡ % 11 8 ns
Dureri osoase / „‘n‡ ’ƒ‹n, % 8 3 ns
Convulsii hipocalcemice / Š›’‘cƒŽc‡‹c c‘n˜—Ž•‹‘n•, % 1 4 ns
ˆ‡…ì‹—‹†‡–ƒ”‡Ȁ†‡n–ƒŽ c‘n†‹–‹‘n•, % 83 80 ns
ƒ”‹‡†‡–ƒ”£Ȁ†‡n–ƒŽ cƒ”‹‡•, % 10 11 ns
Semne digestive / †‹‰‡•–‹˜‡ •›’–‘•, % 66 75 ns
Parazitoze intestinale / ‹n–‡•–‹nƒŽ ’ƒ”ƒ•‹–‘•‹•
”‡˜ƒŽ‡ìƒ‰‡‡”ƒŽ£Ȁ‰‡n‡”ƒŽ ’”‡˜ƒŽ‡nc‡, % 49 63 ns
n–‡”‘„‹—• ˜‡”‹c—Žƒ”‹•ǡ ά 40 20 0,0017
•cƒ”‹• Ž—„”‹c‘‹†‡•ǡ ά 4 14 0,0104
”‹cŠ—”‹• –”‹cŠ‹—”‹ƒǡ ά 2 14 <0,0001

‹ƒ”†ƒ Žƒ„Ž‹ƒǡ ά 0 15 ns
Poliinfestare / ’‘Ž‹‹nˆ‡•–ƒ–‹‘n, % 3 0 ns
‘–£:ƒŽ‘”‹Ž‡•—–‡š’”‹ƒ–‡…ƒ‡†‹‡ά†‡˜‹‡”‡•–ƒ†ƒ”†ǡ•ƒ—…ƒ’”‘…‡–†‡•—„‹‡…ì‹Ǥ‡•–‡•–ƒ–‹•–‹…‡ƒ’Ž‹…ƒ–‡ǣ–Ǧ–—†‡–‡’‡”‡…Š‡ǡ–‡•–—Žɖ2.
‘–‡: ƒŽ—‡• ƒ”‡ ‡š’”‡••‡† ƒ• –Š‡ ‡ƒn ΰ •–ƒn†ƒ”† †‡˜‹ƒ–‹‘nǡ ‘” ƒ• ƒ ’‡”c‡n–ƒ‰‡ ‘ˆ •—„Œ‡c–•Ǥ ’’Ž‹‡† •–ƒ–‹•–‹cƒŽ –‡•–•: —n’ƒ‹”‡† –Ǧ–—†‡n–ǡ ɖ͸ –‡•–Ǥ
Š›•‹cƒŽ †‡˜‡Ž‘’‡n–ǡ ˆ‘‘† ˆƒc–‘” ƒn† ”‡‰—Žƒ–‘”› ˆ”ƒ‡™‘” MJHS 17(3)/2018 27

Tabelul 2.”‘ϐ‹Ž—Ž„‹‘…Š‹‹…ƒŽ•Ÿ‰‡Ž—‹ƒŽƒ„‡Ž‘”Ž‘–—”‹Ǥ
Table 2. Ž‘‘† „‹‘cŠ‡‹cƒŽ ’”‘ϔ‹Ž‡ ƒcc‘”†‹n‰ –‘ •–—†› ‰”‘—’•Ǥ
L1ȋαʹʹ͸Ȍ L0ȋα͹ͳȌ
Parametri / ’ƒ”ƒ‡–‡”• Copii / cŠ‹Ž†”‡nȋαͳͳͺȌ Copii / cŠ‹Ž†”‡nȋαͶͶȌ p
†‘Ž‡•…‡ì‹Ȁ–‡‡nƒ‰‡”•ȋαͳͲͺȌ †‘Ž‡•…‡ì‹Ȁ–‡‡nƒ‰‡”•ȋα͵͹Ȍ
”‘–‡‹ƒ‰‡‡”ƒŽ£Ȁ‰‡n‡”ƒŽ ’”‘–‡‹n‡, g/l 69±11 69±8 ns
Hemoglobina / Šƒ‡‘‰Ž‘„‹n‡, g/dl 11,2±1,1 11,9±0,4 <0,0001
Glucoza / ‰Ž—c‘•‡, mmol/l 4,2±0,8 4,3±0,7 ns
Creatinina / c”‡ƒ–‹n‹n‡, μmol/l ns
ƒ la copii / ‹n cŠ‹Ž†”‡n 41±12 54±10 ns
ƒŽƒƒ†‘Ž‡•…‡ì‹Ȁ‹n –‡‡nƒ‰‡”• 58±13 60±11 <0,0001
Ca++ total, mmol/l 2,14±0,31 2,29±0, 23 0,0007
Ca++ corr., mmol/l* 2,22±0,31 2,36±0,24 0,0025
PO4, mmol/l 1,36±0,38 1,22±0,23 0,0072
Mg++, mmol/l 0,70±0,14 0,83±0,18 <0,0001
‘•ˆƒ–ƒœƒƒŽ…ƒŽ‹£ȀƒŽcƒŽ‹n‡ ’Š‘•’Šƒ–ƒ•‡, UI/l
ƒ la copii / ‹n cŠ‹Ž†”‡n 453±202 407±123 ns
ƒŽƒƒ†‘Ž‡•…‡ì‹Ȁ‹n –‡‡nƒ‰‡”• 596±227 384±136 <0,0001
25(OH)D, nmol/l 44±16 36±12 0,0001
25(OH)D, ng/ml 18±6 14±5 0,0001
‘–£ǣ*Ȃ˜ƒŽ‘”‹Ž‡…‘…‡–”ƒì‹‹Ž‘”•‡”‹…‡ƒŽ‡…ƒŽ…‹—Ž—‹–‘–ƒŽƒ—ˆ‘•–…‘”‡…–ƒ–‡Áˆ—…싇†‡’”‘–‡‹‡‹‡Ǥ‡•–‡•–ƒ–‹•–‹…‡ƒ’Ž‹…ƒ–‡ǣ–Ǧ–—†‡–‡’‡”‡…Š‡ç‹ƒǦŠ‹–‡›Ǥ
‘–‡: *Ȃ –‘–ƒŽ cƒŽc‹— •‡”— c‘nc‡n–”ƒ–‹‘n• ™‡”‡ c‘””‡c–‡† ƒcc‘”†‹n‰ –‘ ‰‡n‡”ƒŽ Ž‡˜‡Ž „Ž‘‘† ’”‘–‡‹n‡Ǥ ’’Ž‹‡† •–ƒ–‹•–‹cƒŽ –‡•–•: —n’ƒ‹”‡† –Ǧ–—†‡n–ǡ  ƒnnǦŠ‹–n‡›Ǥ

…‹ì£ǡ•—ˆ‡”£•££–ƒ–‡ƒ–—–—”‘”ǡ†ƒ”ǡÁ’”‹—Ž”Ÿ†ǡ…‡ƒƒˆ‡‡-
‹Ž‘”Á•£”…‹ƒ–‡è‹ƒ…‘’‹‹Ž‘”‹•–‹–—ì‹‘ƒŽ‹œƒì‹†‡–‘ƒ–‡˜Ÿ”•–‡Ž‡Ǥ
‡‹‡è‹††‹”‡œ—Ž–ƒ–‡Ž‡•–—†‹—Ž—‹ǡ†‘”‹•£ƒ–‡ì‹‘£–‘ƒ–‡
’‡”•‘ƒ‡Ž‡…—†”‡’–†‡†‡…‹œ‹‡…£Á…£Ž…ƒ”‡ƒ‡‰‹‹ c— ’”‹˜‹”‡ Žƒ
†”‡’–—”‹Ž‡ c‘’‹Ž—Ž—‹ƒ…ƒ—œƒ–Ž‹’•ƒ†‡…‘†‹ì‹‹‡…‡•ƒ”‡’‡–”—
dezvoltarea copiilor din Gimnaziul Internat din municipiul Or-
Š‡‹ǡ…‡ƒƒ‹•–”‹‰‡–£’”‘„Ž‡£…‘•–‹–—‹†Ǧ‘ƒ•‹‰—”ƒ”‡ƒŽ‘”
…—Š”ƒ£†‡…ƒŽ‹–ƒ–‡„—£è‹Á…ƒ–‹–£ì‹•—ϐ‹…‹‡–‡ƒƒ…”‘Ǧè‹
‹…”‘—–”‹‡ì‹Ž‘”Ǥ
–—†‹‹Ž‡ ‡ˆ‡…–—ƒ–‡ ’‡ ’ƒ”…—”•—Ž ƒ ƒ‹ —Ž–‘” ƒ‹ †‡ …£–”‡
‡–”—Žƒì‹‘ƒŽg–‹‹ì‹ϐ‹…‘Ǧ”ƒ…–‹…†‡££–ƒ–‡—„Ž‹…£ƒŽ‹-
‹•–‡”—Ž—‹££–£ì‹‹ƒŽ‡’—„Ž‹…‹‹‘Ž†‘˜ƒè‹†‡‡–”‡Ž‡†‡‡-
†‹…‹£”‡˜‡–‹˜£–‡”‹–‘”‹ƒŽ‡ǡ’”‡…—è‹†ƒ–‡Ž‡•–ƒ–‹•–‹…‡‘ϐ‹…‹ƒ-
Ž‡ǡƒ—‡˜‹†‡ì‹ƒ–‘•’‘”‹”‡ǡÁ—Ž–‹‹‹ƒ‹ǡƒ—‘”ƒŽƒ†‹‹Á”Ÿ-
†—Ž…‘’‹‹Ž‘”苃†‘Ž‡•…‡ì‹Ž‘”ǡŽ‡‰ƒ–‡†‡ƒŽ‹‡–ƒì‹ƒ‡”ƒì‹‘ƒŽ£ǣ
ƒ‡‹‹ˆ‡”‹’”‹˜‡ǡ•–£”‹Ž‡‰ƒ–‡†‡†‡”‡‰Ž£”‹Ž‡•‹•–‡—Ž—‹‡”˜‘•
…‡–”ƒŽè‹’‡”‹ˆ‡”‹…ǡ”‡–ƒ”†Á†‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ǡ…ƒ”‹‡†‡–ƒ”£ǡ
ϐŽ—‘”‘œ£ǡ‰ƒ•–”‹–‡è‹†—‘†‡‹–‡‡–…Ǥ
ƒ‘‡–—Žƒ…–—ƒŽǡ’”‡è…‘Žƒ”‹‹è‹‡Ž‡˜‹‹—„‡‡ϐ‹…‹ƒœ£†‡‘
ƒŽ‹‡–ƒì‹‡•££–‘ƒ•£è‹‡…Š‹Ž‹„”ƒ–£Ǥ‡‹—”‹Ž‡ƒ…–—ƒŽ‡ƒ—†”‡’–
•…‘’ ƒ…‘’‡”‹”‡ƒ ‡…‡•ƒ”—Ž—‹ †‡ …ƒŽ‘”‹‹ǡ — ‡ƒ’£”ƒ– è‹ …ƒŽ‹–ƒ-
–‡ƒƒ…‡•–‘”ƒǤBƒŽ‹‡–ƒì‹ƒ…‘’‹‹Ž‘”†‹‹•–‹–—ì‹‹Ž‡†‡‡†—…ƒì‹‡
–‹’—”‹‡•Ǧƒƒ–‡•–ƒ–—…‘•—‡š…‡•‹˜†‡…”—’‡ǡ’ƒ•–‡ˆ£‹‘ƒ-
•‡ǡˆ£‹£†‡‰”Ÿ—è‹—Ž‡‹†‡ϐŽ‘ƒ”‡ƒ•‘ƒ”‡Ž—‹Ǥ‘ˆ‘”†ƒ–‡Ž‘”†‹
ʹͲͳͷǡƒ•‹‰—”ƒ”‡ƒ…—’”‘†—•‡ƒŽ‹‡–ƒ”‡ƒƒ…‘’‡”‹–‡…‡•‹–£ì‹Ž‡
ϐ‹œ‹‘Ž‘‰‹…‡ƒŽ‡‡Ž‡˜‹Ž‘”…—†‘ƒ”͸ʹǡͶΨ†‹‡…‡•ƒ”—ŽŽƒ’–‡ǡ’”‘-
†—•‡Žƒ…–ƒ–‡ǡ†‡Ž‡‰—‡ȋ͸͸ǡ͸ΨȌǡ†‡…ƒ”‡è‹’”‘†—•‡†‹…ƒ”‡
ȋ͹͹ǡʹΨȌ苈”—…–‡ȋ͹ͻǡ͵ΨȌǤ
ƒ…–‘”‹‹ †‡ ”‹•… ‘‹ƒŽ‹œƒì‹ ’‡”•‹•–£ †‡ ƒ‹ —Žì‹ ƒ‹ Á
‹•–‹–—ì‹‹Ž‡ ’‡–”— …‘’‹‹ è‹ ƒ†‘Ž‡•…‡ì‹ è‹ ‹ϐŽ—‡ì‡ƒœ£ ‡‰ƒ–‹˜
•–ƒ”‡ƒ †‡ •££–ƒ–‡ ƒ ’”‡è…‘Žƒ”‹Ž‘” è‹ ‡Ž‡˜‹Ž‘”Ǥ ƒ ‘”‰ƒ‹œƒ”‡ƒ
ƒŽ‹‡–ƒì‹‡‹Á腑Ž‹‹ϐŽ—‡ì‡ƒœ£‡‰ƒ–‹˜è‹Ž‹’•ƒ…‘†‹ì‹‹Ž‘”†‡
’£•–”ƒ”‡ƒ’”‘†—•‡Ž‘”ƒŽ‹‡–ƒ”‡ǡ†‡ϐ‹…‹–—Ž†‡—–‹ŽƒŒ–‡Š‘Ž‘‰‹…
†‡„—…£–£”‹‡•ƒ——–‹Ž‹œƒ”‡ƒ——‹ƒÁ˜‡…Š‹–苐‡‘”‰ƒ‹œƒ”‡ƒ‹-
struirilor pentru personal. În perioada anilor 2012-2015, cota
Š‹Ž† has caused the lack of necessary conditions for the deve-
lopment of children from the Orhei Boarding School, the most
’”‡••‹‰ ’”‘„Ž‡ „‡‹‰ –Š‡‹” ‰‘‘† “—ƒŽ‹–› ƒ† ‹ •—ˆϐ‹…‹‡–
quantities of macro- and micronutrients.
Studies conducted over several years by the National Sci-
‡–‹ϐ‹…ƒ†”ƒ…–‹…ƒŽ‡–‡”ˆ‘”—„Ž‹…‡ƒŽ–Š‘ˆ–Š‡‹‹•–”›‘ˆ
Health of the Republic of Moldova and the Territorial Preven-
–‹˜‡ ‡†‹…‹‡ ‡–‡”•ǡ ƒ• ™‡ŽŽ ƒ• –Š‡ ‘ˆϐ‹…‹ƒŽ •–ƒ–‹•–‹…ƒŽ †ƒ–ƒǡ
have revealed an increase in the number of diseases among
…Š‹Ž†”‡ ƒ† ƒ†‘Ž‡•…‡–•ǡ ”‡Žƒ–‡† –‘ —”‡ƒ•‘ƒ„Ž‡ —–”‹–‹‘ǣ
‹”‘Ǧ†‡ϐ‹…‹‡– ƒ‡‹ƒ•ǡ …‘†‹–‹‘• ”‡Žƒ–‡† –‘ …‡–”ƒŽ ƒ† ’‡-
ripheral nervous system disorders, retardation in physical
†‡˜‡Ž‘’‡–ǡ†‡–ƒŽ…ƒ”‹‡•ǡϐŽ—‘”‘•‹•ǡ‰ƒ•–”‹–‹•ƒ††—‘†‡‹–‹•
etc.
–’”‡•‡–ǡ’”‡Ǧ•…Š‘‘Žƒ†’—’‹Ž•†‘‘–„‡‡ϐ‹–ˆ”‘ƒŠ‡ƒŽ-
thy and balanced diet. Current menus aim to cover the need for
calories, not necessarily their quality. The diet of children in
early education institutions has been proven to be excessive
…‘•—’–‹‘ ‘ˆ ‰”‘ƒ–•ǡ ’ƒ•–ƒǡ ™Š‡ƒ– ϐŽ‘—” ƒ† •—ϐŽ‘™‡” ‘‹ŽǤ
According to the 2015 data, food insurance covered the physi-
ological needs of students with only 62.4% of the milk, dairy,
vegetables (66.6%), meat and meat products (77.2%) and fru-
its (79.3%).
Nominated risk factors persist for many years in childcare
facilities and have a negative impact on the health of prescho-
olers and students. Organizing food in schools also negatively
‹ϐŽ—‡…‡•–Š‡Žƒ…‘ˆˆ‘‘†•–‘”ƒ‰‡…‘†‹–‹‘•ǡ–Š‡•Š‘”–ƒ‰‡‘ˆ
kitchen technological equipment or the use of an obsolete one,
and the lack of organization of training for staff. In the period
2012-2015, the share of hot water provision of food blocks in
early education institutions is increasing, ranging from 59%
to 71.8%. There are mixed pre-processing units for meat and
vegetables with only 74.9% of food blocks in early education
institutions. A similar situation is also observed in primary, se-
28
ƒ•‹‰—”£”‹‹…—ƒ’£…ƒŽ†£ƒ„Ž‘…—”‹Ž‘”ƒŽ‹‡–ƒ”‡†‹‹•–‹–—ì‹‹Ž‡
†‡‡†—…ƒì‹‡–‹’—”‹‡‡•–‡Á…”‡è–‡”‡ǡ˜ƒ”‹‹††‡ŽƒͷͻΨ’Ÿ£
Žƒ ͹ͳǡͺΨǤ ‹•’— †‡ •‡…ì‹‹ ‹š–‡ †‡ ’”‡Ž—…”ƒ”‡ ’”‡Ž‹‹ƒ”£ ƒ
…£”‹‹è‹Ž‡‰—‡Ž‘”†‘ƒ”͹ͶǡͻΨ†‹„Ž‘…—”‹Ž‡ƒŽ‹‡–ƒ”‡†‹‹-
•–‹–—ì‹‹Ž‡†‡‡†—…ƒì‹‡–‹’—”‹‡Ǥ•‹–—ƒì‹‡•‹‹Žƒ”£•‡ƒ–‡•–£è‹Á
‹•–‹–—ì‹‹Ž‡†‡Á˜£ì£Ÿ–’”‹ƒ”ǡ‰‹ƒœ‹ƒŽè‹Ž‹…‡ƒŽǡ—†‡…‘–ƒ
…‡Ž‘” …ƒ”‡ †‹•’— †‡ ƒ’£ …ƒŽ†£ …—”‰£–‘ƒ”‡ Á ’‡”‹‘ƒ†ƒ ƒ‹Ž‘”
ʹͲͳʹǦʹͲͳͷƒ…”‡•…—–†‡ŽƒͷͳΨȋÁƒ—ŽʹͲͳʹȌ’Ÿ£Žƒ͹ͳǡͻΨ
ȋÁƒ—ŽʹͲͳͷȌǡ‹ƒ”͸ʹǡͶΨ†‹‹•–‹–—ì‹‹†‹•’—†‡•‡…ì‹‹…‘—‡
†‡’”‡Ž—…”ƒ”‡’”‡Ž‹‹ƒ”£ƒ…£”‹‹è‹Ž‡‰—‡Ž‘”Ǥ
ƒ…£‡”‡ˆ‡”‹Žƒ†‡”‡‰Ž£”‹Ž‡†‡—–”‹ì‹‡ǡÁ‰‡‡”ƒŽǡƒ”–”‡-
„—‹†‡‡ì‹‘ƒ–…£ƒŽ—–”‹ì‹ƒǡÁ–‘ƒ–‡ˆ‘”‡Ž‡‡‹ǡ…‘–‹—£
•£ …‘’”‘‹–£ ˜‹‡ì‹Ž‡ è‹ ‘’‘”–—‹–£ì‹Ž‡ ƒ ‹Ž‹‘ƒ‡ †‡ ‘ƒ‡‹
†‹Á–”‡ƒ‰ƒŽ—‡ȏͳȐǤ‡è‹ǡŽƒ‹˜‡Ž‰Ž‘„ƒŽǡ”ƒ–ƒƒŽ—–”‹ì‹‡‹ƒ”‡
–‡†‹ì£•’”‡•…£†‡”‡ǡ•–ƒ–‹•–‹…‹Ž‡‘ϐ‹…‹ƒŽ‡†‹’”‡œ‡–ǡ†‡‘–£
…£ͳͷͻ‹Ž‹‘ƒ‡†‡…‘’‹‹…‘–‹—£•£ƒ‹•—ˆ‡”‡†‡†‹ˆ‡”‹–‡ˆ‘”-
me ale ei. Astfel, 41 de milioane de copii sunt supraponderali,
‹ƒ”•–£”‹Ž‡†‡…ƒè‡š‹‡ǡ†‡–‡”‹ƒ–‡†‡‹•—ϐ‹…‹‡ìƒƒŽ‹‡–ƒ”£ǡ
…‘–‹—£ǡƒ—ƒŽǡ•£‹ƒ˜‹ƒìƒƒͷͲ†‡‹Ž‹‘ƒ‡†‡…‘’‹‹Á‹–”‡ƒ‰ƒ
‡œ˜‘Ž–ƒ”‡ƒ ϔ‹œ‹c£ǡ ˆƒc–‘”—Ž ƒŽ‹‡n–ƒ” ç‹ cƒ†”—Ž n‘”ƒ–‹˜
condary and high schools, where the share of hot water in the
period 2012-2015 increased from 51% (in 2012) to 71.9% (in
2015), and 62.4% of the institutions have common pre-proces-
sing sections for meat and vegetables.
If we are referring to nutritional disturbances in general, it
should be noted that malnutrition in all its forms continues to
compromise the lives and opportunities of millions of people
worldwide [1]. Although globally, the malnutrition rate tends
–‘†‡…Ž‹‡ǡ…—””‡–‘ˆϐ‹…‹ƒŽ•–ƒ–‹•–‹…••Š‘™–Šƒ–ͳͷͻ‹ŽŽ‹‘…Š‹Ž-
dren continue to suffer from different forms of malnutrition.
Thus, 41 million children are overweight, and cachexia, cau-
sed by food shortages, continues to take the lives of 50 million
children worldwide every year (UNICEF / WHO / World Bank
”‡’‘”–ʹͲͳͷȌǤŽ–Š‘—‰Šƒ›…‘—–”‹‡•Šƒ˜‡ƒ†‡•‹‰‹ϐ‹…ƒ–
progress in reducing hunger and malnutrition, much remains
to be done to achieve global goals in this area. Thus, Agenda
2030 for Sustainable Development strongly emphasizes the
need for integrated approaches, which are extremely impor-
Ž—‡ȋ”ƒ’‘”–—Ž ȀȀƒ…ƒ‘†‹ƒŽ£ǡʹͲͳͷȌǤ‡è‹
—Ž–‡ 죔‹ ƒ— Á”‡‰‹•–”ƒ– ’”‘‰”‡•‡ •‡‹ϐ‹…ƒ–‹˜‡ Á ”‡†—…‡”‡ƒ
ˆ‘ƒ‡–‡‹ è‹ ƒŽ—–”‹ì‹‡‹ǡ ƒ‹ ”£Ÿ‡ —Ž–‡ †‡ ˆ£…—– ’‡–”—
a atinge obiectivele globale în acest domeniu. Astfel, Agenda
ʹͲ͵Ͳ ’‡–”— ‘ ‡œ˜‘Ž–ƒ”‡ —”ƒ„‹Ž£ •—„Ž‹‹ƒœ£ …— ˆ‡”‹–ƒ–‡
‡…‡•‹–ƒ–‡ƒ—‘”ƒ„‘”†£”‹‹–‡‰”ƒ–‡ǡ‡š–”‡†‡‹’‘”–ƒ–‡Á
Ž—’–ƒÁ’‘–”‹˜ƒˆƒ…–‘”‹Ž‘”†‡–‡”‹ƒì‹ƒ‹ƒŽ—–”‹ì‹‡‹Ǥ‡–”—
‘ƒŽ• ȋȌǡ –Š‡ Ƿ‡”‘ ƒ•‡• ‘ˆ —‰‡”dz
ƒ ƒ”‘‹œƒ ‡ˆ‘”–—”‹Ž‡ ‰Ž‘„ƒŽ‡ǡ ”‡‰‹‘ƒŽ‡ è‹ ƒì‹‘ƒŽ‡ǡ ˜‡‹†
Á •’”‹Œ‹—Ž ‘„‹‡…–‹˜‡Ž‘” ‰Ž‘„ƒŽ‡ ’‡–”— —–”‹ì‹‡ǡ …‘—‹–ƒ–‡ƒ
‹–‡”ƒì‹‘ƒŽ£ ƒ ƒ†‡”ƒ– Žƒ ‹è…ƒ”‡ƒ è‹ ‹‹ì‹ƒ–‹˜ƒ †‡ ƒ …‘„ƒ–‡
…—ˆ‡”‹–ƒ–‡ǡ’‡–‘ƒ–‡ˆ”‘–—”‹Ž‡ǡƒ…‡•–ϐŽƒ‰‡ŽǤ–”ƒ–‡‰‹‹Ž‡‹…Ž—†ǣ
‹è…ƒ”‡ƒ ’‡–”— …‘•‘Ž‹†ƒ”‡ƒ —–”‹ì‹‘ƒŽ£ ȋȌǡ ‘„‹‡…–‹˜‡Ž‡
‰Ž‘„ƒŽ‡’‡–”——–”‹ì‹‡ƒ†—£”‹‹‘†‹ƒŽ‡ƒ££–£ì‹‹ȋȌǡ
obiectivele privind bolile non transmisibile (MNT), provocarea
Ƿ‡”‘ƒœ—”‹†‡ ‘ƒ‡Dzǡ‡…Žƒ”ƒì‹ƒ†‡Žƒ‘ƒ’”‹˜‹†—–”‹-
–ƒ– ‹ –Š‡ ϐ‹‰Š– ƒ‰ƒ‹•– ƒŽ—–”‹–‹‘ †‡–‡”‹ƒ–•Ǥ ‘ Šƒ”-
monize global, regional and national efforts to support global
nutritional goals, the international community has joined the
movement and the initiative to vigorously tackle this scourge
‘ ƒŽŽ ˆ”‘–•Ǥ –”ƒ–‡‰‹‡• ‹…Ž—†‡ǣ –Š‡ —–”‹–‹‘ Šƒ…‡‡–
Movement (SUN), WHA Global Nutrition Objectives, Non-Com-
—‹…ƒ„Ž‡ ‹•‡ƒ•‡
Challenge, the Rome Declaration on Nutrition (ICN2) and the
Framework for Action of the UN Decade for Action on Nutri-
tion [2]. The active participation of countries in the SUN mo-
vement (launched in 2010 to support multi-sectoral actions)
shows that national governments increasingly recognize the
importance of food for development, assuming responsibility
for addressing the nutritional challenges in their country. Only
improving policies and availability of resources is not enough;
싃ȋʹȌè‹…ƒ†”—Ž†‡ƒ…ì‹—‡ƒŽ‡…‡‹—Ž—‹†‡ƒ…ì‹—‡ƒŽ
’‡–”— —–”‹ì‹‡ ȏʹȐǤ ƒ”–‹…‹’ƒ”‡ƒ ƒ…–‹˜£ ƒ 죔‹Ž‘” Á ‹è…ƒ”‡ƒ
 ȋŽƒ•ƒ–£ Á ʹͲͳͲǡ ’‡–”— ƒ •’”‹Œ‹‹ ƒ…ì‹—‹Ž‡ —Ž–‹•‡…–‘-
”‹ƒŽ‡Ȍǡƒ”ƒ–£…£‰—˜‡”‡Ž‡ƒì‹‘ƒŽ‡”‡…—‘•…†‹…‡Á…‡ƒ‹
—Ž–‹’‘”–ƒìƒƒŽ‹‡–ƒì‹‡‹’‡–”—†‡œ˜‘Ž–ƒ”‡ǡƒ•—Ÿ†—Ǧè‹
”‡•’‘•ƒ„‹Ž‹–ƒ–‡ƒ ’‡–”— ƒ„‘”†ƒ”‡ƒ ’”‘˜‘…£”‹Ž‘” —–”‹ì‹‘ƒŽ‡
†‹샔ƒŽ‘”Ǥ‘ƒ”Á„—£–£ì‹”‡ƒ’‘Ž‹–‹…‹Ž‘”†‹†‘‡‹—苆‹•-
’‘‹„‹Ž‹–ƒ–‡ƒ”‡•—”•‡Ž‘”—•—–•—ϐ‹…‹‡–‡Ǣ‹…ƒ’ƒ…‹–ƒ–‡ƒ†‡ƒ
ƒ„•‘”„‹è‹—–‹Ž‹œƒˆ‘†—”‹Ž‡’—•‡Žƒ†‹•’‘œ‹ì‹‡”‡†—…†‹‡ϐ‹…‹‡-
ì£è‹Á–Ÿ”œ‹‡ƒ‰ƒŒƒ‡–‡Ž‡ƒ•—ƒ–‡Ǥ
‡•–‡——Ž†‹–”‡’”‹…‹’ƒŽ‹‹ƒ…–‘”‹…ƒ”‡•’”‹Œ‹£‰—˜‡”-
‡Ž‡Á”‡ƒŽ‹œƒ”‡ƒ‘„‹‡…–‹˜‡Ž‘”—–”‹ì‹‘ƒŽ‡Ǥƒ†ƒ–‡Ž‡—Ž–‘”
†‹–”‡ …‡Ž‡ ƒ‹ ƒ”‹ ƒ‰‡ì‹‹  •—– ’—–‡”‹… ƒšƒ–‡ ’‡ —-
–”‹ì‹‡ǡ‹…Ž—•‹˜ǡ”‰ƒ‹œƒì‹ƒƒì‹—‹Ž‘”‹–‡’‡–”—Ž‹‡–ƒì‹‡
the inability to absorb and use the funds made available redu-
…‡•‡ˆϐ‹…‹‡…›ƒ††‡Žƒ›•…‘‹–‡–•Ǥ
The UN is one of the main actors supporting governments
in meeting their nutritional goals. The mandates of many of
the largest UN agencies are strongly focused on nutrition, in-
cluding the United Nations Food and Agriculture Organization
(FAO), the International Fund for Agricultural Development
(IFAD), the United Nations Children’s Fund (UNICEF), the Wor-
ld Food Program (WFP) and the World Health Organization
(WHO). The SUN movement played a decisive role in maintai-
ning optimal nutrition globally, along with social mobilization
to combat malnutrition [3, 4].
It is important to note that Agenda 2030 for Sustainable
è‹ ‰”‹…—Ž–—”£ ȋ Ȍǡ ‘†—Ž –‡”ƒì‹‘ƒŽ ’‡–”— ‡œ˜‘Ž–ƒ”‡ Development and UN Decade for Action 2016-2025 requires
‰”‹…‘Ž£ȋ Ȍǡ ‘†—Ž ‘†—Žƒì‹—‹Ž‘”‹–‡’‡–”—‘’‹‹ all countries and stakeholders to end hunger and prevent all
ȋ Ȍǡ”‘‰”ƒ—ŽƒŽ‹‡–ƒ”‘†‹ƒŽȋȌè‹”‰ƒ‹œƒì‹ƒ
‘†‹ƒŽ£ƒ££–£ì‹‹ȋȌǤ‹è…ƒ”‡ƒƒŒ—…ƒ–—”‘Ž‡…‹-
•‹˜ Á ‡ì‹‡”‡ƒ —–”‹ì‹‡‹ ‘’–‹‡ Žƒ ‹˜‡Ž ‰Ž‘„ƒŽǡ †‡ ”Ÿ† …—
‘„‹Ž‹œƒ”‡ƒ•‘…‹ƒŽ£’‡–”—Ž—’–ƒÁ’‘–”‹˜ƒ•—„—–”‹ì‹‡‹ȏ͵ǡͶȐǤ
•–‡‹’‘”–ƒ–†‡‡ì‹‘ƒ–…£‰‡†ƒʹͲ͵Ͳ’‡–”—‡œ-
˜‘Ž–ƒ”‡ —”ƒ„‹Ž£ è‹ ‡…‡‹—Ž †‡ ƒ…ì‹—‡ ƒŽ  ’‡–”— —–”‹-
싇ʹͲͳ͸ǦʹͲʹͷǡ•‘Ž‹…‹–£–—–—”‘”죔‹Ž‘”è‹’£”ì‹Ž‘”‹–‡”‡•ƒ–‡•£
’—£ …ƒ’£– ˆ‘ƒ‡‹ è‹ •£ ’”‡˜‹£ –‘ƒ–‡ ˆ‘”‡Ž‡ †‡ •—„—–”‹ì‹‡
forms of malnutrition by 2030 [5]. In 2016, the number of pe-
ople in the world suffering from chronic malnutrition increa-
sed from 777 million in 2015 to 815 million in 2016, which is
below the 900 million recorded in 2000. However, despite the
ˆƒ…––Šƒ––Š‡†‡…Ž‹‡‹Š—‰‡”•‡‡•–‘„‡•‹‰‹ϐ‹…ƒ–ǡ‹–Šƒ•‘–
yet produced the expected impact on the prevalence of retar-
dation in physical development in children, the rate of which is
slower in some regions of the world, including in the Republic
Š›•‹cƒŽ †‡˜‡Ž‘’‡n–ǡ ˆ‘‘† ˆƒc–‘” ƒn† ”‡‰—Žƒ–‘”› ˆ”ƒ‡™‘”
’Ÿ£ÁʹͲ͵ͲȏͷȐǤBʹͲͳ͸ǡ—£”—Ž’‡”•‘ƒ‡Ž‘”†‹Ž—‡…ƒ”‡
•—ˆ‡”‡ƒ—†‡•—„—–”‹ì‹‡…”‘‹…£ƒ…”‡•…—–ǡ†‡Žƒ͹͹͹†‡‹Ž‹‘ƒ-
‡ÁʹͲͳͷŽƒͺͳͷ†‡‹Ž‹‘ƒ‡ÁʹͲͳ͸ǡ…‹ˆ”£…ƒ”‡•‡•‹–—‡ƒœ£
•—„…‡Ž‡ͻͲͲ†‡‹Ž‹‘ƒ‡ǡÁ”‡‰‹•–”ƒ–‡Áƒ—ŽʹͲͲͲǤ‘–—è‹ǡÁ
’‘ϐ‹†ƒ ˆƒ’–—Ž—‹ …£ †‡…Ž‹—Ž ˆ‘ƒ‡–‡‹ ’ƒ”‡ ƒ ϐ‹ •‡‹ϐ‹…ƒ–‹˜ǡ ‡Ž
—ƒ’”‘†—•ǡ†‡‘…ƒ†ƒ–£ǡ‹’ƒ…–—Ž•…‘–ƒ–ƒ•—’”ƒ’”‡˜ƒŽ‡ì‡‹
”‡–ƒ”†—Ž—‹Á†‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£Žƒ…‘’‹‹ǡ”‹–—Ž•…£†‡”‹‹…£”—‹ƒ
este mult mai lent în unele regiuni din lume, inclusiv, în Re-
’—„Ž‹…ƒ‘Ž†‘˜ƒȏ͵ǡͷȐǤ•–ˆ‡ŽǡŽƒ‹˜‡Ž‰Ž‘„ƒŽǡ’”‡˜ƒŽ‡ìƒ”‡–ƒ”-
†—Ž—‹Á†‡œ˜‘Ž–ƒ”‡ƒϐ‹œ‹…£ƒ•…£œ—–†‡ŽƒʹͻǡͷΨ’Ÿ£ŽƒʹʹǡͻΨ
ÁʹͲͳ͸ȏ͸ȐǤBƒ…‡Žƒè‹–‹’ǡ•–—†‹‹Ž‡ƒ—‡•–‹ƒ–…£ǡÁ’”‡œ‡–ǡ
’‡•–‡ͳ͸͸†‡‹Ž‹‘ƒ‡†‡…‘’‹‹•—„˜Ÿ”•–ƒ†‡…‹…‹ƒ‹…‘–‹—£
•£ϐ‹‡†‹ƒ‰‘•–‹…ƒì‹…—”‡–ƒ”†Á…”‡è–‡”‡ǤBƒŒ‘”‹–ƒ–‡ƒ죔‹Ž‘”
†‡’‡‰Ž‘„ǡ…—’”‡†‹Ž‡…싇Á…‡Ž‡ƒϐŽƒ–‡Á…‘ϐŽ‹…–è‹Á…—”•†‡
†‡œ˜‘Ž–ƒ”‡ǡˆ‘”‡Ž‡—Ž–‹’Ž‡†‡ƒŽ—–”‹ì‹‡…‘‡š‹•–£Á–”‡‡Ž‡Ǥ
”‡è–‡”‡ƒ”ƒ–‡Ž‘”‡š…‡•—Ž—‹†‡‰”‡—–ƒ–‡è‹ƒ‘„‡œ‹–£ì‹‹•‡ƒ†ƒ—‰£
ƒ…‡•–‘”’”‡‘…—’£”‹ȏ͹ȐǤ—’”ƒ’‘†‡”ƒ„‹Ž‹–ƒ–‡ƒè‹‘„‡œ‹–ƒ–‡ƒǡÁ
ƒŒ‘”‹–ƒ–‡ƒ œ‘‡Ž‘”ǡ •—– Á …”‡è–‡”‡ Žƒ ƒ†—Žì‹ǡ †ƒ” è‹ Žƒ …‘’‹‹Ǥ
Astfel, în 2016, 41 de milioane de copii sub 5 ani erau supra-
ponderali [4, 6].
„‹ì‹‹Ž‡ –”ƒ•ˆ‘”ƒ–‹˜‡ǡ ƒ•‘…‹ƒ–‡ …— ‰‡†ƒ ’‡–”— †‡œ-
˜‘Ž–ƒ”‡ †—”ƒ„‹Ž£ †‹ ʹͲ͵Ͳǡ •‘Ž‹…‹–£ –—–—”‘” 죔‹Ž‘” è‹ ’£”ì‹Ž‘”
‹–‡”‡•ƒ–‡•£…‘Žƒ„‘”‡œ‡’‡–”—ƒ’—‡…ƒ’£–ˆ‘ƒ‡‹è‹–—–—”‘”
ˆ‘”‡Ž‘”†‡ƒŽ—–”‹ì‹‡Ǥ‡–”—ƒ”£•’—†‡ƒ…‡•–‘”ƒ„‹ì‹‹ǡ˜ƒ
ϐ‹‹’‡”ƒ–‹˜•£•‡†‡œ˜‘Ž–‡ƒ‰”‹…—Ž–—”ƒè‹•‹•–‡‡Ž‡ƒŽ‹‡–ƒ”‡
•—•–‡ƒ„‹Ž‡ǡƒ•–ˆ‡ŽǡÁ…Ÿ–•£•‡ƒ•‹‰—”‡‘ƒ’”‘˜‹œ‹‘ƒ”‡•–ƒ„‹Ž£
…—ƒŽ‹‡–‡è‹•£•‡ƒ•‹‰—”‡ƒ……‡•—Ž–—–—”‘”Žƒ‘—–”‹ì‹‡”ƒì‹‘-
ƒŽ£è‹‡…Š‹Ž‹„”ƒ–£Ǥƒ•ƒ”‡ƒ’”‘‰”ƒ—Ž—‹ÁʹͲ͵Ͳƒ…‘‹…‹•…—
Á…‡’—–—Ž†‡…‡‹—Ž—‹†‡ƒ…ì‹—‡ƒŽ’‡–”——–”‹ì‹‡ȋʹͲͳ͸Ǧ
2025), dându-se, astfel, un nou impuls acestor angajamente
’”‹ •–ƒ„‹Ž‹”‡ƒ ——‹ …ƒŽ‡†ƒ” ‘’‡”ƒ–‹˜ è‹ ƒ ——‹ …ƒ†”— ’‘Ž‹–‹…
coerent. ‡ ‡ì‹‘ƒ–ǡ …£ è‹ Á 죔‹Ž‡ ÁƒŽ– ‹†—•–”‹ƒŽ‹œƒ–‡ǡ •‡
Á–ŸŽ‡•…’£–—”‹•‘…‹ƒŽ‡…—†‡ϐ‹…‹‡ì‡—–”‹ì‹‘ƒŽ‡‰”ƒ˜‡Ǥ•–ˆ‡Žǡ
Á ƒ”‡ƒ ”‹–ƒ‹‡ǡ ƒ— ˆ‘•– •‡ƒŽƒì‹ ƒ†‘Ž‡•…‡ì‹ …— †‡ϐ‹…‹‡-
쇐—–”‹ì‹‘ƒŽ‡†‡…ƒŽ…‹—ǡϐ‹‡”ǡ˜‹–ƒ‹‡Ž‡ǡͳǡʹǡȏͶǡͷǡ͸ȐǤ
MJHS 17(3)/2018 29
of Moldova [3, 5]. Thus, the global prevalence of retardation in
physical development decreased from 29.5% to 22.9% in 2016
[6]. At the same time, studies have estimated that over 166 mil-
Ž‹‘ …Š‹Ž†”‡ —†‡” –Š‡ ƒ‰‡ ‘ˆ ϐ‹˜‡ …‘–‹—‡ –‘ „‡ †‹ƒ‰‘•‡†
with a growing retardation. In most countries around the glo-
„‡ǡ ’”‡†‘‹ƒ–Ž› ‹ …‘ϐŽ‹…– ƒ† †‡˜‡Ž‘’‹‰ …‘—–”‹‡•ǡ —Ž-
tiple forms of malnutrition coexist with each other. Increased
overweight and obesity rates are added to these concerns [7].
Overweight and obesity in most areas are increasing in adults
and children. Thus, in 2016, 41 million children under 5 were
overweight [4, 6].
The transformative ambitions associated with the 2030
Sustainable Development Agenda require all countries and
stakeholders to work together to end hunger and all forms of
malnutrition. To meet these ambitions, it will be imperative
to develop sustainable agriculture and food systems in such
a way as to ensure a stable supply of food and to ensure that
everyone has access to a balanced and balanced diet. The la-
unch of the program in 2030 coincided with the beginning of
the UN Decade of Action on Nutrition (2016-2025), thus giving
a new impetus to these commitments by setting a timetable
and a coherent policy framework. It is worth mentioning that
even in highly industrialized countries, there are social stra-
–ƒ ™‹–Š •‡”‹‘—• —–”‹–‹‘ƒŽ †‡ϐ‹…‹‡…‹‡•Ǥ Š—•ǡ ‹ –Š‡ ǡ –‡‡-
ƒ‰‡”•™‹–Š—–”‹–‹‘ƒŽ†‡ϐ‹…‹‡…‹‡•‘ˆ…ƒŽ…‹—ǡ‹”‘ǡ˜‹–ƒ‹•
A, B1, B2, C [4, 5, 6] were reported. The French Higher Public
›‰‹‡‡ ‘—…‹Ž ˆ‘—† ‘†‡”ƒ–‡ †‡ϐ‹…‹–• ‘ˆ •‡˜‡”ƒŽ ˜‹–ƒ‹•
ȋéȀȽǦ…ƒ”‘–‡‡ǡ ǡ ǡ ˆ‘Žƒ–ǡ ͳǡ ͸ǡ ʹȌ ƒ† ‹‡”ƒŽ• ȋ…ƒŽ…‹—ǡ
magnesium, iron, iodine, zinc, selenium) [ 9, 10, 11]. It should
be noted that a low calcium diet induces, in most cases, the de-
ϐ‹…‹‡…›‘ˆ•‡˜‡”ƒŽ‹…”‘—–”‹‡–•ǤŠ‹•‹•‘‡‘ˆ–Š‡…ƒ—•‡•ˆ‘”
™Š‹…Š ‹– ‹• ‘– ƒ†˜‹•ƒ„Ž‡ –‘ ‡”ƒ†‹…ƒ–‡ …ƒŽ…‹— †‡ϐ‹…‹‡…‹‡• „›
way of medication. Some authors [9] consider that the child’s
body adapts to low nutrition by low stature, which means re-
‘•‹Ž‹—Ž—’‡”‹‘”’‡–”—‰‹‡£—„Ž‹…£†‹ ”ƒìƒƒ…‘•–ƒ–ƒ– ducing the growth rate. According to the numerous studies
†‡ϐ‹…‹–‡ ‘†‡”ƒ–‡ †‡ ƒ‹ —Ž–‡ ˜‹–ƒ‹‡ ȋéȀȽǦ…ƒ”‘–‹‡ǡ ǡ ǡ carried out in the Republic of Moldova at the Mother and Child
ˆ‘Žƒì‹ǡͳǡ͸ǡʹȌ苏‹‡”ƒŽ‡ȋ…ƒŽ…‹—ǡƒ‰‡œ‹—ǡϐ‹‡”ǡ‹‘†ǡœ‹…ǡ
seleniu) [9, 10, 11]. ”‡„—‹‡†‡‡ì‹‘ƒ–ˆƒ’–—Žǡ…£‘ƒŽ‹‡–ƒ-
싇•£”ƒ…£Á…ƒŽ…‹—‹†—…‡ǡÁƒŒ‘”‹–ƒ–‡ƒ…ƒœ—”‹Ž‘”ǡ…ƒ”‡ìƒƒ‹
—Ž–‘” ‹…”‘—–”‹‡ì‹Ǥ …‡ƒ•–ƒ ‡•–‡ —ƒ †‹ …ƒ—œ‡Ž‡ ’‡–”—
…ƒ”‡—•‡”‡…‘ƒ†£‡”ƒ†‹…ƒ”‡ƒ…ƒ”‡ì‡Ž‘”†‡…ƒŽ…‹—’‡…ƒŽ‡
‡†‹…ƒ‡–‘ƒ•£Ǥ‹‹ƒ—–‘”‹ȏͻȐ…‘•‹†‡”£…£‘”‰ƒ‹•—Ž…‘’‹-
Ž—Ž—‹•‡ƒ†ƒ’–‡ƒœ£Žƒ•—„ƒŽ‹‡–ƒì‹‡’”‹•–ƒ–—”£‹…£ǡ…‡‡ƒ…‡
Á•‡ƒ£ ”‡†—…‡”‡ƒ ”‹–—Ž—‹ †‡ …”‡è–‡”‡Ǥ ‘ˆ‘” —‡”‘ƒ-
selor studii, efectuate în Republica Moldova în cadrul Institu-
–—Ž—‹ƒ‡‹è‹‘’‹Ž—Ž—‹ǡ‡–”—Ž—‹ƒì‹‘ƒŽg–‹‹ì‹ϐ‹…‘Ǧ”ƒ…–‹…
†‡ ‡†‹…‹£ ”‡˜‡–‹˜£ǡ ‹˜‡”•‹–£ì‹‹ †‡ –ƒ– †‡ ‡†‹…‹£ è‹
•–‹–—–‡ǡ –Š‡ ƒ–‹‘ƒŽ …‹‡–‹ϐ‹… ƒ† ”ƒ…–‹…ƒŽ ‡–‡” ‘ˆ ”‡-
ventive Medicine, the ‹c‘Žƒ‡ ‡•–‡‹–ƒn— State University of
Medicine and Pharmacy, together with UNICEF and the scien-
–‹•–•ˆ”‘ ”ƒ…‡ȏͳ͵ǦͳͻȐǡ…ƒŽ…‹—†‡ϐ‹…‹‡…›‹ˆ‘‘†‹•ƒ’—„Ž‹…
health problem for the whole country.
According to statistical data, after consumption of milk and
dairy products per capita, Moldova is surpassed by many Eas-
tern European countries. Studies conducted jointly with the
French and Ukrainian scholars on representative samples of
children and adolescents from the towns of Falesti, Calarasi
ƒ†‘”‡•–‹”‡‰ƒ”†‹‰–Š‡•’”‡ƒ†ƒ†‹’ƒ…–‘ˆϐŽ—‘”‘•‹•‘
ƒ”ƒ…‹‡Ƿ‹…‘Žƒ‡‡•–‡‹ìƒ—dzǡÁ…‘—…— è‹savan-
싋†‹ ”ƒìƒȏͳ͵ǦͳͻȐǡ†‡ϐ‹…‹–—Ž…ƒŽ…‹—Ž—‹†‹ƒŽ‹‡–ƒì‹‡‡•–‡‘
’”‘„Ž‡£†‡•££–ƒ–‡’—„Ž‹…£’‡–”—Á–”‡ƒ‰ƒ샔£Ǥ
‘ˆ‘”†ƒ–‡Ž‘”•–ƒ–‹•–‹…‡ǡ†—’£…‘•——Ž†‡Žƒ’–‡è‹†‡’”‘-
†—•‡Žƒ…–ƒ–‡’‡…ƒ’†‡Ž‘…—‹–‘”ǡ‘Ž†‘˜ƒ‡•–‡Á–”‡…—–£†‡—Ž–‡
죔‹†‹—”‘’ƒ†‡•–Ǥ–—†‹‹Ž‡‡ˆ‡…–—ƒ–‡Á…‘—…—•ƒ˜ƒì‹‹
ˆ”ƒ…‡œ‹è‹…‡‹—…”ƒ‹‹‡‹ƒ•—’”ƒ—‘”‡èƒ–‹‘ƒ‡”‡’”‡œ‡–ƒ–‹˜‡
†‡ …‘’‹‹ è‹ ƒ†‘Ž‡•…‡ì‹ †‹ ‘”ƒè‡Ž‡ £Ž‡è–‹ǡ £Ž£”ƒè‹ è‹ ‘”‡è–‹
”‡ˆ‡”‹–‘” Žƒ ”£•’Ÿ†‹”‡ƒ è‹ ‹’ƒ…–—Ž ϐŽ—‘”‘œ‡‹ ƒ•—’”ƒ •££–£ì‹‹
‘•‘ƒ•‡ Žƒ …‘’‹‹‹ †‡ †‹ˆ‡”‹–‡ ˜Ÿ”•–‡ †‹ ƒ…‡•–‡ Ž‘…ƒŽ‹–£ì‹ǡ ƒ— •…‘•
bone health in children of different ages in these localities re-
vealed a high consumption reduced dairy products and, cor-
”‡•’‘†‹‰Ž›ǡ ‹•—ˆϐ‹…‹‡– …ƒŽ…‹— ‹–ƒ‡ǡ ƒ• ™‡ŽŽ ƒ• ƒ ‹…”‡-
ƒ•‡†ƒ‘—–‘ˆϐŽ—‘”‹‡‹†”‹‹‰™ƒ–‡”‹–Š‡•‡Ž‘…ƒŽ‹–‹‡•Ǥ
Probably, the very low amount of milk in the diet could be one
of the main causes of the hypomagnesaemia of children at the
Orhei Boarding Gymnasium. It should not be forgotten that da-
iry products also bring an alkaline load, which reduces urinary
calcium and sodium excretion, the latter, increasing its calcium
excretion.
30
Á‡˜‹†‡ì£—…‘•—ˆ‘ƒ”–‡”‡†—•†‡’”‘†—•‡Žƒ…–ƒ–‡è‹ǡ…‘”‡•-
’—œ£–‘”ǡ — ƒ’‘”– ‹•—ϐ‹…‹‡– †‡ …ƒŽ…‹—ǡ ’”‡…— è‹ ‘ …ƒ–‹–ƒ–‡
•’‘”‹–£ †‡ ϐŽ—‘” Á ƒ’ƒ ’‘–ƒ„‹Ž£ †‹ ƒ…‡•–‡ Ž‘…ƒŽ‹–£ì‹Ǥ ”‘„ƒ„‹Žǡ
…ƒ–‹–ƒ–‡ƒ ˆ‘ƒ”–‡ ”‡†—•£ †‡ Žƒ’–‡ †‹ †‹‡–£ ƒ” ’—–‡ƒ ϐ‹ —ƒ †‹
cauzele principale ale hipomagneziemiei copiilor din Gimnaziul
‡œ˜‘Ž–ƒ”‡ƒ ϔ‹œ‹c£ǡ ˆƒc–‘”—Ž ƒŽ‹‡n–ƒ” ç‹ cƒ†”—Ž n‘”ƒ–‹˜
Conclusion
Unreasonable and unbalanced nutrition, poor in macro-
and micronutrients, had a negative impact on the physical de-
velopment of children and adolescents in the study group. Low
serum creatinine levels may advocate poor muscle mass as a
–‡”ƒ–†‹”Š‡‹Ǥ—–”‡„—‹‡—‹–ƒ–ˆƒ’–—Ž…£’”‘†—•‡Ž‡Žƒ…–ƒ–‡ result of long-term, unbalanced and unbalanced nutri-tion.
ƒ†—… è‹ ‘ Á…£”…£–—”£ ƒŽ…ƒŽ‹£ǡ …ƒ”‡ ”‡†—…‡ ‡š…”‡ì‹ƒ —”‹ƒ”£ †‡
‹˜‡–Š‡Š‹‰Š’”‡˜ƒŽ‡…‡‘ˆŽ‘™Ž‡˜‡Ž•‘ˆʹͷȋȌȋζ͵Ͳ
…ƒŽ…‹—苆‡•‘†‹—ǡƒ…‡•–ƒ†‹—”£ǡ£”‹†ǡ’”‹ƒ…ì‹—‡ƒŽ—‹ǡ‡š- ‘ŽȀŽȌ†—”‹‰™‹–‡”Ȁ•’”‹‰ǡˆ‘”–‹ϐ‹…ƒ–‹‘ƒ†•—’’Ž‡‡–ƒ-
…”‡ì‹ƒ…ƒŽ…‹—Ž—‹Ǥ tion of vitamin D foods is recommended, at least during winter,
ˆ‘”…Š‹Ž†”‡ƒ†ƒ†‘Ž‡•…‡–•†‘‡•‘–”‡…‡‹˜‡•—ˆϐ‹…‹‡–‹–ƒ‡
‘…Ž—œ‹‡
of calcium and / or dairy products.
Ž‹‡–ƒì‹ƒ‡”ƒì‹‘ƒŽ£è‹‡‡…Š‹Ž‹„”ƒ–£ǡ•£”ƒ…£Áƒ…”‘Ǧè‹
‹…”‘—–”‹‡ì‹ƒƒ˜—–—‹’ƒ…–‡‰ƒ–‹˜ƒ•—’”ƒ†‡œ˜‘Ž–£”‹‹ϐ‹- ‘ϐŽ‹…–‘ˆ‹–‡”‡•–•
œ‹…‡ƒ…‘’‹‹Ž‘”苃†‘Ž‡•…‡ì‹Ž‘”†‹Ž‘–—Ž†‡•–—†‹—ǤƒŽ‘”‹Ž‡Œ‘ƒ-
Nothing to mention.
se ale creatininei serice ar putea pleda în favoarea unei mase
—•…—Žƒ”‡•Žƒ„†‡œ˜‘Ž–ƒ–‡ǡ…ƒ—”ƒ”‡ƒƒŽ‹‡–ƒì‹‡‹‡”ƒì‹‘ƒ-
Author’s contribution
Ž‡è‹‡‡…Š‹Ž‹„”ƒ–‡ǡ†‡Ž—‰£†—”ƒ–£Ǥ
ƒ–£ϐ‹‹†’”‡˜ƒŽ‡ìƒÁƒŽ–£ƒ‹˜‡Ž—Ž—‹•…£œ—–†‡ʹͷȋȌ Authors' contribution. Both authors contributed equally to
ȋζ͵Ͳ‘ŽȀŽȌÁ’‡”‹‘ƒ†ƒ†‡‹ƒ”£Ǧ’”‹£˜ƒ”£ǡˆ‘”–‹ϐ‹…ƒ”‡ƒ•ƒ— study design and manuscript writhing.
suplimentarea produselor alimentare cu vitamina D este reco-
ƒ†ƒ–£ǡ…‡Ž’—싐ǡÁ–‹’—Ž‹‡”‹‹ǡ’‡–”—…‘’‹‹‹è‹ƒ†‘Ž‡•…‡-
싋 …ƒ”‡—„‡‡ϐ‹…‹ƒœ£ †‡— ƒ’‘”–•—ϐ‹…‹‡–†‡…ƒŽ…‹— è‹Ȁ•ƒ—
produse lactate.

‘ϐŽ‹…–†‡‹–‡”‡•‡
Nimic de declarat.

‘–”‹„—싃ƒ—–‘”‹Ž‘”
Ambii autori au contribuit în mod egal la elaborarea studiu-
Ž—‹è‹•…”‹‡”‡ƒƒ”–‹…‘Ž—Ž—‹Ǥ
‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
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tional incidence, prevalence, and years lived with disability for 301
acute and chronic diseases and injuries in 188 countries, 1990-
ʹͲͳ͵ǣƒ•›•–‡ƒ–‹…ƒƒŽ›•‹•ˆ‘”–Š‡
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†‡”‡…Š‡”…Š‡‡–†ǯ‹ˆ‘”ƒ–‹‘—–”‹–‹‘‡ŽŽ‡ȂȌǡƒ”‹•ǡŽ‡ʹͳ ”ƒ–ƒ–‡œ˜‘Ž–ƒ”‡ƒ…‘’‹Ž—Ž—‹è‹…‘†—‹–ƒÁƒŽƒ†‹‹Ž‡—–”‹ì‹‘ƒŽ‡Ǥ
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 MJHS 17(3)/2018 31

ARTICOL DE CERCETARE RESEARCH ARTICLE

Aprecierea impactului asupra Assessment of the impact on

…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ƒŽ–”ƒ–ƒ‡–—Ž—‹ the quality of life of the biologiǦ
biologic anti IL6 versus cal treatment with IL6 versus
‘‘–‡”ƒ’‹ƒ‡–‘–”‡šƒ–ç‹ methotrexate monotherapy and
…‘„‹ƒì‹ƒ‡–‘–”‡šƒ–ç‹ –Š‡…‘„‹ƒ–‹‘‘ˆ‡–Š‘–”‡šƒǦ
•—Žˆƒ•ƒŽƒœ‹£Žƒ„‘Žƒ˜‹‹…— –‡ƒ†•—Žˆƒ•ƒŽƒœ‹‡‹’ƒ–‹‡–•
ƒ”–”‹–£”‡—ƒ–‘‹†£ǣ•–—†‹— with rheumatoid arthritis: proǦ
’”‘•’‡…–‹˜ǡ”ƒ†‘‹œƒ– •’‡…–‹˜‡ǡ”ƒ†‘‹œ‡†•–—†›
Oxana Bujor*†1, Liliana Groppa†1,2 Oxana Bujor*†1, Liliana Groppa†1,2
1
’‹–ƒŽ—Ž Ž‹n‹c ‡’—„Ž‹cƒnǡ ƒ„‘”ƒ–‘”—Ž †‡ ”‡—ƒ–‘Ž‘‰‹‡ǡ Š‹ç‹n£—ǡ 1
‡’—„Ž‹cƒn Ž‹n‹cƒŽ ‘•’‹–ƒŽǡ ƒ„‘”ƒ–‘”› ‘ˆ ”Š‡—ƒ–‘Ž‘‰›ǡ Š‹•‹nƒ—ǡ
‡’—„Ž‹cƒ ‘Ž†‘˜ƒǢ ‡’—„Ž‹c ‘ˆ ‘Ž†‘˜ƒǢ
͸
‹•c‹’Ž‹nƒ ”‡—ƒ–‘Ž‘‰‹‡ ç‹ n‡ˆ”‘Ž‘‰‹‡ǡ ‡’ƒ”–ƒ‡n–—Ž †‡ ‡†‹c‹n£ ‹n–‡”n£ǡ ͸
‹•c‹’Ž‹n‡ ‘ˆ ”Š‡—ƒ–‘Ž‘‰› ƒn† n‡’Š”‘Ž‘‰›ǡ ‡’ƒ”–‡n– ‘ˆ ‹n–‡”nƒŽ ‡†‹c‹n‡ǡ
n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹c‘Žƒ‡ ‡•–‡‹ìƒn—dzǡ Š‹ç‹n£—ǡ ‹c‘Žƒ‡ ‡•–‡‹–ƒn— –ƒ–‡ n‹˜‡”•‹–› ‘ˆ ‡†‹c‹n‡ ƒn† Šƒ”ƒc›ǡ Š‹•‹nƒ—ǡ
‡’—„Ž‹cƒ ‘Ž†‘˜ƒǤ ‡’—„Ž‹c ‘ˆ ‘Ž†‘˜ƒǤ
Data depunerii manuscrisului: 07.06.2017 Manuscript received on: 07.06.2017
ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣͳͲǤͲͻǤʹͲͳͺ ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣͳͲǤͲͻǤʹͲͳͺ
Autor corespondent: Corresponding author:
”Ǥ šƒnƒ —Œ‘” ”Ǥ šƒnƒ —Œ‘”
ƒ„‘”ƒ–‘”—Ž †‡ ”‡—ƒ–‘Ž‘‰‹‡ ç‹ n‡ˆ”‘Ž‘‰‹‡ ƒ„‘”ƒ–‘”› ‘ˆ ”Š‡—ƒ–‘Ž‘‰› ƒn† n‡’Š”‘Ž‘‰›
’‹–ƒŽ—Ž Ž‹n‹c ‡’—„Ž‹cƒn ‡’—„Ž‹cƒn Ž‹n‹cƒŽ ‘•’‹–ƒŽ
•–”Ǥ ‹c‘Žƒ‡ ‡•–‡‹ìƒn— ͸Ϳǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ ‘Ž†‘˜ƒǡ Ǧ͸Ͷ͸ͻ ͸Ϳǡ ‹c‘Žƒ‡ ‡•–‡‹–ƒn— •–”Ǥǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c ‘ˆ ‘Ž†‘˜ƒǡ Ǧ͸Ͷ͸ͻ
‡Ǧƒ‹Ž: ‘šƒnƒ„—Œ‘”̻›ƒŠ‘‘Ǥc‘ ‡Ǧƒ‹Ž: ‘šƒnƒ„—Œ‘”̻›ƒŠ‘‘Ǥc‘

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

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ˆ—…ì‹‘ƒŽ‡ƒ„‘Žƒ˜‹Ž‘”…—ƒ”–”‹–£”‡—ƒ–‘‹†£ȋȌǡŽƒˆ‡Žç‹‡ϐ‹…ƒ…‹–ƒ–‡ƒ tients with rheumatoid arthritis (RA) is not known to date, as is the
ç‹–‘Ž‡”ƒ„‹Ž‹–ƒ–‡ƒ–‡”ƒ’‹‡‹„‹‘Ž‘‰‹…‡’”‹ƒ‰‡–—Žƒ–‹͸Ȃ–‘…‹Ž‹œ—ƒ„
ȋȌ˜‡”•—•‘‘–‡”ƒ’‹ƒ‡–‘–”‡šƒ–ȋȌç‹…‘„‹ƒì‹ƒ‡–‘–”‡šƒ–
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†‡ ”‡ƒŽ‹œƒ”‡ ƒ —‡‹ Á„—£–£ì‹”‹ •‡‹ϐ‹…ƒ–‹˜‡ ȋͷͲȌǡ Á ƒ„•‡ìƒ
”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡…ƒ”‡ƒ”‹†—…‡ƒ—Žƒ”‡ƒ‡†‹…ƒì‹‡‹•–—†‹ƒ–‡Ǥ
‡ˆϐ‹…ƒ…› ƒ† –‘Ž‡”ƒ„‹Ž‹–› ‘ˆ –Š‡ „‹‘Ž‘‰‹…ƒŽ –Š‡”ƒ’› ™‹–Š –Š‡ ƒ–‹Ǧ͸
agent tocilizumab (TOC) vs. methotrexate monotherapy (MT) and
the combination of methotrexate and sulfasalazine (MT+SLZ) in RA
’ƒ–‹‡–•Ǥ Š‡”‡ ‹• ‘ ‘™ ˆ”‡“—‡…› ‘ˆ •‹‰‹ϐ‹…ƒ– ‹’”‘˜‡‡–
(ACR50), in the absence of adverse reactions that would induce the
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‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
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•–ƒ†ƒ”†…—ç‹…‘„‹ƒì‹ƒΪ•Ǧƒ…‘•–ƒ–ƒ–Žƒ„‘Žƒ˜‹‹…—Ǥ
ϐ‹…ƒ…‹–ƒ–‡ƒƒˆ‘•–‡š’”‹ƒ–£’”‹ƒ‡Ž‹‘”ƒ”‡ƒ•–£”‹‹ˆ—…ì‹‘ƒŽ‡
ƒ ’ƒ…‹‡ì‹Ž‘”ǡ ƒ ƒ‹ˆ‡•–£”‹Ž‘” …Ž‹‹…‡ ç‹ ’ƒ”ƒ…Ž‹‹…‡ ƒŽ‡ „‘Ž‹‹ǡ –‘Ž‡”ƒ-
„‹Ž‹–ƒ–‡ •ƒ–‹•ˆ£…£–‘ƒ”‡ ƒ ƒ’Ž‹…£”‹‹ Ǥ …‡•– ˆƒ’– ’‡”‹–‡ —–‹Ž‹œƒ”‡ƒ
ƒ…‡•–‡‹•…Š‡‡†‡–”ƒ–ƒ‡–Á…ƒ†”—Ž…ƒ†‡’”‹£Ž‹‹‡.
withdrawal of the medication studied.
Research hypothesis
Biological therapy with TOC for rheumatoid arthritis may be more
effective in improving the functional status of the patients, it could in-
duce a clinical improvement by reducing clinical signs (pain, morning
stiffness, number of painful and swollen joints), by a positive dynam-
ics of all the laboratory indices of disease activity, and the toleration
of the biological therapy could be better compared to the standard
MT and MT+SSZ combination treatment.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
 Š‹‰Š‡” ‡ˆϐ‹…ƒ…› ‘ˆ  –Š‡”ƒ’› ˜‡”•—• •–ƒ†ƒ”†  –”‡ƒ–‡–
and MT+SSZ combination treatment was found in patients with RA.
Š‡‡ˆϐ‹…ƒ…›‘ˆ™ƒ•‡š’”‡••‡†„›–Š‡‹’”‘˜‡‡–‘ˆ–Š‡ˆ—…-
tional status of the patients, the clinical and paraclinical manifesta-
tions of the disease and satisfactory tolerability of TOC application.
Š‹•ƒŽŽ‘™•–Š‡—•‡‘ˆ–Š‹•–”‡ƒ–‡–”‡‰‹‡‹ƒ•ƒDzˆ”‘–Ž‹‡dz
therapy.
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Introducere. ”–”‹–ƒ ”‡—ƒ–‘‹†£ ȋȌ ƒˆ‡…–‡ƒœ£ ƒ’”‘š‹-
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˜ƒ”‹ƒì‹‹ …‘•‹†‡”ƒ„‹Ž‡ ”‡‰‹‘ƒŽ‡Ǥ ‡‡‹Ž‡ •—– ƒˆ‡…–ƒ–‡ †‡ ͵
‘”‹ ƒ‹ ˆ”‡…˜‡– †‡…Ÿ– „£”„ƒì‹‹Ǥ ”ƒ–ƒ‡–—Ž ‡…‘”‡•’—œ£-
–‘”…‘†—…‡ǡ†‡‘„‹…‡‹ǡ•’”‡‘‡˜‘Ž—싇•‡˜‡”£è‹’”‘‰”‡•‹˜£ƒ
ƒŽƒ†‹‡‹ǡϐ‹‹†ƒ…‘’ƒ‹ƒ–£†‡†—”‡”‡è‹‹ϐŽƒƒì‹‡ƒ”–‹…—Žƒ”£ǡ
†‡•–”—…ì‹‹‘•–‡‘…ƒ”–‹Žƒ‰‹‘ƒ•‡è‹Šƒ†‹…ƒ’ˆ—…ì‹‘ƒŽǤ„‘”†£-
rile moderne ale tratamentului AR sunt bazate pe conceptul
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‡†‹‹Ž‡ƒ–‹…‹–‘‹‹…‡è‹…‡Ž‡„‹‘Ž‘‰‹…‡Ǥ
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conform criteriilor de includere/excludere. În rezultatul ran-
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샖”ƒ–ƒ‡–‡Ž‘”Žƒ‡–ƒ’ƒ‹‹ì‹ƒŽ£è‹’‡•–‡ͳʹŽ—‹Ǥ
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‘ƒŽǤB‰”—’—Ž…—–‡”ƒ’‹‡„‹‘Ž‘‰‹…£ǡ‹†‹…‡Ž‡‡†‹—
ƒ•…£œ—–†‡Žƒͳǡͷ’Ÿ£ŽƒͲǡͷǤB‰”—’—Ž…—‘‘–‡”ƒ’‹‡è‹
ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–‘‹†‡
Abstract
Introduction. Rheumatoid arthritis (RA) affects approxi-
mately 0.5-1% of the European and North American popula-
–‹‘™‹–Š•‹‰‹ϐ‹…ƒ–”‡‰‹‘ƒŽ˜ƒ”‹ƒ–‹‘•Ǥ‘‡ƒ”‡ƒˆˆ‡…–‡†
3 times more frequently than men. Inappropriate treatment
or lack of treatment usually has a severe and progressively ag-
‰”ƒ˜ƒ–‹‰ †‡˜‡Ž‘’‡–ǡ ‰‡‡”ƒ–‹‰ Œ‘‹– ’ƒ‹ ƒ† ‹ϐŽƒƒ-
tion, osteochondral destructions and functional impairment.
Modern approaches to RA treatment are based on “aggressive
–Š‡”ƒ’›dzǡ–Š‡‰‘ƒŽ‘ˆ™Š‹…Š‹•–‘•—’’”‡••ƒ—–‘‹—‡‹ϐŽƒ-
mation and prevent joint destruction from the earliest stages
of the disease. In the recent years, attention has been focused
on the anti-cytokines and biological preparations.
Material and methods. The study was carried out within
Republican Clinical Hospital, Arthrology unit, during 2013-
2016. A total batch of 150 patients was created, selected ac-
cording to the inclusion/exclusion criteria. As a result of
Dz„Ž‹†dz ”ƒ†‘‹œƒ–‹‘ǡ ͷͲ ’ƒ–‹‡–• ”‡…‡‹˜‡† ‘‘–Š‡”ƒ’›
™‹–Š‡–Š‘–”‡šƒ–‡ȋȌǡͷͲ’ƒ–‹‡–•Ȃ…‘„‹‡†ǡ‡–Š‘–”‡š-
ate + sulfasalazine (MT+SLZ) treatment and other 50 patients
Ȃ–‘…‹Ž‹œ—ƒ„ȋȌ‘‘–Š‡”ƒ’›Ǥ‘’ƒ”ƒ–‹˜‡‡˜ƒŽ—ƒ–‹‘‘ˆ
–”‡ƒ–‡–•Ʈ‡ˆϐ‹…ƒ…›™ƒ•’‡”ˆ‘”‡†Ǥ
Results. During the study period, functional status was im-
proved in patients of the both treatment groups. In the group
with TOC biological therapy, the HAQ average score decreased
from 1.5 to 0.5, and in the MT monotherapy and MT+SLZ
ΪȂ†‡ŽƒʹǡͲè‹ʹǡͷ’Ÿ£ŽƒͲǡ͹ͷ’—…–‡ȋ’αͲǡͲͲͺȌǤ—
ˆ‘•–‘„•‡”˜ƒ–‡†‹ˆ‡”‡ì‡‹–‡”‰”—’ƒŽ‡Á”‡†—…‡”‡ƒ•‹†”‘—-
Ž—‹‹ϐŽƒƒ–‘”†‡…£–”‡–‡”ƒ’‹ƒ„‹‘Ž‘‰‹…£Ǥ
‘…Ž—œ‹‹Ǥ ‡”ƒ’‹ƒ „‹‘Ž‘‰‹…£ …—  ƒ †‡‘•–”ƒ– ‘ ƒ‹
„—£‡ϐ‹…ƒ…‹–ƒ–‡’‡–”—ƒ‡Ž‹‘”ƒ”‡ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ǡ…‘’ƒ”ƒ–‹˜
cu monoterapia MT sau tratamentul combinat MT+SLZ. Supor-
–ƒ”‡ƒ–‡”ƒ’‹‡‹„‹‘Ž‘‰‹…‡…—ƒˆ‘•–—Ž–•—’‡”‹‘ƒ”£‘‘–‡-
”ƒ’‹‡‹…—•ƒ—–‡”ƒ’‹‡‹…‘„‹ƒ–‡ΪǤ ”‡…˜‡ìƒ”‡ƒ…ì‹‹-
lor adverse, care au necesitat întreruperea tratamentului, a fost
‡Á•‡ƒ–£Žƒ„‘Žƒ˜‹‹…ƒ”‡ƒ—’”‹‹––‡”ƒ’‹‡„‹‘Ž‘‰‹…£ǡƒ˜Ÿ†
‘”ƒ–£•‡‹ϐ‹…ƒ–‹˜ƒ‹ƒ”‡Á‰”—’—Ž…—‘‘–‡”ƒ’‹‡è‹
–‡”ƒ’‹‡…‘„‹ƒ–£ΪǤ
Cuvinte cheie: ƒ”–”‹–£”‡—ƒ–‘‹†£ǡ–”ƒ–ƒ‡–„‹‘Ž‘‰‹…ǡ
‰”‘—’•Ȃˆ”‘ʹǤͲƒ†ʹǤͷ–‘ͲǤ͹ͷ’‘‹–•ȋ’αͲǤͲͲͺȌǤ–‡”‰”‘—’
†‹ˆˆ‡”‡…‡•‹–Š‡”‡†—…–‹‘‘ˆ–Š‡‹ϐŽƒƒ–‘”›•›†”‘‡„›
TOC biological therapy have been observed.
Conclusions. Biological therapy with TOC has shown
‰”‡ƒ–‡”‡ˆϐ‹…ƒ…›‹”‡•–‘”‹‰–Š‡“—ƒŽ‹–›‘ˆŽ‹ˆ‡…‘’ƒ”‡†–‘
monotherapy or combined MT+SLZ therapy. Tolerance of the
„‹‘Ž‘‰‹…ƒŽ–Š‡”ƒ’›™‹–ŠŠƒ•„‡‡—…Š„‡––‡”ƒ†•‹‰‹ϐ‹-
cantly differed from MT monotherapy or combined MT+SLZ
treatment. The frequency of side effects requiring the discon-
tinuation of treatment was negligible in patients receiving bio-
Ž‘‰‹…ƒŽ–Š‡”ƒ’›ƒ†Šƒ†ƒ•‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡””ƒ–‡‹–Š‡
monotherapy group and MT+SLZ combination therapy group.
Key words: rheumatoid arthritis, biological treatment,
–‘…‹Ž‹œ—ƒ„ǡƒ–‹Ǧ͸ǡ‡–‘–”‡šƒ–ǡ•—Žˆƒ•ƒŽƒœ‹£Ǥ
Introducere
”–”‹–ƒ”‡—ƒ–‘‹†£ȋȌƒˆ‡…–‡ƒœ£ƒ’”‘š‹ƒ–‹˜ͲǡͷǦͳΨ†‹
’‘’—Žƒì‹ƒ‡—”‘’‡ƒ£è‹‘”†Ǧƒ‡”‹…ƒ£ǡ…—˜ƒ”‹ƒì‹‹…‘•‹†‡”ƒ-
bile regionale. Femeile sunt afectate de 3 ori mai frecvent de-
…Ÿ–„£”„ƒì‹‹Ǥ”ƒ–ƒ‡–—Ž‡…‘”‡•’—œ£–‘”…‘†—…‡ǡ†‡‘„‹…‡‹ǡ
•’”‡‘‡˜‘Ž—싇•‡˜‡”£è‹’”‘‰”‡•‹˜£ƒƒŽƒ†‹‡‹ǡϐ‹‹†ƒ…‘’ƒ-
‹ƒ–£ †‡ †—”‡”‡ è‹ ‹ϐŽƒƒì‹‡ ƒ”–‹…—Žƒ”£ǡ †‡•–”—…ì‹‹ ‘•–‡‘…ƒ”-
–‹Žƒ‰‹‘ƒ•‡ è‹ Šƒ†‹…ƒ’ ˆ—…ì‹‘ƒŽǤ ”–”‹–ƒ ”‡—ƒ–‘‹†£ ‡•–‡ ‘
ƒˆ‡…ì‹—‡•‡˜‡”£…ƒ”‡ƒˆ‡…–‡ƒœ£…ƒ’ƒ…‹–ƒ–‡ƒ†‡—…£Ǥ’ƒ”‹ì‹ƒ
—‘” Ž‡œ‹—‹ ˜‹•…‡”ƒŽ‡ ”‡†—…‡ •’‡”ƒìƒ †‡ ˜‹ƒì£ …— ͷǦͳͲ ƒ‹Ǥ
‘•‡…‹ìƒƒŒ‘”£ƒƒ…‡•–‡‹ƒˆ‡…ì‹—‹‡•–‡†‹œƒ„‹Ž‹–ƒ–‡ƒȏͳǡʹȐǤ
‹‡”†‡”‡ƒ…ƒ’ƒ…‹–£ì‹‹†‡—…£‡•–‡…‡ƒƒ‹…‘•–‹•‹–‘ƒ”‡…‘-
•‡…‹ì£ƒƒ”–”‹–‡‹”‡—ƒ–‘‹†‡’”‡…‘…‡ǡ†‡ƒ…‡‡ƒƒŽƒ†‹ƒ–”‡„—-
‹‡–”ƒ–ƒ–£…Ÿ–ƒ‹–‹’—”‹—Ǥ
tocilizumab, anti-IL 6, methotrexate, sulfasalazine.
Introduction
Rheumatoid arthritis (RA) affects approximately 0.5-1%
‘ˆ–Š‡—”‘’‡ƒƒ†‘”–Š‡”‹…ƒ’‘’—Žƒ–‹‘™‹–Š•‹‰‹ϐ‹-
cant regional variations. Women are affected 3 times more
frequently than men. Inappropriate treatment or lack of treat-
ment usually has a severe and progressively aggravating devel-
‘’‡–ǡ ‰‡‡”ƒ–‹‰ Œ‘‹– ’ƒ‹ ƒ† ‹ϐŽƒƒ–‹‘ǡ ‘•–‡‘…Š‘-
dral destructions and functional impairment. Rheumatoid
arthritis is a severe condition that affects work capacity. The
occurrence of visceral lesions is responsible for shortening the
average life span from 5 to 10 years. The major consequence of
this condition is disability [1, 2]. Loss of work capacity is the
most costly consequence of early rheumatoid arthritis that is
why rheumatoid arthritis should be treated in time. Despite
—ƒŽ‹–› ‘ˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– ‘ˆ ”Š‡—ƒ–‘‹† ƒ”–Š”‹–‹•
B’‘ϐ‹†ƒ’”‘‰”‡•‡Ž‘”ƒŒ‘”‡†‹†‘‡‹—Ž–‡”ƒ’‹‡‹ǡ’Ÿ£
în ’”‡œ‡–—•‡…—‘ƒè–‡‹…‹—”‡‡†‹—…—”ƒ–‹˜’‡–”—ƒ”–”‹-
–ƒ”‡—ƒ–‘‹†£ǡ†—’£…——•—–†‹•’‘‹„‹Ž‡‹…‹‡–‘†‡’”‘-
ϐ‹Žƒ…–‹…‡ȏ͵ȐǤ”ƒ–ƒ‡–—Ž‘’–‹ƒŽ„‘Ž‹‹‡…‡•‹–£—†‹ƒ‰‘•–‹…
’”‡…‘…‡ǡ’”‡…—è‹—–‹Ž‹œƒ”‡ƒ•—ϐ‹…‹‡–†‡†‡˜”‡‡ƒƒ‰‡ì‹Ž‘”
care reduc probabilitatea leziunilor articulare ireversibile [4,
5, 6].
…‘’—Ž •–—†‹—Ž—‹ ƒ ˆ‘•– ‡˜ƒŽ—ƒ”‡ƒ …‘’ƒ”ƒ–‹˜£ ƒ …ƒŽ‹–£ì‹‹
˜‹‡ì‹‹ „‘Žƒ˜‹Ž‘” …— ƒ”–”‹–£ ”‡—ƒ–‘‹†£ǡ –”ƒ–ƒì‹ ’”‹ ‘‘–‡-
”ƒ’‹‡ …— ‡–‘–”‡šƒ– ȋȌ ˜‡”•—• …‘„‹ƒì‹‡ ‡–‘–”‡šƒ– …—
MJHS 17(3)/2018 33
major advances in the domain of therapy, no cure remedy for
rheumatoid arthritis is known so far, and also no prophylactic
methods are available either [3]. Optimal disease treatment
requires early diagnosis, as well as timely (i.e. early enough)
use of agents that reduce the probability of irreversible joint
damage [4, 5, 6].
The purpose of the study is to assess the impact on the
quality of life of methotrexate (MT) monotherapy or its com-
bination with sulfasalazine (SLZ) and of the biological treat-
ment with the anti-IL6 agent tocilizumab (TOC) in patients
•—Žˆƒ•ƒŽƒœ‹£ȋΪȌ•ƒ—–”ƒ–ƒ‡–„‹‘Ž‘‰‹…ƒ–‹Ǧ͸Ȃ–‘-
cilizumab (TOC).
ƒ–‡”‹ƒŽç‹‡–‘†‡
Pentru realizarea obiectivelor propuse, a fost selectat un lot
†‡ͳͷͲ†‡’ƒ…‹‡ì‹…—†‹ƒ‰‘•–‹…—Ž†‡ǡ•–ƒ„‹Ž‹–Á…‘ˆ‘”‹–ƒ–‡
cu criteriile de diagnostic EULAR 2010 [7] (Tabelul 1).
˜‹œ—Ž ˆƒ˜‘”ƒ„‹Ž ƒŽ ‘‹–‡–—Ž—‹ †‡ –‹…£ ƒ ‡”…‡–£”‹‹ ƒŽ
 Ƿ‹…‘Žƒ‡‡•–‡‹ìƒ—dzȋ”ǤʹͳȀͳ͸†‹ͲͷǤͲʹǤʹͲͳͷȌƒˆ‘•–
‘„싐—–Ǥ
–—†‹—Ž •Ǧƒ †‡•ˆ£è—”ƒ– Á „ƒœƒ ’‹–ƒŽ—Ž Ž‹‹… ‡’—„Ž‹…ƒǡ
‡…싃 ƒ”–”‘Ž‘‰‹‡ǡ Á ’‡”‹‘ƒ†ƒ ƒ‹Ž‘” ʹͲͳ͵ǦʹͲͳ͸Ǥ ƒ†‘‹œƒ-
”‡ƒ’ƒ…‹‡ì‹Ž‘”ƒˆ‘•–‡ˆ‡…–—ƒ–£ˆ‘Ž‘•‹†…ƒ”†—”‹ǡ…ƒ”‡ƒ—‹†‹-
…ƒ–—£”—Ž——‹ƒ†‹–”‡…‡Ž‡–”‡‹–‹’—”‹•–—†‹ƒ–‡†‡–”ƒ–ƒ‡–
ȋΪǢ  •ƒ— ȌǤ ƒ”†—”‹Ž‡ ƒ— ˆ‘•– †‹•’‡”•ƒ–‡ è‹ ’Žƒ-
•ƒ–‡Á’Ž‹…—”‹‘’ƒ…‡ǤŽ‹…—”‹Ž‡ƒ˜‡ƒ——£”†‡•‡”‹‡ȋͳǦͳͷͲȌǤ
…‡ƒ•–£ ’”‘…‡†—”£ ƒ ˆ‘•– ‡ˆ‡…–—ƒ–£ Áƒ‹–‡ †‡ …‡”…‡–ƒ”‡ǡ ”ƒ–ƒ
†‡”ƒ†‘‹œƒ”‡ϐ‹‹††‡ͳǣͳǣͳǤB”‡œ—Ž–ƒ–—Ž”ƒ†‘‹œ£”‹‹ǡͷͲ
†‡’ƒ…‹‡ì‹ƒ—ƒ†‹‹•–”ƒ–‘‘–‡”ƒ’‹ƒ…—ǡͷͲ†‡’ƒ…‹‡ì‹
Ȃ–”ƒ–ƒ‡–…‘„‹ƒ–Ϊǡ苃Žì‹ͷͲ†‡’ƒ…‹‡ì‹Ȃ‘‘-
–‡”ƒ’‹‡…—Ǥƒ…‹‡ì‹‹ƒ—ˆ‘•–…‘’ƒ”ƒ„‹Ž‹†—’£’ƒ”ƒ‡–”‹‹
…Ž‹‹…‹è‹†‡‘‰”ƒϐ‹…‹”‡Ž‡˜ƒì‹Ǥ‘ì‹’ƒ…‹‡ì‹‹†‹Ž‘–—Ž†‡•–—-
†‹— ƒ— ˆ‘•– •—’—è‹ —‡‹ ‡˜ƒŽ—£”‹ †‡–ƒŽ‹ƒ–‡ǡ ‡ˆ‡…–—ƒ–‡ …‘ˆ‘”
——‹’”‘‰”ƒ†‡‡šƒ‹ƒ”‡…Ž‹‹…£…‘’Ž‡š£ǡ’‡–”—ƒ†‡–‡”-
‹ƒƒ–Ÿ–‰”ƒ†—Ž†‡ƒ˜ƒ•ƒ”‡…Ž‹‹…£è‹’ƒ”ƒ…Ž‹‹…£ƒǡ…Ÿ–è‹
‡ϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—Ž—‹ƒ†‹‹•–”ƒ–Ǥ
”‹–‡”‹‹Ž‡†‡‹…Ž—†‡”‡ƒ’ƒ…‹‡ì‹Ž‘”Á•–—†‹—ƒ—ˆ‘•–ǣ
ƒDiagnostic cert de AR, stabilit conform Criteriilor EULAR
2010 [7] (Tabelul 1).
ƒVârsta de 18-65 de ani;
ƒ—”ƒ–ƒ†‡…‡Ž’—싐͸Ž—‹Ǣ
ƒ‹•’‘‹„‹Ž‹–ƒ–‡ƒ †‡ ˆƒœ£ ƒ…–‹˜£ ƒ ǡ Á …‘ˆ‘”‹–ƒ–‡ …—
—”£–‘ƒ”‡Ž‡…”‹–‡”‹‹ǣ
ȋͳȌ—£”—Ž†‡ƒ”–‹…—Žƒì‹‹–—‡ϐ‹ƒ–‡Ȃ…‡Ž’—싐͸Ǣ
ȋʹȌ—£”—Ž†‡ƒ”–‹…—Žƒì‹‹†—”‡”‘ƒ•‡Ȃ…‡Ž’—싐ͺǢ
ȋ͵Ȍ†—”ƒ–ƒ”‡†‘”‹‹ƒ–‹ƒŽ‡Ȃ…‡Ž’—싐Ͷͷ†‡‹—–‡Ǣ
ȋͶȌǦ—Ž†‡’‡•–‡͵ͲȀ‘”£Ǥ
ƒ…–‹˜£‡•–‡ƒ†‹•£’”‹’”‡œ‡ìƒ‘„Ž‹‰ƒ–‘”‹‡ƒ’”‹—Ž—‹
…”‹–‡”‹—è‹‘”‹…£”‘”†‘—£†‹–”‡…‡Ž‡ŽƒŽ–‡–”‡‹‡ì‹‘ƒ–‡Ǥ
ƒ‹’•ƒƒ†‹‹•–”£”‹‹Á–”‡…—–ƒǡˆ‘Ž‘•‹–‡Áƒ…‡•–
studiu recunoscut, în mod adecvat, prin utilizarea de MT,
•ƒ—ƒ‘”‹…£”—‹’”‡’ƒ”ƒ–„‹‘Ž‘‰‹…Ǣ
ƒ‹’•ƒ …‘–”ƒ‹†‹…ƒì‹‹Ž‘” ’‡–”— ƒ’Ž‹…ƒ”‡ƒ  †‹
studiu;
with rheumatoid arthritis.
Material and methods
In order to perform the study and meet the proposed ob-
jectives, we selected a group of 150 patients with RA diagno-
sis, established in accordance with the EULAR diagnostic cri-
teria (2010) [7] (Table 1).
ˆƒ˜‘—”ƒ„Ž‡‘–‹ϐ‹…ƒ–‹‘‘ˆ–Š‡‡•‡ƒ”…Š–Š‹…•‘‹––‡‡
(no. 21/16 from 05.02.2015) was obtained.
The study was carried out within Republican Clinical Hos-
pital, Arthrology unit, during the period 2013-2016. Patient
randomization was performed using cards that indicated the
number of one of the three treatment types studied (MT+SLZ,
MT or TOC). The cards were dispersed and placed in opaque
envelopes. Envelopes are described by serial numbers (1-150).
This procedure was performed prior to the research, with a
ͳǣͳǣͳ”ƒ†‘‹œƒ–‹‘”ƒ–‡Ǥ•ƒ”‡•—Ž–‘ˆ–Š‡”ƒ†‘‹œƒ–‹‘ǡͷͲ
’ƒ–‹‡–• ”‡…‡‹˜‡† ‘‘–Š‡”ƒ’› ™‹–Š ǡ ͷͲ ’ƒ–‹‡–• Ȃ …‘-
„‹‡†Ϊ–”‡ƒ–‡–ƒ†ͷͲ‘–Š‡”’ƒ–‹‡–•Ȃ‘‘-
therapy. The patients were comparable according to relevant
clinical and demographic indices. All the patients in the study
group were subjected to a detailed assessment, performed ac-
cording to a complex clinical examination program in order
to determine both the clinical and paraclinical advancement
†‡‰”‡‡‘ˆƒ†–Š‡‡ˆϐ‹…ƒ…›‘ˆ–Š‡–”‡ƒ–‡–ƒ†‹‹•–‡”‡†Ǥ
Š‡…”‹–‡”‹ƒˆ‘”‹…Ž—•‹‘‘ˆ–Š‡’ƒ–‹‡–•‹–Š‡•–—†›™‡”‡ǣ
ƒA certain RA diagnosis according to the 2010 EULAR cri-
teria [7] (Table 1).
ƒAge 18-65 years old;
ƒRA duration of at least 6 months;
ƒActive phase availability of RA according to the following
…”‹–‡”‹ƒǣ
ȋͳȌ–Š‡—„‡”‘ˆ•™‘ŽŽ‡Œ‘‹–•Ȃƒ–Ž‡ƒ•–͸Ǣ
ȋʹȌ–Š‡—„‡”‘ˆ’ƒ‹ˆ—ŽŒ‘‹–•Ȃƒ–Ž‡ƒ•–ͺǢ
ȋ͵Ȍ–Š‡†—”ƒ–‹‘‘ˆ–Š‡‘”‹‰•–‹ˆˆ‡••Ȃˆ‘”ƒ–Ž‡ƒ•–Ͷͷ
minutes;
(4) ESR was not less than 30 mm/h.
Active RA diagnosis is allowed by the mandatory presence
‘ˆ–Š‡ϐ‹”•–…”‹–‡”‹‘ƒ†ƒ›–™‘‘ˆ–Š‡‘–Š‡”–Š”‡‡Ǥ
ƒLack of previous use of DMARDs used in this study,
adequately recognized by the use of MT, SLZ or any bio-
logical preparation;
ƒNo contraindications for the application of DMARDs in
the study;
ƒ–‹Ž‹œƒ”‡ƒ ‘”‹…£”—‹ ‡†‹…ƒ‡– †‹ ‰”—’—Ž †‡  è‹Ȁ ƒThe use of any drug in the NSAID and/or corticosteroid
•ƒ—…‘”–‹…‘•–‡”‘‹œ‹Á–”Ǧ‘†‘œ£•–ƒ„‹Ž£†‡…‡Ž’—싐Ͷ•£’- group at a stable dose of at least 4 weeks prior to the
34
–£Ÿ‹Áƒ‹–‡†‡•–—†‹—ǡ†‘œƒœ‹Ž‹…£†‡’”‡†‹•‘Ž‘•£
—†‡’£è‡ƒ•…£ͳͲ‰ǡ†‡‡–‹Ž’”‡†‹•‘Ž‘Ȃͺ‰Ǣ
ƒš…Ž—†‡”‡ƒ†‡‹Œ‡…–ƒ”‡‹–”ƒƒ”–‹…—Žƒ”£†‡…‘”–‹…‘•–‡”‘‹œ‹
–‹’†‡ͳŽ—£Áƒ‹–‡†‡•–—†‹—Ǣ
ƒPosibilitatea de vizite regulate a pacientului la SCR, sec-
싃ƒ”–”‘Ž‘‰‹‡è‹•—’”ƒ˜‡‰Š‡”‡‡†‹…ƒŽ£†‡–”ƒ–ƒ‡–ƒ-
bulator;
ƒ‡ƒ”‡ƒ†‡…£–”‡’ƒ…‹‡–ǡÁ•…”‹•ǡƒ…‘•‹ì£Ÿ–—Ž—‹
informat pentru a participa la acest studiu.
”‹–‡”‹‹†‡‡š…Ž—†‡”‡ƒ’ƒ…‹‡ì‹Ž‘”†‹ƒ…‡•–•–—†‹—ǣ
ƒ‘˜‡œ‹•ƒ—•—•’‹…‹—‹Žƒ’”‘…‡•‡‹ϐŽƒƒ–‘”‹‹ƒ…–‹˜‡•ƒ—
‘Ǧƒ…–‹˜‡ȋŽƒ–‡–‡Ȍ†‡‡–‹‘Ž‘‰‹‡‹ˆ‡…ì‹‘ƒ•£ȋ„ƒ…–‡”‹‡‡ǡ
virale, fungice sau parazitare);
ƒ‹†”‘ƒ‡Ž‡ ‡Ž–› •ƒ— Œ‘‰”‡ •‡…—†ƒ”ǡ ˜ƒ•…—Ž‹–£ ”‡—-
ƒ–‘‹†£ǡŠ‹’‡”–‡”‹‡…ƒ—œƒ–£†‡ǡ‘•—•’‹…‹—‡Žƒƒ‹-
Ž‘‹†‘œ£Ǣ
ƒ•–‡‘ƒ”–”‘œƒ•‡…—†ƒ”£•ƒ—’”‹ƒ”£ǡ…Ž‹‹…•‡‹ϐ‹…ƒ–‹-
˜£ǡƒƒ”–‹…—Žƒì‹‹Ž‘”‹…‹ǡ‡…”‘œ£ƒ•‡’–‹…£†‡‘•Ǣ
ƒ‘Ž‹ …‘…‘‹–‡–‡ •‡˜‡”‡ǡ …ƒ”‡ ‡…‡•‹–£ ‡šƒ‹ƒ”‡ •ƒ—
–”ƒ–ƒ‡–ƒ…–‹˜ǡ‹…Ž—•‹˜ǣ–—‘”£ƒŽ‹‰£ǡÁƒ–‡…‡†‡–‡
•ƒ— Á ’”‡œ‡–ǡ ‹ˆ‡…ì‹‹ ȋ‹…Ž—•‹˜ǡ …”‘‹…‡Ȍǡ ƒˆ‡…ì‹—‹ …ƒ”-
†‹ƒ…‡ •‡˜‡”‡ǡ Š‹’‡”–‡•‹—‡ ƒ”–‡”‹ƒŽ£ ‡…‘–”‘Žƒ–£ǡ „‘Ž‹
’—Ž‘ƒ”‡•‡˜‡”‡ǡ‹…Ž—•‹˜ǡϐ‹„”‘œ£’—Ž‘ƒ”£•‡˜‡”£Ǣ
ƒUlcere active ale tractului gastrointestinal;
ƒBoli hepatice, o istorie de abuz de alcool;
ƒ”‡è–‡”‡ƒ–‡•–‡Ž‘”ˆ—…싇‹Š‡’ƒ–‹…‡†‡Žƒ„‘”ƒ–‘”ȋǡ
ǡˆ‘•ˆƒ–ƒœƒƒŽ…ƒŽ‹£ǡ„‹Ž‹”—„‹ƒȌ•ƒ—ƒˆ—…싇‹”‡ƒŽ‡
ȋ…”‡ƒ–‹‹ƒȌǡ…‘’ƒ”ƒ–‹˜…—Ž‹‹–ƒ•—’‡”‹‘ƒ”£ƒ‹–‡”˜ƒ-
lului valorilor normale recomandate;
ƒ…£†‡”‡ƒŠ‡‘‰Ž‘„‹‡‹Ȃƒ‹’—싐†‡ͻͲ‰ȀŽǡŽ‡—…‘…‹–‡
Ȃƒ‹’—싐†‡͵ͲͲͲǡ–”‘„‘…‹–‡Ȃƒ‹’—싐†‡ͳͲͲǤͲͲͲǤ
—’£ ˜‡”‹ϐ‹…ƒ”‡ƒ …”‹–‡”‹‹Ž‘” †‡ ‹…Ž—†‡”‡ǡ ’ƒ…‹‡–—Ž ƒ ˆ‘•–
inclus în tratamentul care a fost indicat pe cardul de rando-
mizare.
Doza de MT în grupurile de tratament a fost de 12,5-15 mg
’‡•£’–£Ÿ£ǤB–‹’—Ž’”‹‡‹•£’–£Ÿ‹†‡•–—†‹—ǡ’ƒ…‹‡-
싋Ž‘””ƒ†‘‹œƒì‹Žƒ—–‹Ž‹œƒ”‡ƒ–‡”ƒ’‹‡‹…‘„‹ƒ–‡ǡŽ‹•Ǧƒƒ†‹-
‹•–”ƒ– —ƒ‹ Ǥ B ƒ„•‡ìƒ —‘” ”‡ƒ…ì‹‹ ƒ†˜‡”•‡ …ƒ”‡ ’‘– ϐ‹
ƒ–”‹„—‹–‡Žƒǡƒ–”‡‹ƒ•£’–£Ÿ£ƒƒ†‡”ƒ–Ǥ‘œƒ‹‹ì‹ƒŽ£Ȃ
’”‹‡Ž‡͹œ‹Ž‡ƒƒˆ‘•–†‡ͷͲͲ‰’‡œ‹ǡƒ’‘‹ǡÁƒ„•‡ìƒ—‘”
”‡ƒ…ì‹‹ƒ†˜‡”•‡…ƒ”‡’‘–ϐ‹ƒ–”‹„—‹–‡Žƒǡ†‘œƒƒˆ‘•–…”‡•…—–£
Žƒϐ‹‡…ƒ”‡͹œ‹Ž‡…—ͷͲͲ‰ǡ’Ÿ£Žƒ†‘œƒ–‘–ƒŽ£†‡ʹǡͲ‰’‡œ‹Ǥ
ƒ’ƒ…‹‡ì‹‹…—–”ƒ–ƒ‡–’”‹ǡ†—’£†‹Ž—ƒ”‡ǡƒˆ‘•–ƒ†-
‹‹•–”ƒ–•—„ˆ‘”£†‡’‡”ˆ—œ‹‡‹–”ƒ˜‡‘ƒ•£Á†‡…—”•†‡ͳ
‘”£Ǥ”‡’ƒ”ƒ–—Žƒˆ‘•–†‹Ž—ƒ–’Ÿ£Žƒ—˜‘Ž—ϐ‹ƒŽ†‡ͳͲͲŽǡ
…—‘•‘Ž—싇•–‡”‹Ž£ǡƒ’‹”‘‰‡£†‡…Ž‘”—”£†‡•‘†‹—ͲǡͻΨǡ”‡•-
’‡…–Ÿ†–‡Š‹…ƒƒ•‡’–‹…£Ǥ‹–”Ǧ‘’—‰£†‡’‡”ˆ—œ‹‡†‡ͳͲͲŽ
•‡‡š–”£‰‡ƒǡÁ…‘†‹ì‹‹ƒ•‡’–‹…‡ǡ—˜‘Ž—†‡•‘Ž—싇‹Œ‡…–ƒ„‹-
Ž£•–‡”‹Ž£ǡƒ’‹”‘‰‡£†‡…Ž‘”—”£†‡•‘†‹—ͻ‰ȀŽȋͲǡͻΨȌ‡‰ƒŽ
cu volumul de concentrat de Tocilizumab, necesar pentru doza
’ƒ…‹‡–—Ž—‹Ǥƒ–‹–ƒ–‡ƒ‡…‡•ƒ”£†‡…‘…‡–”ƒ–†‡‘…‹Ž‹œ—ƒ„
•Ǧƒ …ƒŽ…—Žƒ– …‘ˆ‘” ‹•–”—…ì‹—‹Ž‘” †‡ —–‹Ž‹œƒ”‡ è‹ …‘•–‹–—‹ƒ
ͲǡͶŽȋͶ‰ȌȀ‰ǡϐ‹‹†‡š–”ƒ•£†‹ϐŽƒ…‘è‹‹–”‘†—•£Á’—‰ƒ
†‡’‡”ˆ—œ‹‡†‡ͳͲͲŽǤ…‡ƒ•–ƒƒ˜‡ƒ—˜‘Ž—ϐ‹ƒŽ†‡ͳͲͲŽǤ
ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–‘‹†‡
study, the daily dose of prednisolone should not exceed
ͳͲ‰ǡ‘ˆ‡–Š›Ž’”‡†‹•‘Ž‘‡Ȃͺ‰Ǣ
Exclusion of the intra-articular injection of corticoste-
ƒ
roids for 1 month before the study;
The possibility for the patient of performing regular vi-
ƒ
sits to PMSI CRH Arthrology Department and medical
supervision of ambulatory treatment;
Written signing by the patient of the informed consent
ƒ
for the participation in this study.
”‹–‡”‹ƒ‘ˆ‡š…Ž—•‹‘ˆ‘”–Š‡’ƒ–‹‡–•‘ˆ–Š‹••–—†›ǣ
ƒ˜‹†‡…‡‘”•—•’‹…‹‘‘ˆ‹ϐŽƒƒ–‘”›ƒ…–‹˜‡‘”‘Ǧƒ…-
tive (latent) infectious (bacterial, viral, fungal or parasi-
tic) processes;
ƒFelty or secondary Sjogren syndromes, rheumatoid vas-
culitis, hyperthermia caused by RA, suspicion of amylo-
idosis;
ƒŽ‹‹…ƒŽŽ›•‹‰‹ϐ‹…ƒ–•‡…‘†ƒ”›‘”’”‹ƒ”›‘•–‡‘ƒ”–Š”‹–‹•
of the small joints, aseptic bone necrosis;
ƒSevere concomitant illnesses requiring active examinati-
‘‘”–”‡ƒ–‡–ǡ‹…Ž—†‹‰ǣƒŽ‹‰ƒ––—‘”ǡ‹–Š‡’ƒ•–
or at present, infections (including chronic ones), seve-
re cardiac diseases, uncontrolled arterial hypertension,
severe pulmonary diseases, including severe pulmonary
ϐ‹„”‘•‹•Ǣ
ƒActive ulcers of the gastrointestinal tract;
ƒLiver diseases, a history of alcohol abuse;
ƒIncreased liver function tests (ALT, AST, alkaline pho-
sphatase, bilirubin) or renal function tests (creatinine),
compared to the upper limit of the recommended nor-
mal range;
ƒ‡…”‡ƒ•‡‹Šƒ‡‘‰Ž‘„‹ȂŽ‡••–ŠƒͻͲ‰ȀŽǡŽ‡—‘…›–‡•Ȃ
Ž‡••–Šƒ͵ͲͲͲǡ’Žƒ–‡Ž‡–•ȂŽ‡••–ŠƒͳͲͲǡͲͲͲǤ
After checking the inclusion criteria, the patient was in-
cluded in the treatment that was indicated on the card.
The MT dose in the treatment groups was 12.5-15 mg per
™‡‡Ǥ—”‹‰–Š‡ϐ‹”•–™‡‡‘ˆ–Š‡•–—†›ǡ’ƒ–‹‡–•”ƒ†‘‹œ‡†
to the combination therapy received only MT. In the absence of
adverse reactions attributable to MT, SLZ was added the third
™‡‡ǤŠ‡‹‹–‹ƒŽ†‘•‡†—”‹‰–Š‡ϐ‹”•–͹†ƒ›•‘ˆ™ƒ•ͷͲͲ
mg daily, then, in the absence of adverse reactions attributable
to SLZ, the dose was increased every 7 days by 500 mg to a
total dose of 2.0 g per day.
In patients treated with TOC, after dilution, it had to be giv-
en as an intravenous infusion within 1 hour. The preparation
™ƒ•†‹Ž—–‡†–‘ƒϐ‹ƒŽ˜‘Ž—‡‘ˆͳͲͲŽ™‹–Š•–‡”‹Ž‡ǡͲǤͻΨ•‘†‹-
um chloride pyrogen-free solution, following the aseptic tech-
nique. From a 100 ml infusion bag, 9 mg/ml (0.9%) of sterile,
apyrogenic sodium chloride injection solution was extracted
under aseptic conditions, equal to the volume of the Tocilizu-
mab concentrate required for the patient’s dose. The required
amount of Tocilizumab concentrate was calculated according
to the recommendations and consisted of 0.4 ml (4mg/kg), be-
ing withdrawn from the vial and inserted into the 100 ml infu-
‡–”—ƒƒ‡•–‡…ƒ•‘Ž—싃ǡ’—‰ƒ•‡Á–‘”…‡ƒ—è‘”’‡–”—ƒ•‡ •‹‘„ƒ‰Ǥ–Šƒ†ƒϐ‹ƒŽ˜‘Ž—‡‘ˆͳͲͲŽǤ‘‹š–Š‡•‘Ž—–‹‘ǡ
‡˜‹–ƒˆ‘”ƒ”‡ƒ†‡•’—£Ǥ the bag was turned slightly to avoid foaming.
—ƒŽ‹–› oˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– oˆ ”Š‡—ƒ–o‹† ƒ”–Š”‹–‹• MJHS 17(3)/2018 35

—£”—Ž‡…‡•ƒ”†‡’ƒ…‹‡ì‹’‡–”—…‡”…‡–ƒ”‡ƒˆ‘•–…ƒŽ…—- The required number of patients for the research was cal-
Žƒ–’”‹—–‹Ž‹œƒ”‡ƒ—”£–‘ƒ”‡‹ˆ‘”—Ž‡ǣ …—Žƒ–‡†—•‹‰–Š‡ˆ‘ŽŽ‘™‹‰ˆ‘”—Žƒǣ
2(Z a + Z b ) x P(1 - P )
2
2(Z a + Z b ) x P(1 - P )
2
1 1
n= ´ n= ´
(1 - f ) (Po - P1 )2 (1 - f ) (Po - P1 )2
™Š‡”‡ǣ
—†‡ǣ Poαƒ……‘”†‹‰–‘–Š‡„‹„Ž‹‘‰”ƒ’Š‹…†ƒ–ƒǡ–Š‡•—……‡••‘ˆ–Š‡
Po α …‘ˆ‘” †ƒ–‡Ž‘” „‹„Ž‹‘‰”ƒϐ‹…‡ǡ ”‡—è‹–ƒ –”ƒ–ƒ‡–—Ž—‹ treatment using the traditional method (MT) represents an
’”‹ƒ’Ž‹…ƒ”‡ƒ‡–‘†‡‹–”ƒ†‹ì‹‘ƒŽ‡ȋȌǡ…‘•–‹–—‹‡ǡÁ‡†‹—ǡ average of 45.0% (P0αͲǤͶͷȌǤ
45.0% (P0αͲǡͶͷȌǤ P1ዐ–Š‡”‡•‡ƒ”…Š‰”‘—’‘ˆ’ƒ–‹‡–•™Š‘™‹ŽŽ„‡–”‡ƒ–‡†
P1αÁŽ‘–—Ž†‡…‡”…‡–ƒ”‡ǡ’ƒ…‹‡ì‹‹…ƒ”‡˜‘”ϐ‹–”ƒ–ƒì‹’”‹ „›–Š‡‘†‹ϐ‹‡†‡–Š‘†ȋΪƒ†Ȍǡ–Š‡–”‡ƒ–‡–
‡–‘†ƒ‘†‹ϐ‹…ƒ–£ȋΪè‹Ȍǡ”‡—è‹–ƒ–”ƒ–ƒ‡–—Ž—‹˜ƒ success will be 75.0% (P1 αͲǤ͹ͷȌǤ
ϐ‹†‡͹ͷǡͲΨȋ1αͲǡ͹ͷȌǤ Pαȋ0 + P1ȌȀʹαͲǤ͸Ͳ
Pαȋ0 + P1ȌȀʹαͲǡ͸Ͳ ZȽȂ–ƒ„Ž‡˜ƒŽ—‡ǤŠ‡–Š‡•–ƒ–‹•–‹…ƒŽ•‹‰‹ϐ‹…ƒ…‡‹•ͻͷǤͲΨǡ
ZȽȂ˜ƒŽ‘ƒ”‡–ƒ„‡Žƒ”£ǤŸ†•‡‹ϐ‹…ƒì‹ƒ•–ƒ–‹•–‹…£‡•–‡†‡ –Š‡–Š‡…‘‡ˆϐ‹…‹‡–ZȽαͳǤͻ͸
ͻͷǤͲΨǡƒ–—…‹…‘‡ϐ‹…‹‡–—ŽZȽαͳǤͻ͸Ǥ ZȾ Ȃ–ƒ„Ž‡˜ƒŽ—‡ǤŠ‡–Š‡•–ƒ–‹•–‹…ƒŽ’‘™‡”‘ˆ–Š‡…‘’ƒ”‹-
ZȾ Ȃ˜ƒŽ‘ƒ”‡–ƒ„‡Žƒ”£ǤŸ†’—–‡”‡ƒ•–ƒ–‹•–‹…£ƒ…‘’ƒ”ƒì‹‡‹ •‘‹•ͺͲǤͲΨǡ–Š‡–Š‡…‘‡ˆϐ‹…‹‡–ZȾ αͲǤͺͶ
‡•–‡†‡ͺͲǤͲΨǡƒ–—…‹…‘‡ϐ‹…‹‡–—ŽZȾ αͲǡͺͶ ˆ α –Š‡ ’”‘’‘”–‹‘ ‘ˆ •—„Œ‡…–• ‡š’‡…–‡† –‘ ƒ„ƒ†‘ –Š‡
ˆ α ’”‘’‘”싃 •—„‹‡…ì‹Ž‘” …ƒ”‡ •‡ ƒè–‡ƒ’–£ •£ ƒ„ƒ†‘‡œ‡ study for reasons other than the effect investigated “ ε 1Ȁȋ1ǦˆȌǡ
studiul din motive diferite de efectul investigat “ ε 1Ȁȋ1ǦˆȌǡ ˆαͳͲǡͲΨȋͲǡͳȌǤ
ˆ αͳͲǡͲΨȋͲǡͳȌǤ ›‡–‡”‹‰–Š‡†ƒ–ƒ‹–‘–Š‡ˆ‘”—Žƒ™‡‘„–ƒ‹‡†ǣ
–”‘†—…Ÿ††ƒ–‡Ž‡Áˆ‘”—Ž£ǡƒ‘„싐—–ǣ
1 2(1.96 + 0.84)2 x0.60x0.40
nα (1 – 0.1) ´ αͶ͸
ȋͲǤͶͷȂͲǤ͹ͷȌ2
‡–”—…‡”…‡–ƒ”‡ǡ•Ǧƒ—ƒ’Ž‹…ƒ–†‘—£‡–‘†‡‘†‹ϐ‹…ƒ–‡†‡
–”ƒ–ƒ‡–ǡÁ…‘’ƒ”ƒì‹‡…—‡–‘†ƒ…Žƒ•‹…£Ǥ
胆ƒ”ǡŽ‘–—Ž†‡…‡”…‡–ƒ”‡1Aƒ‹…Ž—•ͷͲ†‡’ƒ…‹‡ì‹…—ǡ
Žƒ…ƒ”‡ƒˆ‘•–ƒ’Ž‹…ƒ–£‡–‘†ƒ‘†‹ϐ‹…ƒ–£†‡–”ƒ–ƒ‡–…—
è‹ Ž‘–—Ž 1Bǡ …ƒ”‡ ƒ ‹…Ž—• ͷͲ †‡ ’ƒ…‹‡ì‹ …— ǡ Žƒ …ƒ”‡ ƒ ˆ‘•–
ƒ’Ž‹…ƒ–£‡–‘†ƒ‘†‹ϐ‹…ƒ–£†‡–”ƒ–ƒ‡–…—ΪǤ‘–—Ž†‡
control L0ƒ‹…Ž—•ͷͲ†‡’ƒ…‹‡ì‹…—ǡ…ƒ”‡ƒ—ˆ‘•––”ƒ–ƒì‹’”‹
aplicarea metodei clasice cu MT.
ƒ”ƒ‡–”‹‹ ’”‹…‹’ƒŽ‹ Á”‡‰‹•–”ƒì‹ ƒ— ˆ‘•–ǣ —£”—Ž ƒ”–‹…—-
ȌȂŒ‘‹–‹†‡šʹͺǡ—„‡”‘ˆ•™‘ŽŽ‡Œ‘‹–•ȋ
ȌȂ
Žƒì‹‹Ž‘”†—”‡”‘ƒ•‡ȋȌȂ‹†‹…‡Ž‡ƒ”–‹…—Žƒ”ʹͺǡ—£”—Žƒ”–‹-
…—Žƒì‹‹Ž‘”–—‡ϐ‹ƒ–‡ȋȌȂ‹†‹…‡Ž‡ƒ”–‹…—Žƒ”ʹͺǡ‹–‡•‹–ƒ–‡ƒ
†—”‡”‹‹†—’£•…ƒŽƒ˜‹œ—ƒŽ£ƒƒŽ‘‰£ȋȌǡ’”‘–‡‹ƒ”‡ƒ…–‹˜£
ȋȌǡ ˜‹–‡œƒ †‡ •‡†‹‡–ƒ”‡ ƒ Š‡ƒ–‹‹Ž‘” ȋȌ è‹ …ƒŽ‹–ƒ–‡ƒ
˜‹‡ì‹‹ȋȌǤ
˜Ÿ†Á˜‡†‡”‡’”‡œ‡ìƒÁ‡šƒ‡—Ž•–ƒ–‹•–‹…ƒŽ‰”—’—”‹-
Ž‘”…—ƒ‹—Ž–‡–‹’—”‹ƒŽ‡˜ƒ”‹ƒ„‹Ž‡Ž‘”ȋ‘‹ƒŽ‡è‹•…ƒŽƒ”‡Ȍǡ
ƒ—ˆ‘•–ƒ’Ž‹…ƒ–‡–”‡‹˜ƒ”‹ƒ–‡†‡’”‡Ž—…”ƒ”‡•–ƒ–‹•–‹…£ǣ
ͳȌ †ƒ…£ ƒ„‡Ž‡ ˜ƒ”‹ƒ„‹Ž‡ …‘”‡•’—†‡ƒ— –‹’—Ž—‹ ‘‹ƒŽǡ
ƒ–—…‹ •Ǧƒ …ƒŽ…—Žƒ– –ƒ„‡Ž—Ž ˆ”‡…˜‡ì‡‹ †‹•–”‹„—ì‹‹Ž‘” …‘—‡ǡ
…ƒ”‡ƒˆ‘•–…‘–”‘Žƒ–…—ƒŒ—–‘”—Ž…”‹–‡”‹—Ž—‹ɖ;Ǣ
ʹȌ†ƒ…£—ƒ†‹˜ƒ”‹ƒ„‹Ž‡…‘”‡•’—†‡ƒ–‹’—Ž—‹‘‹ƒŽǡ‹ƒ”
ƒŽ–ƒ–‹’—Ž—‹•…ƒŽƒ”ǡƒ–—…‹ǡ†—’£†ƒ–‡Ž‡˜ƒ”‹ƒ„‹Ž‡‹†‡–‹’‘‹ƒŽǡ
‰”—’—Žƒˆ‘•–•‡’ƒ”ƒ–Á•—„‰”—’‡ǡ…—…‡”…‡–ƒ”‡ƒ‹‹ì‹ƒŽ£ƒ˜ƒ-
Ž‘”‹Ž‘”–‹’•…ƒŽƒ”†—’£‡–‘†ƒ–—†‡–苃ƒƒŽ‹œ‡‹†‹•’‡”•‹‡‹Ǣ
͵Ȍ†ƒ…£ƒ„‡Ž‡˜ƒ”‹ƒ„‹Ž‡…‘”‡•’—†‡ƒ—–‹’—Ž—‹•…ƒŽƒ”ǡ†‡…‹ǡ
‹‹ì‹ƒŽ •—– †‡–‡”‹ƒ–‡ ˜ƒŽ‘”‹Ž‡ ‡†‹‹ǡ ƒ–—…‹ǡ Á …ƒŽ‹–ƒ–‡ †‡
ƒƒŽ‹œ£•–ƒ–‹•–‹…£•Ǧƒ‡ˆ‡…–—ƒ–…‡”…‡–ƒ”‡ƒ…—‘†‹ϐ‹…ƒ”‡ƒ—‡‹
˜ƒŽ‘”‹‡†‹‹‹ϐŽ—‡ì‡ƒœ£‘†‹ϐ‹…ƒ”‡ƒƒŽ–‡‹˜ƒŽ‘”‹Ǥ
èƒ …— •Ǧƒ ‡ì‹‘ƒ– ƒ–‡”‹‘”ǡ ƒƒŽ‹œƒ ϐ‹ƒŽ£ ’”‹…‹’ƒŽ£
ƒ‡ϐ‹…ƒ…‹–£ì‹‹ƒˆ‘•–‡ˆ‡…–—ƒ–£Á–‘ƒ–‡…‡Ž‡–”‡‹‰”—’—”‹†‡’ƒ…‹-
‡ì‹ǣÁ’‘’—Žƒì‹ƒ•‡Ž‡…–ƒ–£’‡„ƒœ£†‡…‘”‡•’—†‡”‡è‹Á”Ÿ-
1 2(1.96 + 0.84)2 x0.60x0.40
nα (1 – 0.1) ´ αͶ͸
ȋͲǤͶͷȂͲǤ͹ͷȌ2
‘” –Š‡ ”‡•‡ƒ”…Šǡ –™‘ ‘†‹ϐ‹‡† –”‡ƒ–‡– ‡–Š‘†• ™‡”‡
applied compared to the classical method.
Thus, the L1A study group included 50 patients with RA
™Š‘™‡”‡–”‡ƒ–‡†™‹–Š–Š‡‘†‹ϐ‹‡†–”‡ƒ–‡–‡–Š‘†ǡ
and L1B included 50 patients with RA who were treated with
–Š‡‘†‹ϐ‹‡†–”‡ƒ–‡–‡–Š‘†ΪǤŠ‡0 control group
included 50 RA patients who were treated using the classical
MT method.
Š‡ƒ‹”‡‰‹•–‡”‡†’ƒ”ƒ‡–‡”•™‡”‡ǣ—„‡”‘ˆ’ƒ‹ˆ—Ž
Œ‘‹–•ȋ
joint index 28, pain assessment using the visual analogue pain
intensity scale (VAS), C-reactive protein (CRP), erythrocyte
sedimentation rate (ESR) and quality of life (HAQ).
Given the presence in the statistical examination of groups
with several types of variables (nominal and scalar), three sta-
–‹•–‹…ƒŽ’”‘…‡••‹‰˜ƒ”‹ƒ–•™‡”‡ƒ’’Ž‹‡†ǣ
1) if both variables corresponded to the nominal type, then
the table of the frequency of common distributions was calcu-
Žƒ–‡†ǡ™Š‹…Š™ƒ•…‘–”‘ŽŽ‡†„›–Š‡…”‹–‡”‹‘ɖ;Ǣ
2) if one of the variables corresponded to the nominal type
and the other to the scalar type, then according to the data of
the nominal type variable, the group was subdivided into sub-
groups with the initial scalar type value research according to
the Student method and the dispersion analysis;
3) if both variables corresponded to the scalar type, and
thus the average values are initially determined, then, as a sta-
tistical analysis, the research studying the way modifying an
ƒ˜‡”ƒ‰‡˜ƒŽ—‡ ‹ϐŽ—‡…‡•–Š‡ƒŽ–‡”ƒ–‹‘‘ˆƒ‘–Š‡”˜ƒŽ—‡ ™ƒ•
carried out.
• ‡–‹‘‡† ƒ„‘˜‡ǡ –Š‡ ƒ‹ ϐ‹ƒŽ ƒƒŽ›•‹• ‘ˆ ‡ˆϐ‹…ƒ…›
™ƒ•’‡”ˆ‘”‡†‹ƒŽŽ–Š”‡‡’ƒ–‹‡–‰”‘—’•ǣ‹–Š‡’‘’—Žƒ–‹‘
selected on the basis of compliance and among the selected
 36 ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–o‹†‡

Design-ul studiului Study design

 Pacienìii cu AR RA patients


 Monoterapie ‡”ƒ’‹‡…‘„‹ƒ–£ ‡”ƒ’‹‡„‹‘Ž‘‰‹…£ Monotherapy Combination therapy Biological therapy
(MT) (n=50) (MT+SLZ) (n=50) (TOC) (n=50) (MT) (n=50) (MT+SLZ) (n=50) (TOC) (n=50)

 Ini ial T0
Initially T0


– IA-28, NAD, NAT, SVA, DAS28, HAQ Clinical assessment ± IA-28, NPJ, NDJ, VAS, DAS28, HAQ
 – General paraclinical investigations ± general blood analysis and urinalysis; biochemical
 tests; inflammation indices; renal function;
– radiografia articulaЮiilor afectate. Instrumental investigations ± radiography of the affected joints

7±OXQL T2 ± 6 months

7±OXQL T3 ± 9 months

 – IA-28, NAD, NAT, SVA, DAS28, HAQ (ACR20, ACR50, ACR70) Clinical assessment ± IA-28, NPJ, NDJ, VAS, DAS28, HAQ (ACR20, ACR50, ACR70)
– inei; teste General paraclinical investigations ± general blood analysis and urinalysis; biochemical

tests; inflammation indices; renal function;

7±OXQL T4 ± 12 months


– IA-28, NAD, NAT, SVA, DAS28, HAQ (ACR20, ACR50, ACR70) Clinical assessment ± IA-28, NPJ, NDJ, VAS, DAS28, HAQ (ACR20, ACR50, ACR70)

– General paraclinical investigations ± general blood analysis and urinalysis; biochemical

biochimice; indicii infla tests; inflammation indices; renal function;
 – radiografia articulaЮiilor afectate Instrumental investigations ± radiography of the affected joints



ANALYSIS AND PROCESSING OF THE DATA OBTAINED
 CONCLUSIONS AND PRACTICAL RECOMMENDATIONS


†—Ž’‘’—Žƒì‹‡‹•‡Ž‡…–ƒ–£’‡„ƒœ£†‡–”ƒ–ƒ‡–ǤƒŽ‹œƒ‹†‹…‹Ž‘” treatment-based population. The analysis of performance

†‡ ’‡”ˆ‘”ƒì£ ƒ ˆ‘•– ‡ˆ‡…–—ƒ–£ †‘ƒ” Á–”Ǧ‘ ’‘’—Žƒì‹‡ Žƒ ’ƒ-
…‹‡ì‹‹•‡Ž‡…–ƒì‹’‡„ƒœ£†‡…‘”‡•’—†‡”‡ǤƒŽ‹œƒ•‹‰—”ƒì‡‹ǡ
‡ϐ‹…ƒ…‹–£ì‹‹è‹–‘Ž‡”ƒ„‹Ž‹–£ì‹‹ƒˆ‘•–‡ˆ‡…–—ƒ–£Žƒ–‘ì‹’ƒ…‹‡ì‹‹…ƒ”‡
ƒ—’”‹‹–…‡Ž’—싐‘†‘œ£†‡‡†‹…ƒ‡–†‡•–—†‹—ȏ͵ǡ͹ȐǤ
‡–”—ƒƒŽ‹œƒ•–ƒ–‹•–‹…£ǡ•Ǧƒ—ˆ‘Ž‘•‹–‡–‘†‡‡’ƒ”ƒ‡–”‹-
…‡Ǥ ‡‹ϐ‹…ƒì‹ƒ †‹ƒ‹…‹‹ ƒ ˆ‘•– ƒƒŽ‹œƒ–£ Á ϐ‹‡…ƒ”‡ ‰”—’ †‡
–”ƒ–ƒ‡–ǡˆ‘Ž‘•‹†–‡•–—Ž‹Ž…‘š‘Ǥ‡–”—ƒ‡˜ƒŽ—ƒ•‡‹ϐ‹-
…ƒì‹ƒ†‹ˆ‡”‡ì‡‹…ƒ”ƒ…–‡”‹•–‹…‹Ž‘”ˆ”‡…˜‡ì‡‹ǡƒˆ‘•–—–‹Ž‹œƒ––‡•–—Ž
‹•Š‡”Ǥ ‡–”— ‡˜ƒŽ—ƒ”‡ƒ •‡‹ϐ‹…ƒì‹‡‹ †‹ˆ‡”‡ì‡Ž‘” Žƒ ‹†‹…ƒ-
torii cantitativi, în grupuri de tratament individual, s-a folosit
U-testul Mann-Whitney. Datele au fost prelucrate statistic cu
soft-ul STATISTICA 7.0.
indices has only been performed in a population of patients
•‡Ž‡…–‡†‘–Š‡„ƒ•‹•‘ˆ…‘’Ž‹ƒ…‡Ǥƒˆ‡–›ǡ‡ˆϐ‹…ƒ…›ƒ†–‘Ž‡”-
ability analysis was performed in all patients who received at
least one dose of the study drug [3, 7].
Nonparametric methods were used for the statistical ƒnƒǦ
Ž›•‹•Ǥ Š‡ •‹‰‹ϐ‹…ƒ…‡ ‘ˆ –Š‡ †›ƒ‹…• ™ƒ• ƒƒŽ›•‡† ‹ ‡ƒ…Š
treatment group using the Wilcoxon test. To evaluate the sig-
‹ϐ‹…ƒ…‡‘ˆ†‹ˆˆ‡”‡…‡•‹ˆ”‡“—‡…›…Šƒ”ƒ…–‡”‹•–‹…•™‡—•‡†
the Fisher`s test. The Mann-Whitney U-test was used to eva-
Ž—ƒ–‡ –Š‡ •‹‰‹ϐ‹…ƒ…‡ ‘ˆ †‹ˆˆ‡”‡…‡• ‹ –Š‡ “—ƒ–‹–ƒ–‹˜‡ ‹†‹-
ces in individual treatment groups. The data were statistically
processed in the STATISTICA 7.0 software package.

‡œ—Ž–ƒ–‡
˜ƒŽ—ƒ”‡ƒ ’ƒc‹‡n싎o” ‰”—’—Ž—‹ †‡ –”ƒ–ƒ‡n– „‹oŽo‰‹c c— oǦ
c‹Ž‹œ—ƒ„
‹ ͷͲ †‡ ’ƒ…‹‡ì‹ ”ƒ†‘‹œƒì‹ …— –‡”ƒ’‹‡ „‹‘Ž‘‰‹…£ ǡ
ƒ— ϐ‹ƒŽ‹œƒ– –”ƒ–ƒ‡–—Ž †‡ϐ‹‹–‹˜ Á …ƒ†”—Ž •–—†‹—Ž—‹ ͷͲ †‡
’ƒ…‹‡ì‹ǡ ͳͶ ȋʹͺΨȌ •—– Žƒ –”ƒ–ƒ‡– …‘–‹——Ǥ B ”‡œ—Ž–ƒ–—Ž
ƒ…–—ƒŽ—Ž—‹•–—†‹—ȋϐ‹ƒŽ‹œƒ–Á†‡…‡„”‹‡ʹͲͳͷǡ–‹’—Ž‡†‹—
†‡ƒ†‹‹•–”ƒ”‡ͳʹŽ—‹ǡ‹‹Ȃ͸Ž—‹ȌǡŽƒͳ͵†‹ͳͶ„‘Žƒ˜‹
‡ˆ‡…–—Žϐ‹ƒŽ‘„싐—–•‡‡ì‹‡ˆ‡”ǣ͸„‘Žƒ˜‹…—”‡‹•‹—‡ǡ
͸„‘Žƒ˜‹…—ƒ‡Ž‹‘”ƒ”‡ǡ—’ƒ…‹‡–’”‡œ‹–£ƒ‡Ž‹‘”ƒ”‡…‘-
form criteriilor ACR.
‡‹•‹—‡ƒ ’”‡…‘…‡ ’‡”•‹•–‡–£ǡ ‘„싐—–£ ‡†‹…ƒ‡–‘•ǡ
•Ǧƒ‡˜‹†‡ì‹ƒ–Žƒ‘’ƒ…‹‡–£–‹’†‡ͳǡͷƒ‹ǡŽƒ͵’ƒ…‹‡ì‹Ȃ–‹’
Results
˜ƒŽ—ƒ–‹on oˆ –Š‡ ’ƒ–‹‡n–• ˆ”o –Š‡ ‰”o—’ oˆ „‹oŽo‰‹cƒŽ –”‡ƒ–Ǧ
‡n– ™‹–Š oc‹Ž‹œ—ƒ„
Out of 50 patients randomized to TOC biological therapy, 50
’ƒ–‹‡–•†‡ϐ‹‹–‹˜‡Ž›…‘’Ž‡–‡†–Š‡–”‡ƒ–‡–™‹–Š‹–Š‡•–—†›ǡ
14 (28%) of them being on continuous treatment. As a result of
–Š‡…—””‡–•–—†›ȋϐ‹ƒŽ‹œ‡†‹‡…‡„‡”ʹͲͳͷǡƒ˜‡”ƒ‰‡ƒ†‹-
‹•–”ƒ–‹‘’‡”‹‘†Ȃͳʹ‘–Š•ǡ™‹–Šƒ‹‹—‘ˆ͸‘–Š•Ȍǡ‹
ͳ͵‘—–‘ˆͳͶ’ƒ–‹‡–•ǡ–Š‡ϐ‹ƒŽ‡ˆˆ‡…–‘„–ƒ‹‡†‹•ϐ‹”Ž›ƒ‹-
–ƒ‹‡†ǣ͸’ƒ–‹‡–•™‹–Š”‡‹••‹‘ǡ͸’ƒ–‹‡–•™‹–Š‹’”‘˜‡‡–ǡ
1 patient with improvement according to ACR criteria.
Early persistent, drug-obtained remission was seen in 1
ˆ‡ƒŽ‡ ’ƒ–‹‡– ˆ‘” ͳǤͷ ›‡ƒ”•ǡ ‹ ͵ ’ƒ–‹‡–• Ȃ ˆ‘” ʹ ›‡ƒ”•ǡ ‹ ͳ
†‡ʹƒ‹ǡŽƒ‘’ƒ…‹‡–£Ȃʹǡͷƒ‹ǡŽƒ‘’ƒ…‹‡–£Ȃ͵ǡͷƒ‹Ǥƒͷ†‹ ˆ‡ƒŽ‡’ƒ–‹‡–ȂʹǤͷ›‡ƒ”•ǡ‹ͳˆ‡ƒŽ‡’ƒ–‹‡–Ȃ͵Ǥͷ›‡ƒ”•Ǥ
—ƒŽ‹–› oˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– oˆ ”Š‡—ƒ–o‹† ƒ”–Š”‹–‹• MJHS 17(3)/2018 37

͸’ƒ…‹‡ì‹ƒ‹ƒ…‡•–—‹Ž‘–ǡ•Ǧƒ†‡–‡”‹ƒ–—†‡„—–’”‡…‘…‡ƒŽ 5 out of 6 patients in this group, an early onset of RA was de-

ȋÁ‡†‹—ǡ„‘ƒŽƒƒ’‡”•‹•–ƒ–Ͳǡ͸ͻƒ‹ȌǤB…£Žƒ͸’ƒ…‹‡ì‹ǡ’‡’ƒ”- termined (in average, the disease persisted for 0.69 years). In
…—”•—ŽƒͲǡͷǦʹƒ‹†‡‡˜‹†‡ì£‡†‹…ƒŽ£ǡƒ—’‡”•‹•–ƒ–‡ˆ‡…–‡Ž‡ other 6 patients over the course of 0.5-2 years of medical su-
’‘œ‹–‹˜‡‘„싐—–‡ǡ…‘•–‹–—‹†Á„—£–£ì‹”‡’‡–”—ͷͲǡ‹ƒ” pervision, persisted the obtained positive effects, constituting
Žƒ—’ƒ…‹‡–ȂʹͲǡ…ƒ”‡ƒˆ‘•–•–ƒ„‹Žȋƒ…‡•–’ƒ…‹‡–ƒ•…Š‹- ‹’”‘˜‡‡– ˆ‘” ͷͲ ƒ† ‹ ‘‡ ’ƒ–‹‡– Ȃ ʹͲǡ ™Š‹…Š
„ƒ–ǡ—Ž–‡”‹‘”ǡ–‡”ƒ’‹ƒ„‹‘Ž‘‰‹…£’‡ ȌǤ was stable (this patient subsequently changed the TOC biologi-
ˆ‡…–—Ž ‘„싐—– …£–”‡ •ˆŸ”è‹–—Ž –‡”ƒ’‹‡‹ „‹‘Ž‘‰‹…‡  •Ǧƒ cal therapy for LF).
‹…è‘”ƒ–†‘ƒ”Žƒ—’ƒ…‹‡–ȋ–”ƒ–ƒ‡–—Ž•–—†‹ƒ–ƒˆ‘•–•…Š‹- The effect achieved at the end of the biological treatment
bat pe tratament DMARD LF). with TOC decreased in only one patient (the treatment studied
B”‡œ—Ž–ƒ–—Ž‡˜‹†‡ì‡‹’ƒ…‹‡ì‹Ž‘”…ƒ”‡ƒ—”‡ƒŽ‹œƒ––‡”ƒ’‹ƒ was changed to DMARD LF treatment).
„‹‘Ž‘‰‹…£ǡ†—’£ƒ„ƒ†‘ƒ”‡ƒ–”ƒ–ƒ‡–—Ž—‹”‡ƒ…ì‹‹ƒ†˜‡”- As a result of the evidence of patients who followed bio-
•‡—ƒ—ˆ‘•–Á”‡‰‹•–”ƒ–‡ǤB…ƒ†”—Ž”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡–ƒ”†‹˜‡ǡ logical therapy with TOC, after the treatment was abandoned,
ƒ—ˆ‘•–Á”‡‰‹•–”ƒ–‡Žƒʹ’ƒ…‹‡ì‹…”‡è–‡”‡ƒ–”ƒ•ƒ‹ƒœ‡Ž‘”†‹ no adverse reactions were recorded. Among the late-onset ad-
•‡”—ƒ‹—Ž–†‡ʹ‘”‹ˆƒì£†‡˜ƒŽ‘”‹Ž‡‘”ƒŽ‡è‹ƒ‡‹‡…— verse reactions, in 2 patients serum transaminases increased
‘Š‡‘‰Ž‘„‹£—ƒ‹Œ‘ƒ•£†‡ͳͲͲ‰ȀŽǡ‹ƒ”ŽƒͶ’ƒ…‹‡ì‹ƒ—ˆ‘•– by no more than 2 times the normal values and anemia with
Á”‡‰‹•–”ƒ–‡‹ˆ‡…ì‹‹”‡•’‹”ƒ–‘”‹‹˜‹”ƒŽ‡ƒ…—–‡Ǥ not less than 100 g/l Hb was recorded, and in 4 patients acute
‡ƒ•‡‡‡ƒǡƒ—ˆ‘•–•—’”ƒ˜‡‰Š‡ƒì‹ͺ„‘Žƒ˜‹ǡŽƒ…ƒ”‡–‡”ƒ- viral respiratory infections were recorded.
’‹ƒ„‹‘Ž‘‰‹…£ƒˆ‘•–•…Š‹„ƒ–£ϐ‹‡…Š‹ƒ”†—’£–‡”‹ƒ”‡ƒ Also, 8 patients were monitored for which TOC biological
–”ƒ–ƒ‡–—Ž—‹ †ƒ–ǡ ϐ‹‡ …£–”‡ ϐ‹ƒŽ‹œƒ”‡ƒ •–—†‹—Ž—‹ ’”‘’”‹—Ǧœ‹•ǡ therapy was changed either after the end of the given treat-

Tabelul 1. Criteriile de diagnostic EULAR din 2010.

‡–”—ƒ•–ƒ„‹Ž‹†‹ƒ‰‘•–‹…—Ž†‡‡•–‡‡…‡•ƒ”—•…‘”†‡η͸†‹ͳͲc
Ǥ’Ž‹…ƒ”‡ƒƒ”–‹…—Žƒ”£d
ƒ”–‹…—Žƒì‹‡ƒ”‡e 0 puncte
ʹǦͳͲƒ”–‹…—Žƒì‹‹ƒ”‹     ͳ’—…–‡
ͳǦ͵ƒ”–‹…—Žƒì‹‹‹…‹ȋ…—•ƒ—ˆ£”£‹’Ž‹…ƒ”‡ƒƒ”–‹…—Žƒì‹‹Ž‘”ƒ”‹Ȍf 2 puncte
ͶǦͳͲƒ”–‹…—Žƒì‹‹‹…‹ȋ…—•ƒ—ˆ£”£‹’Ž‹…ƒ”‡ƒƒ”–‹…—Žƒì‹‹Ž‘”ƒ”‹Ȍ ͵’—…–‡
>ͳͲƒ”–‹…—Žƒì‹‹ȋ…‡Ž’—싐ͳƒ”–‹…—Žƒì‹‡‹…£Ȍg 5 puncte
Ǥ‡”‘Ž‘‰‹‡ȋ‡•–‡‡…‡•ƒ”…‡Ž’—싐—”‡œ—Ž–ƒ–ƒŽ–‡•–—Ž—‹Ȍh
‡‰ƒ–‹˜è‹ƒ–‹Ǧ‡‰ƒ–‹˜    Ͳ’—…–‡
FR slab-pozitiv sau anti-CCP slab-pozitiv 2 puncte
FR înalt-pozitiv sau anti-CCP înalt-pozitiv 3 puncte
Ǥ‡ƒ…–ƒì‹‹†‡ˆƒœ£ƒ…—–£ȋ‡•–‡‡…‡•ƒ”…‡Ž’—싐—”‡œ—Ž–ƒ–ƒŽ–‡•–—Ž—‹Ȍi
ƒŽ‘”‹Ž‡‘”ƒŽ‡ƒŽ‡è‹    Ͳ’—…–‡
ƒŽ‘”‹Ž‡…”‡•…—–‡ƒŽ‡è‹    ͳ’—…–‡
D. Durata simptomatologiei j
δ͸•£’–£Ÿ‹   Ͳ’—…–‡
η͸•£’–£Ÿ‹      ͳ’—…–‡

a
…‡•–‡ …”‹–‡”‹‹ •—– ‘”‹‡–ƒ–‡ •’”‡ …Žƒ•‹ϐ‹…ƒ”‡ƒ ’ƒ…‹‡ì‹Ž‘” ’”‹ƒ” ’”‡œ‡–ƒì‹Ǥ B ƒ†‹ì‹‡ǡ ’ƒ…‹‡ì‹‹ …— ’ƒ–‘Ž‘‰‹‡ ‡”‘œ‹˜£ –‹’‹…£ ’‡–”— ƒ”–”‹–ƒ ”‡—ƒ–‘‹†£ è‹ — ‹•–‘”‹…
…‘’ƒ–‹„‹Ž†‡Á†‡’Ž‹‹”‡ƒ–‡”‹‘ƒ”£ƒ…”‹–‡”‹‹Ž‘”†‹ʹͲͳͲǡƒ”–”‡„—‹ǡ†‡ƒ•‡‡‡ƒǡ†‹ƒ‰‘•–‹…ƒì‹…—Ǥg‹’ƒ…‹‡ì‹‹…—†—”ƒ–ƒŽ—‰£ƒ„‘Ž‹‹ǡ‹…Ž—•‹˜ǡ…‡‹Žƒ…ƒ”‡„‘ƒŽƒ‡•–‡
‹ƒ…–‹˜£ȋ…—•ƒ—ˆ£”£–”ƒ–ƒ‡–Ȍǡ’‡„ƒœƒ†ƒ–‡Ž‘””‡–”‘•’‡…–‹˜‡†‹•’‘‹„‹Ž‡è‹…ƒ”‡ƒ—Á†‡’Ž‹‹–ǡƒ–‡”‹‘”ǡ…”‹–‡”‹‹Ž‡†‹ʹͲͳͲǡƒ”–”‡„—‹†‹ƒ‰‘•–‹…ƒì‹…—Ǥ
b
‹ƒ‰‘•–‹…—Ž†‹ˆ‡”‡ì‹ƒŽ˜ƒ”‹ƒœ£Á–”‡’ƒ…‹‡ì‹‹…—’”‡œ‡–£”‹†‹ˆ‡”‹–‡ǡ†ƒ”ƒ”’—–‡ƒ‹…Ž—†‡ƒèƒ’ƒ–‘Ž‘‰‹‹…ƒŽ—’—•—Ž‡”‹–‡ƒ–‘•†‡•‹•–‡ǡƒ”–”‹–ƒ’•‘”‹ƒœ‹…£è‹‰—–ƒǤƒ…£
ƒŽƒ†‹‹Ž‡ǡ…‡‡…‡•‹–£ƒϐ‹†‹ˆ‡”‡ì‹ƒ–‡ǡ—•—–…Žƒ”‡ǡ•‡”‡…‘ƒ†£…‘•—Ž–ƒì‹ƒ——‹•’‡…‹ƒŽ‹•–†‡’”‘ϐ‹ŽǤ
c
‡è‹’ƒ…‹‡ì‹‹…——•…‘”δ͸†‹ͳͲ—’‘–ϐ‹†‹ƒ‰‘•–‹…ƒì‹…—ǡ•–ƒ–—–—ŽŽ‘”’‘ƒ–‡ϐ‹ƒ’”‡…‹ƒ–†‹‘—è‹…”‹–‡”‹‹Ž‡ƒ”’—–‡ƒϐ‹…——Žƒ–‡’‡’ƒ”…—”•—Ž–‹’—Ž—‹Ǥ
d
’Ž‹…ƒ”‡ƒƒ”–‹…—Žƒ”£•‡”‡ˆ‡”£Žƒ‘”‹…‡ƒ”–‹…—Žƒì‹‡–—‡ϐ‹ƒ–£•ƒ—†—”‡”‘ƒ•£Žƒ‡šƒ‹ƒ”‡ǡ…ƒ”‡ƒ”’—–‡ƒϐ‹…‘ϐ‹”ƒ–£’”‹†ƒ–‡‹ƒ‰‹•–‹…‡†‡•‹‘˜‹–£Ǥ”–‹…—Žƒì‹‹Ž‡ ǡ
’”‹ƒƒ”–‹…—Žƒì‹‡…ƒ”’‘‡–ƒ…ƒ”’‹ƒ£è‹’”‹ƒƒ”–‹…—Žƒì‹‡•—–‡š…Ž—•‡†‹ƒ’”‡…‹‡”‡Ǥƒ–‡‰‘”‹‹Ž‡†‡†‹•–”‹„—싇ƒƒ”–‹…—Žƒì‹‹Ž‘”•—–†‡–‡”‹ƒ–‡Á…‘ˆ‘”‹–ƒ–‡…—
Ž‘…ƒŽ‹œƒ”‡ƒè‹—£”—Ž…‡Ž‘”‹’Ž‹…ƒ–‡ǡ‹ƒ”ƒ’”‡…‹‡”‡ƒƒ”‡Ž‘…Á…‡ƒƒ‹ÁƒŽ–£…ƒ–‡‰‘”‹‡’‘•‹„‹Ž£Á„ƒœƒƒ‹‡”‡‹†‡‹’Ž‹…ƒ”‡ƒ”–‹…—Žƒ”£Ǥ
e
”–‹…—Žƒì‹‹Ž‡ƒ”‹•—–—£”—Žǡ…‘–—Žǡ葎†—Žǡ‰‡—…Š‹—Žè‹‰Ž‡œƒǤ
f
”–‹…—Žƒì‹‹Ž‡‹…‹•—–ǡ ǡǦǡ‹–‡”ˆƒŽƒ‰‹‡‡ƒŽ‡’‘Ž‹…‡Ž—‹ǡŠƒŽ—…‡Ž—‹è‹”ƒ†‹‘…ƒ”’‹ƒ£Ǥ
g
Bƒ…‡ƒ•–£…ƒ–‡‰‘”‹‡ǡ…‡Ž’—싐—ƒ†‹ƒ”–‹…—Žƒì‹‹Ž‡ƒˆ‡…–ƒ–‡–”‡„—‹‡•£ϐ‹‡‹…£Ǣ…‡Ž‡ŽƒŽ–‡’‘–‹…Ž—†‡‘”‹…ƒ”‡†‹…‘„‹ƒì‹‹Ž‡†‡ƒ”–‹…—Žƒì‹‹ƒ”‹è‹‹…‹ƒ†‹ì‹‘ƒŽ‡ǡƒŽ–‡
ƒ”–‹…—Žƒì‹‹…‡—ƒ—ˆ‘•–‡—‡”ƒ–‡ÁƒŽ–£’ƒ”–‡ȋ‡šǤ–‡’‘”‘ƒ†‹„—Žƒ”£ǡƒ…”‘‹‘…Žƒ˜‹…—Žƒ”£ǡ•–‡”‘…Žƒ˜‹…—Žƒ”£‡–…ǤȌǤ
h
‡‰ƒ–‹˜•‡”‡ˆ‡”£Žƒ‹˜‡Ž‡ƒŽ‡ƒ‹Œ‘ƒ•‡†‡…Ÿ–Ž‹‹–ƒ•—’‡”‹‘ƒ”£ƒ‘”‡‹…‘”‡•’—œ£–‘ƒ”‡Žƒ„‘”ƒ–‘”—Ž—‹è‹‹–—Ž—‹—–‹Ž‹œƒ–Ǣ•Žƒ„’‘œ‹–‹˜•‡”‡ˆ‡”£Žƒ˜ƒŽ‘”‹…”‡•…—–‡ƒŽ‡
ǡ†ƒ”ζ͵‘”‹ƒ‹ƒ”‹†‡…Ÿ–Ž‹‹–ƒ•—’‡”‹‘ƒ”£ƒ‘”‡‹ǢÁƒŽ–’‘œ‹–‹˜•‡”‡ˆ‡”£Žƒ˜ƒŽ‘”‹ε͵‘”‹ƒ‹ƒ”‹†‡…Ÿ–Ž‹‹–ƒ•—’‡”‹‘ƒ”£ƒ‘”‡‹Ǥ–—…‹…Ÿ† ‡•–‡†‹•’‘‹„‹Ž
sub forma unui rezultat calitativ, rezultatul pozitiv este interpretat ca FR slab pozitiv.
i
ƒŽ‘”‹‘”ƒŽ‡è‹ƒ‘”ƒŽ‡•—–†‡–‡”‹ƒ–‡’‡„ƒœƒ•–ƒ†ƒ”†‡Ž‘”Ž‘…ƒŽ‡†‡Žƒ„‘”ƒ–‘”Ǥ
j
—”ƒ–ƒ•‹’–‘ƒ–‘Ž‘‰‹‡‹•‡”‡ˆ‡”£Žƒ†—”ƒ–ƒ”ƒ’‘”–ƒ–£†‡…£–”‡’ƒ…‹‡–ƒ•‡‡Ž‘”è‹•‹’–‘‡Ž‘”ȋ‡šǤ†—”‡”‡ǡ–—‡ϐ‹‡”‡Ȍ•‹‘˜‹–‡‹ƒ”–‹…—Žƒì‹‹Ž‘”‹’Ž‹…ƒ–‡Žƒ‘‡–—Ž
‡šƒ‹£”‹‹ǡ‹†‹ˆ‡”‡–†‡–”ƒ–ƒ‡–—Žƒ’Ž‹…ƒ–Ǥ
38
†ƒ”—ƒ‹Áƒ‹–‡†‡ͻŽ—‹†‡…‡”…‡–£”‹ǡƒ†‹…£ǡŽƒ‡–ƒ’ƒ…Ÿ†
…‘…Ž—œ‹‹Ž‡’”‡˜‡–‹˜‡’—–‡ƒ—ϐ‹•–ƒ„‹Ž‹–‡Ǥ
ƒ†‘‹’ƒ…‹‡ì‹ȋ——Ž…—Á„—£–£ì‹”‡ƒ‡ˆ‡…–—Ž—‹…—ͷͲΨè‹
ƒŽ†‘‹Ž‡ƒȂ…—ʹͲΨȌǡ–‡”ƒ’‹ƒ…‘„‹ƒ–£Ϊƒˆ‘•–•…Š‹-
„ƒ–£Žƒ Ǥƒ—œƒ†‡ƒ—Žƒ”‡ƒΪŽƒƒ…‡è–‹’ƒ…‹‡ì‹ƒˆ‘•–
’”‡œ‡ìƒ ‹…”‘‡ˆ”‘Ž‹–‹ƒœ‡‹ǡ ‘„‹‡…–‹˜‹œƒ–£ ’”‹ 
 ȋŽƒ ‹‹ì‹‡- LF. The cause of MT+SLZ cancellation in these patients was the
”‡ƒ –”ƒ–ƒ‡–—Ž—‹ •–—†‹ƒ–ǡ ƒ…‡è–‹ „‘Žƒ˜‹ †‡Œƒ ’”‡œ‡–ƒ— ’ƒ-
–‘Ž‘‰‹‡”‡‘Ǧ—”‹ƒ”£ǡ‡ì‹‘ƒ–£ƒ–‡”‹‘”ȌǤƒ‘’ƒ…‹‡–£•Ǧƒ
†‡œ˜‘Ž–ƒ–Š‡ƒ–—”‹‡‡Á•‡ƒ–£Ǥ‡’ƒ”…—”•—Ž—”£–‘ƒ”‡Ž‘”
͸ǦͳʹŽ—‹†‡‡˜‹†‡ì£ǡ…—–”‡…‡”‡ƒ†‡Žƒ–‡”ƒ’‹‡…‘„‹ƒ–£Žƒ
‘‘–‡”ƒ’‹‡ǡ•Ǧƒ‡˜‹†‡ì‹ƒ–•…£†‡”‡ƒ’”‘‰”‡•‹˜£ƒ‘†‹ϐ‹…£”‹-
lor patologice suplimentare (la un pacient, la ACR50 s-a men-
싐—–‡ˆ‡…–—Ž„‡‡ϐ‹…ǡ‹ƒ”ŽƒƒŽ–—ŽǡŽƒʹͲȌǤ”‡è–‡”‡ƒÁ˜‘Ž—
ƒ…ƒŽ…—Ž—Ž—‹”‡ƒŽ•Ǧƒ‡˜‹†‡ì‹ƒ–Žƒ‘•‹‰—”£’ƒ…‹‡–£ǡ–‡”ƒ’‹ƒ
…‘„‹ƒ–£ϐ‹‹†•‹•–ƒ–£Ǥ
ƒ‘’ƒ…‹‡–£…—Á„—£–£ì‹”‡ƒ•–£”‹‹†—’£…”‹–‡”‹‹Ž‡ͷͲǡ
Ϊ ƒ ˆ‘•– ƒ„ƒ†‘ƒ–£ †‹ …ƒ—œƒ ’”‡œ‡ì‡‹ ƒ‡‹‡‹ ȋ„
80 g/l), continuând administrarea doar a SLZ. Nivelul Hb pe
’ƒ”…—”••Ǧƒ”‹†‹…ƒ–ǡ‹ƒ”‡ˆ‡…–—Ž‘„싐—–—•Ǧƒ‘†‹ϐ‹…ƒ–Á—”-
£–‘ƒ”‡Ž‡ͳʹŽ—‹†‡‡˜‹†‡ì£Ǥ
’ƒ…‹‡–£ƒ‘„싐—–”‡‹•‹—‡…Ž‹‹…£†—’£ͳʹ†‡Ž—‹†‡
Table 1 EULAR criteria from 2010.
ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–o‹†‡
ment or towards the completion of the study itself, but not
earlier than 9 months of research, i.e. at the stage when the
preventive conclusions could be established.
Two patients (one with 50% and the other with 20% im-
provement) with combined MT+SLZ therapy were switched to
presence of micronephrolythiasis, echographically document-
ed (at the initiation of the study, these patients already had the
above-mentioned reno-urinary tract pathology). A female pa-
–‹‡– †‡˜‡Ž‘’‡† ‹•‹‰‹ϐ‹…ƒ– Šƒ‡ƒ–—”‹ƒǤ —”‹‰ –Š‡ ˆ‘ŽŽ‘™-
ing 6-12 months of supervision, with the shift from combina-
tion therapy to monotherapy, the progressive decrease of the
above-mentioned additional pathological changes was noted
(one patient at ACR50 and the other at ACR20 maintained the
„‡‡ϐ‹…‹ƒŽ‡ˆˆ‡…–ȌǤŠ‡‹…”‡ƒ•‡‹˜‘Ž—‡‘ˆ–Š‡”‡ƒŽ…ƒŽ…—Ž—•
was determined in one female patient, the combination thera-
py being discontinued.
In one female patient with status improvement accord-
ing to the ACR50 criteria, MT+SLZ was abandoned due to the
presence of anemia (Hb 80 g/l), continuing SLZ alone. The Hb
level over time has risen and the effect has not changed over
the next 12 months of evidence.
‘”†‡”–‘‡•–ƒ„Ž‹•Š–Š‡†‹ƒ‰‘•‹•ǡƒ•…‘”‡‘ˆη͸‘—–‘ˆͳͲ‹•”‡“—‹”‡†c
A. Joint involvementd
1 large joint e 0 points
2-10 large joints 1 points
1-3 small joints (with or without the involvement of large joints) f 2 points
4-10 small joints (with or without the involvement of large joints) 3 points
> 10 joints (at least 1 small joint) g 5 points
B. Serology (at least one test result is required) h
Negative RF and negative ACPA 0 points
Low positive RF or low positive ACPA 2 points
High positive RF or high positive ACPA 3 points
C. Acute phase reactants (at least one test result is required) i
Normal CRP and normal ESR 0 points
High CRP and high ESR 1 points
D. Symptom duration j
<6 weeks 0 points
η͸™‡‡•        ͳ’‘‹–•

a
Š‡•‡…”‹–‡”‹ƒƒ”‡‰‡ƒ”‡†–‘™ƒ”†•–Š‡…Žƒ••‹ϐ‹…ƒ–‹‘‘ˆ–Š‡’”‹ƒ”›’ƒ–‹‡–•’”‡•‡–‡†Ǥ††‹–‹‘ƒŽŽ›ǡ’ƒ–‹‡–•™‹–Š–›’‹…ƒŽ‡”‘•‹˜‡’ƒ–Š‘Ž‘‰›ˆ‘””Š‡—ƒ–‘‹†
ƒ”–Š”‹–‹•ƒ†ƒ…‘’ƒ–‹„Ž‡Š‹•–‘”›‘ˆ’”‹‘”ˆ—Žϐ‹ŽŽ‡–‘ˆ–Š‡ʹͲͳͲ…”‹–‡”‹ƒ•Š‘—Ž†ƒŽ•‘„‡†‹ƒ‰‘•‡†™‹–ŠǤŽ•‘ǡ–Š‡’ƒ–‹‡–•™‹–ŠƒŽ‘‰Ǧ–‡”†‹•‡ƒ•‡ǡ‹…Ž—†-
ing those with inactive disease (with or without treatment) on the basis of the available retrospective data and who previously met the 2010 criteria, should be
diagnosed with RA.
b
Differential diagnosis varies between patients with different presentations, but could include such pathologies as systemic lupus erythematosus, psoriatic
arthritis and gout. If the illnesses that require differentiation are not clear, it is advisable to consult a specialist.
c
Although patients with a score of <6 out of 10 can not be diagnosed with RA, their status may be appreciated again and the criteria could be cumulated over time.
d

‘‹–‹˜‘Ž˜‡‡–”‡ˆ‡”•–‘ƒ›Œ‘‹–•™‘ŽŽ‡‘”’ƒ‹ˆ—Žƒ–‡šƒ‹ƒ–‹‘ǡ™Š‹…Š…‘—Ž†„‡…‘ϐ‹”‡†„›‹ƒ‰‹‰•›‘˜‹–‹•†ƒ–ƒǤŠ‡ Œ‘‹–•ǡ–Š‡ϐ‹”•–…ƒ”’‘-
‡–ƒ…ƒ”’ƒŽŒ‘‹–ƒ†–Š‡ϐ‹”•–Œ‘‹–ƒ”‡‡š…Ž—†‡†ˆ”‘–Š‡‡˜ƒŽ—ƒ–‹‘ǤŠ‡†‹•–”‹„—–‹‘…ƒ–‡‰‘”‹‡•‘ˆ–Š‡Œ‘‹–•ƒ”‡†‡–‡”‹‡†ƒ……‘”†‹‰–‘–Š‡Ž‘…ƒ–‹‘ƒ†
number of the involved ones, and the appreciation takes place in the highest possible category based on the joint involvement.
e
The "large joints" are the shoulder, elbow, hip, knee and ankle joints.
f
The "small joints" are MCP, PIF, MTP II-V, interphalangeal of the police, toe and radiocarpian joints.
g
In this category, at least one of the affected joints must be small; the other may include any combination of the large and small additional joints, other joints not
listed elsewhere (e.g., temporomandibular, acromioclavicular, sternoclavicular joints etc.).
h
‡‰ƒ–‹˜‡”‡ˆ‡”•–‘Ž‘™‡”Ž‡˜‡Ž•–Šƒ–Š‡—’’‡”Ž‹‹–‘ˆ–Š‡•–ƒ†ƒ”†ˆ‘”–Š‡Žƒ„‘”ƒ–‘”›ƒ†‹–—•‡†ǢŽ‘™’‘•‹–‹˜‡”‡ˆ‡”•–‘‡Ž‡˜ƒ–‡†˜ƒŽ—‡•ǡ„—–ζ͵–‹‡•
the upper limit of the norm; high positive refers to values > 3 times the upper limit of the norm. When RF is available as a qualitative result, the positive result is
interpreted as a low positive RF.
i
The normal and abnormal values are determined based on the local laboratory standards.
j
The duration of the symptoms refers to the duration reported by the patient of the signs and symptoms (e.g., pain, swelling) of the synovitis of the joints involved
at the time of examination, regardless of the treatment applied.
—ƒŽ‹–› oˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– oˆ ”Š‡—ƒ–o‹† ƒ”–Š”‹–‹•
–”ƒ–ƒ‡– è‹ ƒ ˆ‘•– ‡…‡•ƒ”£ •‹•–ƒ”‡ƒ  †‹ …ƒ—œƒ ƒ’ƒ”‹ì‹‡‹
‰ƒ•–”‘†—‘†‡‹–‡‹ƒ…—–‡ȋ†‘œƒƒˆ‘•–‹…è‘”ƒ–£†‡Žƒͳͷ‰
’Ÿ£ŽƒͳͲ‰’‡•£’–£Ÿ£ȌǤ—’£–”ƒ–ƒ”‡ƒ‰ƒ•–”‘†—‘†‡‹–‡‹
è‹–”‡…‡”‡ƒ’ƒ…‹‡–—Ž—‹’‡ǡ…ƒ‘‘–‡”ƒ’‹‡ǡ’‡•–‡͵Ž—‹ƒ—
ƒ’£”—–ƒ”–”ƒŽ‰‹‹ǡ†—’£…ƒ”‡•Ǧƒ”‡‹‹ì‹ƒ–Ǥ
ƒ…‹‡–ƒ…ƒ”‡ƒ†‡œ˜‘Ž–ƒ–†‹•–”‘ϐ‹‡”‡–‹‹ƒ£ǡ†—’£ͻŽ—‹†‡
–”ƒ–ƒ‡–è‹’‘œ‹–‹˜ƒ”‡ƒ‡ˆ‡…–‡Ž‘”ÁʹͲΨǡ†—„Žƒ–‡”ƒ’‹‡ƒˆ‘•–
•…Š‹„ƒ–£…—‘‘–‡”ƒ’‹‡Ǥ‡•–‡͵Ž—‹†‡ƒ†‹‹•–”ƒ”‡
†‡ǡ‡ˆ‡…–—Ž‘„싐—–•Ǧƒ‡ì‹—–Ǥ
ƒ…‹‡–ƒ…—’—Ž‘ƒ”£ǡƒ‰”ƒ˜ƒ–£†‡ȋƒˆ‘•–‡˜‹†‡-
싃–£Á•££–‘è‹”‡…—ͷͲȌǡ†—’£–”ƒ–ƒ”‡ƒǦŽ—‹ǡ‹•Ǧƒ”‡…‘-
ƒ†ƒ–…‘–‹—ƒ”‡ƒ–”ƒ–ƒ‡–—Ž—‹…—•—Žˆƒ•ƒŽƒœ‹£Ǥ
’ƒ…‹‡–£…ƒ”‡ƒϐ‹ƒŽ‹œƒ––”ƒ–ƒ‡–—Ž…—Á„—£–£ì‹”‡†‡
ʹͲǡ–‡”ƒ’‹ƒ„‹‘Ž‘‰‹…£ƒˆ‘•–•…Š‹„ƒ–£’‡ǡ†‘œƒ†‡
ƒ†‹‹•–”ƒ”‡ ϐ‹‹† †‡ ͳͲ ‰Ȁ•£’–£Ÿ£ ‹Ȁǡ Á•£ …”‡è–‡”‡ƒ
†‘œ‡‹ è‹ •…Š‹„ƒ”‡ƒ ‘†—Ž—‹ †‡ ƒ†‹‹•–”ƒ”‡ ƒ ’”‡’ƒ”ƒ–—Ž—‹
—ƒ…‘†—•Žƒ‡ˆ‡…–—Ž•…‘–ƒ–ȋϐ‹‹†‡šƒ‹ƒ–’‡•–‡͵Ž—‹†‡
monoterapie).
ƒ†‘‹’ƒ…‹‡ì‹ǡ†ƒ–‘”‹–£–”ƒ–ƒ‡–—Ž—‹‡ˆ‡…–‹˜–‹’†‡ͻè‹ǡ
”‡•’‡…–‹˜ǡ ͳʹ Ž—‹ǡ –‡”ƒ’‹ƒ „‹‘Ž‘‰‹…£  ƒ ˆ‘•– •—„•–‹–—‹–£ …—
–”ƒ–ƒ‡–Á‘‘–‡”ƒ’‹‡ǤB–”Ǧ—…ƒœǡƒˆ‘•–‘„싐—–‡ˆ‡…–
’‘œ‹–‹˜†‡ʹͲǡ‹ƒ”Žƒ…‡Ž£ŽƒŽ–’ƒ…‹‡–ƒˆ‘•–ˆ£”£‡ˆ‡…–Ǥ
Patru pacieì‹ƒ—ˆ‘•–‡š…Ž—苆‹•–—†‹—’‡•–‡ͻŽ—‹†‡…‡”-
…‡–£”‹ǡ†‹…ƒ—œƒǡ‹ƒ”ͷ’ƒ…‹‡ì‹ƒ—ˆ‘•–‡š…Ž—苆‹•–—†‹—Žƒ
†‹ˆ‡”‹ì‹–‡”‡‹†‡–”ƒ–ƒ‡–†‹…ƒ—œƒÁ…£Ž…£”‹Ž‘”†‡”‡‰—Žƒ-
ment al protocolului de cercetare.
˜ƒŽ—ƒ”‡ƒ ’ƒc‹‡n싎o” †‹n ‰”—’—Ž –”ƒ–ƒ‡n–—Ž—‹ ’”‹n onoǦ
–‡”ƒ’‹‡ c— ‡–o–”‡šƒ–
‹ͷͲ†‡’ƒ…‹‡ì‹”ƒ†‘‹œƒì‹Žƒ‘‘–‡”ƒ’‹‡…—ǡƒ—
ϐ‹ƒŽ‹œƒ– –”ƒ–ƒ‡–—Ž †‡ϐ‹‹–‹˜ †‹ …ƒ†”—Ž •–—†‹—Ž—‹ ͷͲ †‡ ’ƒ-
…‹‡ì‹ǡ‹ƒ”ͳʹ•—–Žƒ–”ƒ–ƒ‡–…‘–‹——…—ƒ…‡‡ƒè‹†‘œ£ȋ†‡-
싐‡‹ˆ‘”ƒì‹‡Žƒ‘‡–†‘ƒ”†‡•’”‡ƒ…‡è–‹ͳʹ’ƒ…‹‡ì‹ȌǤ
În rezultatul actualului studiu (terminat în decembrie 2015,
–‹’—Ž‡†‹—†‡ƒ†‹‹•–”ƒ”‡ͳʹŽ—‹ǡ–‹’—Ž‹‹Ȃ͵Ž—‹ǡ
ƒš‹ȂͶƒ‹ȌǡŽƒͳͲ†‹ͳʹ„‘Žƒ˜‹ǡ‡ˆ‡…–—Žϐ‹ƒŽ‘„싐—–•‡
‡ì‹‡ˆ‡”ǣ—„‘Žƒ˜…—”‡‹•‹—‡ȋ–‹’†‡Ͷǡͷƒ‹ȌǡͶ„‘Ž-
ƒ˜‹ …— ƒ‡Ž‹‘”ƒ”‡ǡ — ’ƒ…‹‡– ’”‡œ‹–£ ƒ‡Ž‹‘”ƒ”‡ …‘ˆ‘”
…”‹–‡”‹‹Ž‘” ͷͲ ȋ†‡ Žƒ ͵ ’Ÿ£ Žƒ ͳʹ Ž—‹Ȍǡ ‹ƒ” Žƒ ͷ „‘Žƒ˜‹ǡ
Tabelul 2. ƒ”ƒ…–‡”‹œƒ”‡ƒ‰‡‡”ƒŽ£ƒŽ‘–—”‹Ž‘”†‡•–—†‹—Ǥ
Table 2Ǥ
‡n‡”ƒŽ cŠƒ”ƒc–‡”‹•–‹c oˆ •–—†› ‰”o—’•Ǥ
Parametri Lot MT
Pƒ”ƒ‡–‡”• (nαͷͲȌ
Vârsta, ani
56,0±1,5
‰‡ǡ ›ǤoǤ
Durata AR, ani
3,7±0,1
 †—”ƒ–‹onǡ ›‡ƒ”•
˜‘Ž—싃δͳƒ
 ‡˜oŽ—–‹on <1 ›‡ƒ” 16 (32%)
ƒ‹ˆ‡•–£”‹‡š–”ƒƒ”–‹…—Žƒ”‡Á
š–”ƒƒ”–‹c—Žƒ” •‹‰n• ‹n  17 (34%)
”‡œ‡ìƒ Á•‡”
P”‡•‡nc‡ oˆ  ‹n •‡”— 50 (100%)
Anticorpi anti-CCP în ser >10 U/ml
50 (100%)
n–‹ǦP ƒn–‹„o†‹‡• ‹n •‡”— ι1Ͷ ȀŽ
MJHS 17(3)/2018 39
A female patient obtained clinical remission after 12
months of treatment and MT was discontinued due to the oc-
currence of acute gastroduodenitis (the MT dose was reduced
from 15 mg to 10 mg per week). After treating gastroduodeni-
tis and passing the patient on MT, as monotherapy, arthralgias
occurred after 3 months, after which it was restarted.
In the female patient who developed retinal dystrophy af-
ter 9 months of treatment and the positivity of the effects in
20%, dual therapy was changed with SLZ monotherapy. After
3 months of SLZ administration, the effect obtained was main-
tained.
In the female patient with pulmonary TB, aggravated by
MT (ACR50 was shown to be associated with recovery), after
TB was treated, continuation of the treatment with sulfasala-
zine was recommended.
In a female patient who completed the treatment with
ACR20 improvement, TOC biological therapy was switched
to MT, the dose being 10 mg/week i/m, but the increase of
the dose and the change in the mode of administration of the
preparation did not result in the expected effect (being exam-
ined over 3 months of monotherapy).
In two patients due to the effective treatment for 9 and 12
months respectively, TOC biological therapy was substituted
with MT monotherapy. In one case, a positive ACR20 effect
was obtained, and in the other patient, MT had no effect.
Four patients were excluded from the study after 9 months
of research due to adverse reactions, and 5 patients were ex-
cluded from the study at different treatment terms due to vio-
lations of the research protocol regulation.
˜ƒŽ—ƒ–‹on oˆ –Š‡ ’ƒ–‹‡n–• ‹n –Š‡ ono–Š‡”ƒ’› –”‡ƒ–‡n–
‰”o—’ ™‹–Š ‡–Šo–”‡šƒ–‡
Out of the 50 patients randomized to monotherapy with
ǡ ͷͲ ’ƒ–‹‡–• †‡ϐ‹‹–‹˜‡Ž› …‘’Ž‡–‡† –Š‡ •–—†› –”‡ƒ–‡–
and 12 were on continuous treatment at the same dose (we
currently have information only about these 12 patients).
•ƒ”‡•—Ž–‘ˆ–Š‡…—””‡–•–—†›ȋϐ‹‹•Š‡†‹‡…‡„‡”ʹͲͳͷǡ
ƒ˜‡”ƒ‰‡ –‹‡ ‘ˆ ƒ†‹‹•–”ƒ–‹‘ ͳʹ ‘–Š•ǡ ‹‹— –‹‡ Ȃ
͵‘–Š•ǡƒš‹—ȂͶ›‡ƒ”•ȌǡͳͲ‘—–‘ˆͳʹ’ƒ–‹‡–•ϐ‹”Ž›
Lot MT+SLZ Lot TOC
(nαͷͲȌ (nαͷͲȌ
55,0±1,5 54,5±1,5
4,1±0,1 4,2±0,1
12 (24%) 16 (32%)
16 (32%) 20 (40%)
50 (100%) 50 (100%)
50 (100%) 50 (100%)
40 ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–o‹†‡

ʹͲ†‡ƒ‡Ž‹‘”ƒ”‡Ǥˆ‡…–—Ž‘„싐—–…£–”‡•ˆŸ”è‹–—Ž•–—†‹—Ž—‹
’‡ˆ—†ƒŽ—Ž†‡‘‘–‡”ƒ’‹‡‡•–‡ǣ•Ǧƒ‹…è‘”ƒ–ƒ…–‹˜‹–ƒ–‡ƒ
„‘Ž‹‹Žƒ†‘‹’ƒ…‹‡ì‹ȋ‹‹ì‹ƒŽǡϐ‹‹†Á„—£–£ì‹”‡ƒ•–£”‹‹…—ͷͲΨǡ
‹ƒ”•’”‡•ˆŸ”è‹–ǡ…—ʹͲΨ†—’£…”‹–‡”‹‹Ž‡ǡϐ‹‹†Žƒ‡˜‹†‡ì£
timp de 6-12 luni).
ƒ‡šƒ‡—Ž’ƒ…‹‡ì‹Ž‘”ǡ†—’£”‡ƒŽ‹œƒ”‡ƒ–”ƒ–ƒ‡–—Ž—‹…—
MT, RA ulterioare nu au fost înregistrate. RA tardive au fost
Á”‡‰‹•–”ƒ–‡ Žƒ Ͷ ’ƒ…‹‡ì‹ ȋ…”‡è–‡”‡ƒ –”ƒ•ƒ‹ƒœ‡Ž‘” †‹ •‡”
—ƒ‹—Ž–†‡ʹ‘”‹Ȍè‹͵…ƒœ—”‹Á”‡‰‹•–”ƒ–‡†‡‹ˆ‡…ì‹‹”‡•’‹-
”ƒ–‘”‹‹˜‹”ƒŽ‡ƒ…—–‡è‹—’ƒ…‹‡–…—„”‘è‹–£ƒ…—–£Ǥ
ƒ†‘—£’ƒ…‹‡–‡•Ǧƒ”‡Ž‡˜ƒ–‹•—ϐ‹…‹‡ìƒ‘‘–‡”ƒ’‹‡‹…—
ȋʹͲΨ†‡Á•££–‘è‹”‡…‘ˆ‘”…”‹–‡”‹‹Ž‘”Ȍǡ‹ƒ”–”ƒ–ƒ-
‡–—Žƒˆ‘•–•—’Ž‹‡–ƒ–…—Ǥƒ…‘„‹ƒ”‡ƒƒ…‡•–‘”†‘—£
’”‡’ƒ”ƒ–‡•Ǧƒ‡˜‹†‡ì‹ƒ–Á„—£–£ì‹”‡ƒ‡ˆ‡…–—Ž—‹…—ͷͲΨ†—’£
ȋϐ‹‹†Žƒ‡˜‹†‡ì£–‹’†‡͸ǦͳʹŽ—‹ȌǤ
gƒ’–‡•’”‡œ‡…‡ ’ƒ…‹‡ì‹ — ƒ— •ˆŸ”è‹– ‘‘–‡”ƒ’‹ƒ …— 
‹‹ì‹ƒ–£ǡ†‹…ƒ—œƒ”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡†‡œ˜‘Ž–ƒ–‡’‡•–‡ͻŽ—‹†‡
–”ƒ–ƒ‡–Ǥƒ†‘—£†‹’ƒ…‹‡–‡Ž‹•Ǧƒ•…Š‹„ƒ––‡”ƒ’‹ƒ‡†‹-
…ƒ‡–‘ƒ•£ …— ƒ†‹‹•–”ƒ”‡ƒ †‡ •—Žˆƒ•ƒŽƒœ‹£Ǥ  ’ƒ…‹‡–£ ƒ
ˆ‘•–‡š…Ž—•£†‹•–—†‹—†‹…ƒ—œƒ†‡œ˜‘Ž–£”‹‹Š‡’ƒ–‹–‡‹‡†‹…ƒ-
mentoase (cu 50% de efect pozitiv), iar pe fundal de tratament
…—•—Žˆƒ•ƒŽƒœ‹£ƒˆ‘•–’”‡œ‡–ʹͲΨ†‡‡ˆ‡…–’‘œ‹–‹˜…‘ˆ‘”
ȋ—Ž–‹ƒ”‡‡˜ƒŽ—ƒ”‡ϐ‹‹††—’£ͳͺŽ—‹†‹…ƒ†”—Žƒ…‡•–—‹
•–—†‹—ȌǤƒ—’ƒ…‹‡–…—ƒ—Žƒ”‡ƒ†—’£ͳ͹Ž—‹†‡•–—†‹—
è‹…—‡ˆ‡…–’‘œ‹–‹˜ͷͲŽƒƒ…‡Ž‘‡–ǡ†‹…ƒ—œƒŠ‡”’‡•—-
ƒ‹–ƒ‹‡†–Š‡ϐ‹ƒŽ‡ˆˆ‡…–ǣƒ’ƒ–‹‡–™‹–Š”‡‹••‹‘ȋˆ‘”ͶǤͷ
years), 4 patients with amelioration, one patient shows im-
provement according to ACR50 criteria (3 to 12 months), and
5 patients with improvement of ACR20. The effect achieved at
–Š‡‡†‘ˆ–Š‡•–—†›‘–Š‡‘‘–Š‡”ƒ’›„ƒ…‰”‘—†™ƒ•ǣ
the disease activity was reduced in two patients (initially by
•–ƒ–—•‹’”‘˜‡‡–„›ͷͲΨƒ†ϐ‹ƒŽŽ›„›ʹͲΨƒ……‘”†‹‰–‘
ACR criteria, being supervised for 6-12 months).
At the patients’ examination after MT treatment comple-
tion, subsequent ARs were not recorded. Late ARs were re-
corded in 4 patients (increased serum transaminases no more
than 2 times) and 3 recorded cases of acute viral respiratory
infections and one patient with acute bronchitis.
™‘ ˆ‡ƒŽ‡ ’ƒ–‹‡–• ’”‡•‡–‡† ‹•—ˆϐ‹…‹‡…› ‘ˆ  ‘-
otherapy (20% recovery according to ACR criteria), and the
treatment was supplemented with SLZ. The combination of
these two preparations revealed an improvement of the effect
by 50% according to ACR (being supervised for 6-12 months).
Seventeen patients did not complete the initiated MT
monotherapy due to the adverse reactions developed after 9
months of treatment. Two female patients were switched to
sulfasalazine therapy. A female patient was excluded from the
study due to the development of drug-induced hepatitis (with
50% of the positive effect), and on the background of sul-
fasalazine treatment, 20% of the positive effect was present

ƒ„‡Ž—Ž͵ǤƒŽ‘”‹Ž‡…‘’ƒ”ƒ–‹˜‡ƒŽ‡’ƒ”ƒ‡–”‹Ž‘”•–—†‹ƒì‹ǡ’‡Ž‘–—”‹ǡ‹‹ì‹ƒŽè‹’‡•–‡ͳʹŽ—‹†‡–”ƒ–ƒ‡–Ǥ
Table 3. o’ƒ”ƒ–‹˜‡ ˜ƒŽ—‡• oˆ ”‡‰‹•–‡”‡† ’ƒ”ƒ‡–‡”• ƒcco”†‹n‰ –o •–—†› ‰”o—’•ǡ ƒ– –Š‡ „‡‰‹nn‹n‰ ƒn† ƒˆ–‡” 1͸ on–Š• oˆ –”‡ƒ–‡n–Ǥ

Parametrii Lot MT Lot MT+SSZ Lot TOC

p
Pƒ”ƒ‡–‡”• T0 T12 T0 T12 T0 T12

NAD 22,0 10,0 22,0 10,0 22,0 9,0

< 0,001
P (9,0-28,0) (0,0-28,0) (9,0-28,0) (0,0-28,0) (8,0-36,0) (0,0-32,0)

NAT 15,0 5,0 15,0 5,0 15,0 4,0

< 0,001
 (7,0-26,0) (0,0-24,0) (7,0-26,0) (0,0-24,0) (7,0-29,0) (0,0-10,0)

Intensitatea durerii
articulare, mm SVA 53,0 20,0 53,0 20,0 56,0 12,0
< 0,001
In–‡n•‹–› oˆ Œo‹n– ’ƒ‹nǡ  (35,0-90,0) (0,0-80,0) (35,0-90,0) (0,0-80,0) (14,0-90,0) (14,0-90,0)


VSH, mm/h 37,0 12,0 37,0 12,0 29,0 14,0

< 0,001
ǡ ȀŠ (10,0-65,0) (5,0-40,0) (10,0-65,0) (5,0-40,0) (7,0-60,0) (4,0-55,0)

PCR, mg/ml 48,0 12,0 48,0 12,0 96,0 12,0

< 0,001
Pǡ ‰ȀŽ (0,0-96,0) (0,0-24,0) (0,0-96,0) (0,0-24,0) (12,0-124,0) (0,0-48,0)

Scor DAS28, puncte 4,7 3,1 4,7 3,1 4,7 2,6

< 0,001
͸; •co”‡ǡ ’o‹n–• (3,7-6,5) (1,0-6,1) (3,7-6,5) (1,0-6,1) (3,6-6,1) (0,6-5,4)

Scor HAQ, puncte 2,5 0,75 2,5 0,75 1,5 0,5

< 0,001
 •co”‡ǡ ’o‹n–• (0,45-3,0) (0,0-1,5) (0,45-3,0) (0,0-1,5) (0,37-3,0) (0,0-2,5)

‘–£ǣȂ—£”†‡ƒ”–‹…—Žƒì‹‹†—”‡”‘ƒ•‡ǢȂ—£”†‡ƒ”–‹…—Žƒì‹‹–—‡ϐ‹ƒ–‡ǤͲȂ‹‹ì‹ƒŽǢͳʹȂ’‡•–‡ͳʹŽ—‹ǤƒŽ‘”‹Ž‡—‡”‹…‡ƒŽ‡’ƒ”ƒ‡–”‹Ž‘”•—–
‡š’”‹ƒ–‡†”‡’–‡†‹‡è‹‡š–”‡‡Ǥ‡•–•–ƒ–‹•–‹…ƒ’Ž‹…ƒ–ǣ‹Ž…‘š‘Ǥ
Note:
Ȃ—„‡”‘ˆ’ƒ‹ˆ—ŽŒ‘‹–•Ǣ
Ȃ—„‡”‘ˆ•™‘ŽŽ‡Œ‘‹–•ǤͲȂ‹‹–‹ƒŽŽ›ǢͳʹȂƒˆ–‡”ͳʹ‘–Š•ǤŠ‡—‡”‹…ƒŽ˜ƒŽ—‡•‘ˆ–Š‡’ƒ”ƒ‡–‡”•ƒ”‡‡š’”‡••‡†ƒ•
‡ƒƒ†‡š–”‡‡•Ǥ’’Ž‹‡†•–ƒ–‹•–‹…ƒŽ–‡•–ǣ‹Ž…‘š‘Ǥ
—ƒŽ‹–› oˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– oˆ ”Š‡—ƒ–o‹† ƒ”–Š”‹–‹•
Ž—‹”‡…‹†‹˜ƒ–ƒˆ‘•–‘†‹ϐ‹…ƒ––”ƒ–ƒ‡–—Žǡϐ‹‹†ƒ†‹‹•–”ƒ–£
•—Žˆƒ•ƒŽƒœ‹£ǡÁ•£‡ˆ‡…–—Ž’‘œ‹–‹˜—ƒˆ‘•–’”‡œ‡–ȋϐ‹‹†Žƒ•—-
’”ƒ˜‡‰Š‡”‡•—’Ž‹‡–ƒ”£ͶŽ—‹ȌǤ
’ƒ…‹‡–£ƒˆ‘•–‡š…Ž—•£–‹’—”‹—†‹•–—†‹—†‹…ƒ—œƒǡ
苃—‡ƒŠ‡”’‡•—Ž—‹œ‘•–‡”ǡƒƒ˜—–‡ˆ‡…–’‘œ‹–‹˜†‡ͷͲǡƒ
ˆ‘•–‘†‹ϐ‹…ƒ–’‡–”ƒ–ƒ‡–…—苇ˆ‡…–—Ž‘„싐—–†‡ͷͲ
•Ǧƒ‡ì‹—–’‡’ƒ”…—”•—Ž—”£–‘ƒ”‡Ž‘”ͳʹŽ—‹†‡‡˜‹†‡ì£Ǥ
Trei paciente au fost excluse din studiu timpuriu din cauza
‘‘–‡”ƒ’‹‡‹‡‡ˆ‡…–‹˜‡…—–‹’†‡ͻŽ—‹Ǥƒ†‘—£„‘Žƒ-
˜‡ǡ–”ƒ–ƒ‡–—Ž…—ƒˆ‘•–ƒ„ƒ†‘ƒ–’‡•–‡ͳͷè‹ǡ”‡•’‡…–‹˜ǡ
18 luni de tratament cu MT, a fost schimbat cu LF, care, de ase-
‡‡ƒǡƒˆ‘•–‡‡ˆ‡…–‹˜ȋϐ‹‹†Žƒ‡˜‹†‡ì£͵è‹ǡ”‡•’‡…–‹˜ǡͶŽ—‹Ȍǡ
ulterior, cu administrare de tocilizumab 4 mg/kg/corp, cu
‡ˆ‡…–’‘œ‹–‹˜ͷͲǤ–”‡‹ƒ’ƒ…‹‡–£ƒˆ‘•–‡š…Ž—•£†‹•–—†‹—
†—’£ͳʹŽ—‹†‡–”ƒ–ƒ‡–ǡ‹•Ǧƒ‹†‹…ƒ– Ϊ ȋŽƒ”‡‡˜ƒŽ—ƒ”‡ƒ
pacientei peste 3 luni, efectul pozitiv nu s-a semnalat).
‹…‹’ƒ…‹‡–‡ƒ—•ˆŸ”è‹––”ƒ–ƒ‡–—Ž•–—†‹ƒ–苃—ˆ‘•–‡š-
cluse din studiu din cauza RA grave (cancer gastric, limfom
ƒŽ‹‰ǡˆ”ƒ…–—”ƒ…‘Ž—Ž—‹ˆ‡—”ƒŽǡ’‡—‘‹‡ǡ‘–‹–£’—”—Ž‡–£ȌǤ
胆ƒ”ǡ ƒ— ˆ‘•– ƒ…——Žƒ–‡ †‘ƒ” ͷͲ †‡ ’ƒ…‹‡–‡ …ƒ”‡ ƒ—
…‘–‹—ƒ–ƒ†‹‹•–”ƒ”‡ƒ‘‘–‡”ƒ’‹‡‹’Ÿ£Žƒϐ‹ƒŽ‹œƒ”‡ƒ
•–—†‹—Ž—‹ȋ†‡Žƒ͵Ž—‹’Ÿ£Žƒʹƒ‹ȌǢ‡ˆ‡…–—Ž†‘”‹–ƒ–‹•ƒˆ‘•–
‡ì‹—–Žƒͳ͵„‘Žƒ˜‡ȋʹ͸ΨȌǡ‹ƒ”†‹ͳʹ’ƒ…‹‡–‡…ƒ”‡ƒ—ƒ†-
‹‹•–”ƒ–‘‘–‡”ƒ’‹ƒ…—ȋ†‡Žƒ͵Ž—‹’Ÿ£ŽƒͶƒ‹ȌȂ͹
bolnavi (14%).
˜ƒŽ—ƒ”‡ƒ ’ƒc‹‡n싎o” †‹n ‰”—’—Ž –”ƒ–ƒ‡n–—Ž—‹ co„‹nƒ– ’”‹n
‡–o–”‡šƒ– è‹ —Žˆƒ•ƒŽƒœ‹n£
‹ͷͲ†‡’ƒ…‹‡ì‹”ƒ†‘‹œƒì‹Žƒ–”ƒ–ƒ‡–…‘„‹ƒ–…—
Ϊǡƒ—ϐ‹ƒŽ‹œƒ––”ƒ–ƒ‡–—Ž†‡ϐ‹‹–‹˜†‹…ƒ†”—Ž•–—†‹—-
Ž—‹ͷͲ†‡’ƒ…‹‡ì‹ǡ‹ƒ”ͻ•—–Žƒ–”ƒ–ƒ‡–…‘–‹——…—ƒ…‡‡ƒè‹
†‘œ£ȋ†‡ì‹‡‹ˆ‘”ƒì‹‡ǡŽƒ‘‡–ǡ†‘ƒ”†‡•’”‡ƒ…‡è–‹ͻ’ƒ-
…‹‡ì‹ȌǤB”‡œ—Ž–ƒ–—Žƒ…–—ƒŽ—Ž—‹•–—†‹—ȋ–‡”‹ƒ–Á†‡…‡„”‹‡
ʹͲͳͷǡ†—”ƒ–ƒ‡†‹‡†‡ƒ†‹‹•–”ƒ”‡ȂͳʹŽ—‹ǡ…‡ƒ‹‹£Ȃ͵
Ž—‹ǡƒš‹£Ȃʹǡͺƒ‹ȌǡŽƒ͸†‹ͻ„‘Žƒ˜‹‡ˆ‡…–—Žϐ‹ƒŽ‘„싐—–
•‡‡ì‹‡ˆ‡”ǣ—„‘Žƒ˜…—”‡‹•‹—‡ȋ–‹’†‡ʹǡ͹ƒ‹Ȍè‹
ͷ„‘Žƒ˜‹…—ƒ‡Ž‹‘”ƒ”‡ǡ†‘‹’ƒ…‹‡ì‹’”‡œ‹–£ƒ‡Ž‹‘”ƒ”‡…‘-
ˆ‘”…”‹–‡”‹‹Ž‘”ͷͲȋ†‡Žƒʹ’Ÿ£ŽƒͳͶŽ—‹Ȍǡ‹ƒ”Žƒ͵„‘Žƒ˜‹
Ȃƒ‡Ž‹‘”ƒ”‡ʹͲǤˆ‡…–—Ž‘„싐—–…£–”‡•ˆŸ”è‹–—Ž•–—†‹—Ž—‹ǡ
’‡ˆ—†ƒŽ†‡–”ƒ–ƒ‡–…‘„‹ƒ–…—Ϊ‡•–‡ǣ•Ǧƒ‹…è‘”ƒ–
ƒ…–‹˜‹–ƒ–‡ƒ „‘Ž‹‹ Žƒ …‹…‹ ’ƒ…‹‡ì‹ ȋ‹‹ì‹ƒŽǡ ϐ‹‹† Á„—£–£ì‹”‡ƒ
•–£”‹‹ …— ͷͲΨǡ ‹ƒ” •’”‡ •ˆŸ”è‹– Ȃ …— ʹͲΨ †—’£ …”‹–‡”‹‹Ž‡ ǡ
ϐ‹‹†Žƒ‡˜‹†‡ì£–‹’†‡͸ǦͳʹŽ—‹ȌǤ
ƒ ‡šƒ‡—Ž ’ƒ…‹‡ì‹Ž‘” †—’£ –‡”‹ƒ”‡ƒ –”ƒ–ƒ‡–—Ž—‹
…‘„‹ƒ– …— Ϊǡ ƒ— ˆ‘•– Á”‡‰‹•–”ƒ–‡ ”‡ƒ…ì‹‹ ƒ†˜‡”•‡ —Ž-
–‡”‹‘ƒ”‡ǡƒ‹ˆ‡•–ƒ–‡’”‹Š‡’ƒ–‹–£–‘š‹…£‡†‹…ƒ‡–‘ƒ•£è‹
ƒ‡‹‡Ǥ–ƒ”†‹˜‡ƒ—ˆ‘•–Á”‡‰‹•–”ƒ–‡ŽƒͶ’ƒ…‹‡ì‹ȋ…”‡è–‡”‡ƒ
–”ƒ•ƒ‹ƒœ‡Ž‘”†‹•‡”ƒ‹—Ž–†‡ʹ‘”‹ˆƒì£†‡˜ƒŽ‘”‹Ž‡‘”-
ƒŽ‡Ȍè‹–”‡‹’ƒ…‹‡ì‹…—„”‘è‹–£ƒ…—–£è‹——Ž…—’‡—‘‹‡
”‡…‹†‹˜ƒ–£Ǥ
ƒ †‘—£ ’ƒ…‹‡–‡ •Ǧƒ ”‡Ž‡˜ƒ– ‹•—ϐ‹…‹‡ìƒ –”ƒ–ƒ‡–—Ž—‹
…‘„‹ƒ–…—ΪȋʹͲΨ†‡Á•££–‘è‹”‡ǡ…‘ˆ‘”…”‹–‡”‹‹-
Ž‘”Ȍǡ‹ƒ”–”ƒ–ƒ‡–—Žƒˆ‘•–•…Š‹„ƒ–…— è‹•Ǧƒ‡˜‹†‡ì‹ƒ–
Á„—£–£ì‹”‡ƒ ‡ˆ‡…–—Ž—‹ …— ͷͲΨ †—’£  ȋϐ‹‹† Žƒ ‡˜‹†‡ì£
timp de 12 luni).
‘—£œ‡…‹ è‹ –”‡‹ †‡ ’ƒ…‹‡–‡ — ƒ— ϐ‹ƒŽ‹œƒ– –”ƒ–ƒ‡–—Ž
MJHS 17(3)/2018 41
according to ACR (the last reassessment being after 18 months
within this study). In a patient with MT discontinuation after
17 months of study and a positive ACR50 effect at that time,
†—‡–‘”‡…—””‡–Š‡”’‡•ǡ–”‡ƒ–‡–™ƒ•‘†‹ϐ‹‡†™‹–Š–Š‡ƒ†-
ministration of sulfasalazine, but the positive effect was not
present (being under 4 months of additional surveillance).
A female patient was excluded early from the study due to
the ARs, namely herpes zoster, had a positive ACR50 effect,
was switched to SLZ treatment, and the obtained ACR50 effect
was maintained over the next 12 months of evidence.
Three female patients were excluded early from the study
due to ineffective monotherapy with MT for 9 months. In
two patients, MT treatment was abandoned after 15 and 18
months of MT treatment, was switched to LF, which was also
ineffective (being supervised for 3 and 4 months, respec-
tively), followed by 4 mg/kg/body tocilizumab with positive
ACR50 effect. The third female patient was excluded from the
study after 12 months of treatment, was indicated LF+SLF (at
the re-evaluation of the patient 3 months later, the positive ef-
fect was not reported).
‹˜‡ˆ‡ƒŽ‡’ƒ–‹‡–•†‹†‘–ϐ‹‹•Š–Š‡•–—†›–”‡ƒ–‡–ƒ†
were excluded from the study due to serious AR (gastric can-
cer, malignant lymphoma, femoral neck fracture, pneumonia,
purulent otitis).
Thus, only 50 female patients who continued to receive MT
monotherapy at study completion were accumulated (from 3
months to 2 years, the achieved desired effect was maintained
in 13 female patients (26%), and out of 12 female patients who
”‡…‡‹˜‡†‘‘–Š‡”ƒ’›™‹–Šȋˆ”‘͵‘–Š•–‘Ͷ›‡ƒ”•ȌȂ͹
patients (14%).
˜ƒŽ—ƒ–‹on oˆ ’ƒ–‹‡n–• ‹n –Š‡ co„‹n‡† –”‡ƒ–‡n– ‰”o—’
™‹–Š ‡–Šo–”‡šƒ–‡ ƒn† —Žˆƒ•ƒŽƒœ‹n‡
Out of 50 patients randomized to combined treatment
™‹–ŠΪǡͷͲ’ƒ–‹‡–•†‡ϐ‹‹–‡Ž›…‘’Ž‡–‡†–Š‡–”‡ƒ–‡–
within the study, and 9 are on continuous treatment at the
same dose (we currently have information only about these
ͻ ’ƒ–‹‡–•ȌǤ • ƒ ”‡•—Ž– ‘ˆ –Š‡ …—””‡– •–—†› ȋϐ‹‹•Š‡† ‹ ‡-
…‡„‡” ʹͲͳͷǡ ƒ˜‡”ƒ‰‡ –‹‡ ‘ˆ ƒ†‹‹•–”ƒ–‹‘ Ȃ ͳʹ ‘–Š•ǡ
‹‹— –‹‡ Ȃ ͵ ‘–Š•ǡ ƒš‹— Ȃ ʹǤͺ ›‡ƒ”•Ȍǡ ‹ ͸ ‘—–
‘ˆͻ’ƒ–‹‡–•–Š‡‘„–ƒ‹‡†ϐ‹ƒŽ‡ˆˆ‡…–‹•ϐ‹”Ž›ƒ‹–ƒ‹‡†ǣƒ
patient with remission (for 2.7 years) and 5 patients with im-
provement, 2 patients show improvement according to ACR50
criteria (from 2 to 14 months) and in 3 patients with improve-
ment of ACR20. The effect achieved at the end of the study on
–Š‡ „ƒ…‰”‘—† ‘ˆ …‘„‹‡† –”‡ƒ–‡– ™‹–Š Ϊ ‹•ǣ –Š‡
disease activity was reduced in 5 patients (initially improve-
‡–‘ˆ–Š‡…‘†‹–‹‘„›ͷͲΨƒ†ϐ‹ƒŽŽ›„›ʹͲΨƒ……‘”†‹‰–‘
the ACR criteria, being supervised for 6-12 months).
At the examination of the patients after the completion of
the treatment with MT+SLZ, subsequent adverse reactions,
manifested by toxic drug-induced hepatitis and anemia, were
recorded. Late ARs were recorded in 4 patients (increase in se-
rum transaminases more than 2 times the normal range) and
three patients with acute bronchitis and one with recurrent
pneumonias were reported.
In two patients, combined treatment with MT+SLZ proved
42
…‘„‹ƒ–…—Ϊ†‹…ƒ—œƒ”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡†‡œ˜‘Ž–ƒ–‡
’‡•–‡ͻŽ—‹†‡–”ƒ–ƒ‡–Ǥƒ†‘—£†‹‡Ž‡Ž‹•Ǧƒ—•…Š‹„ƒ––‡-
”ƒ’‹ƒ‡†‹…ƒ‡–‘ƒ•£…—ƒ†‹‹•–”ƒ”‡ƒ†‡•ƒ— ǡ‹ƒ”Žƒ
cinci s-a început tratamentul cu tocilizumab 4 mg/kg/corp. O
’ƒ…‹‡–£ƒˆ‘•–‡š…Ž—•£†‹•–—†‹—†‹…ƒ—œƒ†‡œ˜‘Ž–£”‹‹Š‡’ƒ-
titei medicamentoase (cu ACR50 efect pozitiv), iar pe fundalul
de tratament cu SLZ, a fost prezent un efect pozitiv conform
ʹͲȋ—Ž–‹ƒ”‡‡˜ƒŽ—ƒ”‡ϐ‹‹††—’£ͳʹŽ—‹†‹…ƒ†”—Žƒ…‡•–—‹
•–—†‹—ȌǤƒ–”‡‹’ƒ…‹‡–‡…—ƒ—Žƒ”‡ƒΪ†—’£ͳʹŽ—‹†‡
•–—†‹—è‹ͷͲ‡ˆ‡…–’‘œ‹–‹˜ǡŽƒƒ…‡Ž‘‡–ǡ†‹…ƒ—œƒŠ‡”-
’‡•—Ž—‹”‡…‹†‹˜ƒ–ǡƒˆ‘•–‘†‹ϐ‹…ƒ––”ƒ–ƒ‡–—Žǡϐ‹‹†ƒ†‹‹•-
–”ƒ–£  …— ’”‡œ‡ìƒ Á„—£–£ì‹”‹‹ …‘ˆ‘” ʹͲǡ ϐ‹‹† Žƒ
•—’”ƒ˜‡‰Š‡”‡•—’Ž‹‡–ƒ”£Á…£ͺŽ—‹Ǥ
Trei paciente au fost excluse din studiu la stadiile timpurii
†‹…ƒ—œƒǡ苃—‡ǡŠ‡”’‡•œ‘•–‡”ǡƒƒ˜—–‡ˆ‡…–’‘œ‹–‹˜†‡
ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ †—’£ –”ƒ–ƒ‡n–—Ž ƒ”–”‹–‡‹ ”‡—ƒ–o‹†‡
–‘ „‡ ‹•—ˆϐ‹…‹‡– ȋʹͲΨ ”‡…‘˜‡”› ƒ……‘”†‹‰ –‘  …”‹–‡”‹ƒȌǡ
thus the treatment was changed with LF and the effect im-
proved by 50% according to ACR (being supervised for 12
months).
Twenty-three female patients did not complete the com-
bined treatment with MT+SLZ due to adverse reactions devel-
oped after 9 months of treatment. Two of them were switched
to drug therapy with the administration of SLZ or LF, and in
ϐ‹˜‡‘ˆ–Š‡ǡ–”‡ƒ–‡– ™‹–Š –‘…‹Ž‹œ—ƒ„ Ͷ‰Ȁ‰Ȁ„‘†›™ƒ•
initiated. A female patient was excluded from the study due
to the development of drug-induced hepatitis (with a positive
ACR50 effect), and a positive effect according to ACR20 was
present on the background of SLZ treatment (the last reas-
sessment being 12 months later within this study). In three
female patients with MT+SLZ cancellation after 12 months of
ͷͲǡƒˆ‘•–•…Š‹„ƒ–’‡–”ƒ–ƒ‡–…—è‹ǡ‹ƒ”‡ˆ‡…–—Ž
‘„싐—–†‡ʹͲ•Ǧƒ‡ì‹—–’‡’ƒ”…—”•—Ž—”£–‘ƒ”‡Ž‘”ͳʹ
Ž—‹†‡‡˜‹†‡ì£Ǥ
‘—£’ƒ…‹‡–‡ƒ—ˆ‘•–‡š…Ž—•‡†‹•–—†‹—–‹’—”‹—†‹…ƒ—-
za terapiei combinate cu MT+SLZ, neefective timp de 9 luni. La
‘„‘Žƒ˜£ǡ–”ƒ–ƒ‡–—Ž…—ƒˆ‘•–ƒ„ƒ†‘ƒ–’‡•–‡͸Ž—‹è‹
•Ǧƒ‘†‹ϐ‹…ƒ–…—ƒ†‹‹•–”ƒ”‡ƒ†‡–‘…‹Ž‹œ—ƒ„Ͷ‰Ȁ‰Ȁ…‘”’ǡ
…—‡ˆ‡…–’‘œ‹–‹˜ͷͲǤB…£‘’ƒ…‹‡–£ƒˆ‘•–‡š…Ž—•£†‹•–—-
†‹—†—’£ͻŽ—‹†‡–”ƒ–ƒ‡–Ǣ‡‹‹•Ǧƒ‹†‹…ƒ–ƒ•‘…‹‡”‡ƒ†‡è‹
tocilizumab 4 mg/kg corp, cu efect pozitiv ACR50 (la reevalu-
area pacientei peste 3 luni).
gƒ’–‡’ƒ…‹‡–‡—ƒ—ϐ‹ƒŽ‹œƒ––”ƒ–ƒ‡–—Žè‹ƒ—ˆ‘•–‡š…Ž—-
•‡†‹•–—†‹— †‹…ƒ—œƒ ”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡‰”ƒ˜‡ȋ…ƒ…‡”’—Ž-
‘ƒ”ǡŽ‹ˆ‘ƒŽ‹‰ǡˆ”ƒ…–—”ƒ…‘Ž—Ž—‹ˆ‡—”ƒŽǡˆ”ƒ…–—”£’”‹
–ƒ•ƒ”‡ƒ˜‡”–‡„”‡Ž‘”ǡ’‡—‘‹‡ǡ‘–‹–£’—”—Ž‡–£ǡƒ‰”ƒ—Ž‘…‹-
–‘œ£ȌǤ
‹•…—ì‹‹
B–‹’—Ž’‡”‹‘ƒ†‡‹†‡•–—†‹—ǡŽƒ’ƒ…‹‡ì‹‹†‹ƒ„‡Ž‡‰”—-
’—”‹†‡–”ƒ–ƒ‡–•ǦƒÁ„—£–£ì‹–•–ƒ–—–—Žˆ—…ì‹‘ƒŽǤB‰”—-
’—Ž…—–‡”ƒ’‹‡„‹‘Ž‘‰‹…£ǡ‹†‹…‡Ž‡‡†‹—ƒ•…£œ—–†‡
Žƒͳǡͷ’Ÿ£ŽƒͲǡͷǤB‰”—’—Ž…—‘‘–‡”ƒ’‹‡è‹ΪȂ†‡
ŽƒʹǡͲè‹ʹǡͷ’Ÿ£ŽƒͲǡ͹ͷ’—…–‡ȋ’αͲǡͲͲͺȌǤ—£”—Ž’ƒ…‹‡ì‹-
Ž‘”…—–—Ž„—”ƒ”‡ƒ•–£”‹‹ˆ—…ì‹‘ƒŽ‡‹‹£ȋͲǦͳǡͲȌǡ‡†‹‡
ȋͳǡͳǦʹǡͲȌ苇š’”‹ƒ–£ȋʹǡͳǦ͵ǡͲȌǡŽƒ•ˆŸ”è‹–—Ž•–—†‹—-
Ž—‹ǡÁƒ„‡Ž‡‰”—’—”‹ǡƒˆ‘•–•‹‹Žƒ”£Ǥ•–ˆ‡ŽǡÁ–”‡‰”—’—”‹—
ƒ—ˆ‘•–‘„•‡”˜ƒ–‡†‹ˆ‡”‡ì‡•‡‹ϐ‹…ƒ–‹˜‡ÁÁ„—£–£ì‹”‡ƒ•–£-
”‹‹ˆ—…ì‹‘ƒŽ‡Ǥ
Utilizarea tuturor tipurilor de terapie a redus doza medie
œ‹Ž‹…£ŽƒŽ—ƒ”‡ƒ•‹—Ž–ƒ£ƒ…‘”–‹…‘•–‡”‘‹œ‹Ž‘”†‡ŽƒͷǡͲ’Ÿ£Žƒ
study and ACR50 positive effect at that time, due to recurrent
Š‡”’‡•ǡ–Š‡–”‡ƒ–‡–™ƒ•‘†‹ϐ‹‡†ǡ„‡‹‰ƒ†‹‹•–‡”‡†
with the presence of improvement according to ACR20, being
under additional supervision for another 8 months.
Three female patients were excluded from the study at ear-
ly stages due to ARs, i.e. herpes zoster, had a positive ACR50
effect, were switched to SLZ and NSAID treatment, and the
achieved ACR20 effect was maintained over the following 12
months of supervision.
Two female patients were excluded from the early stages of
the study due to ineffective combination therapy with MT+SLZ
for 9 months. In a female patient, the treatment with MT was
abandoned after 6 months of treatment and was changed with
the administration of tocilizumab 4 mg/kg/body with positive
ACR50 effect, and another female patient, being excluded from
the study after 9 months of treatment, was indicated the associ-
ation of MT and tocilizumab 4 mg/kg/body with positive ACR50
effect (at the re-evaluation of the patient after 3 months).
Seven female patients did not complete the study treat-
ment and were excluded from the study due to serious ad-
verse reactions (lung cancer, malignant lymphoma, femoral
neck fracture, vertebral fracture by compression, pneumonia,
purulent otitis, agranulocytosis).
Discussion
During the study period, functional status improved in
patients of the both treatment groups. In the TOC biological
therapy group, the average HAQ index decreased from 1.5 to
ͲǤͷƒ†‹–Š‡ƒ†Ϊ‘‘–Š‡”ƒ’›‰”‘—’•Ȃˆ”‘ʹǤͲ
–‘ʹǤͷ–‘ͲǤ͹ͷ’‘‹–•ȋ’αͲǤͲͲͺȌǤŠ‡—„‡”‘ˆ’ƒ–‹‡–•™‹–Š
ʹǡͷ‰ȋÁƒ„‡Ž‡‰”—’—”‹Ȍè‹•Ǧƒƒ—Žƒ–Žƒ͹͸Ψ’ƒ…‹‡ì‹
–”ƒ–ƒì‹…—–‡”ƒ’‹‡„‹‘Ž‘‰‹…£ǡè‹Žƒƒ’”‘š‹ƒ–‹˜ͷͲΨǡ–”ƒ–ƒì‹
…— ‘‘–‡”ƒ’‹‡  è‹ Ϊ ȋ…— †‹ˆ‡”‡ì£ •‡‹ϐ‹…ƒ–‹˜£ǡ
’αͲǡͲʹ͹ȌǤ•–ˆ‡Žǡƒ—ˆ‘•–‘„•‡”˜ƒ–‡†‹ˆ‡”‡ì‡Ž‡‹–‡”‰”—’ƒŽ‡Á
”‡†—…‡”‡ƒ •‹†”‘—Ž—‹ ‹ϐŽƒƒ–‘” †‡ …£–”‡ –‡”ƒ’‹ƒ „‹‘Ž‘‰‹…£
TOC.
ƒ…‘’ƒ”ƒ”‡ƒ‡ϐ‹…ƒ…‹–£ì‹‹ƒ–”‡‹–‹’—”‹†‡–‡”ƒ’‹‹†‡„ƒœ£ǡ
•Ǧƒ…‘•–ƒ–ƒ–…£–‡”ƒ’‹ƒ„‹‘Ž‘‰‹…£…—ǡ…‘’ƒ”ƒ–‹˜…—‘-
‘–‡”ƒ’‹ƒè‹…‘„‹ƒì‹ƒΪǡƒ”‡†‘—£ƒ˜ƒ–ƒŒ‡•‡‹-
ϐ‹…ƒ–‹˜‡ǣ•–ƒ„‹Ž‹–ƒ–‡•‡‹ϐ‹…ƒ–‹˜£ȋεͷͲȌƒ‡ˆ‡…–—Ž—‹…Ž‹‹…è‹
”‡†—…‡”‡ƒ”ƒ–‡‹”‡ƒ…ì‹‹Ž‘”ƒ†˜‡”•‡Ǥ”–”‡„—‹†‡”‡ƒ”…ƒ–ˆƒ’–—Ž
a minimal (HAQ 0-1.0), average (HAQ 1.1-2.0) and expressed
(HAQ 2.1-3.0) functional disorder at the end of the study in
both groups was similar. Thus, true intergroup differences in
the improvement of the functional status were not observed.
The use of all types of therapy reduced the daily average
dose at the concomitant administration of corticosteroids
from 5.0 to 2.5 mg (in both groups), and NSAIDs were can-
celled in 76% patients treated with TOC biological therapy
and in approximately 50% patients treated with MT mono-
–Š‡”ƒ’›ƒ†Ϊȋ™‹–Šƒ•‹‰‹ϐ‹…ƒ–†‹ˆˆ‡”‡…‡ǡ’αͲǤͲʹ͹ȌǤ
Š—•ǡ‹–‡”‰”‘—’†‹ˆˆ‡”‡…‡•‹–Š‡”‡†—…–‹‘‘ˆ–Š‡‹ϐŽƒƒ-
tory syndrome by the biological TOC therapy were observed.
—ƒŽ‹–› oˆ Ž‹ˆ‡ ƒˆ–‡” –Š‡ –”‡ƒ–‡n– oˆ ”Š‡—ƒ–o‹† ƒ”–Š”‹–‹•
…£ƒ…‡•–‡ƒ˜ƒ–ƒŒ‡•—–‡ì‹—–‡è‹Žƒ‘‹–‘”‹œƒ”‡ƒ—Ž–‡”‹‘ƒ-
”£ƒ’ƒ…‹‡ì‹Ž‘”Áƒˆƒ”ƒ•–—†‹—Ž—‹ȋˆ‘ŽŽ‘™Ǧ—’Ǧ—Žƒš‹ƒˆ‘•–
†‡ʹƒ‹ȌǤB‘’‹‹ƒ‘ƒ•–”£ǡƒ…‡•–‡’”‘’”‹‡–£ì‹ƒŽ‡–‡”ƒ’‹‡‹„‹‘-
Ž‘‰‹…‡•—–‹’‘”–ƒ–‡†‹’—…–†‡˜‡†‡”‡…Ž‹‹…苘ƒŽ‘”‘ƒ•‡
’‡–”— ’ƒ…‹‡ì‹‹ …— Ǥ B •’‡…‹ƒŽǡ •‡ ’‘– ”‡†—…‡ ‡…‡•‹–£ì‹Ž‡
MJHS 17(3)/2018 43
Š‡ …‘’ƒ”‹‰ –Š‡ ‡ˆϐ‹…ƒ…› ‘ˆ –Š‡ –Š”‡‡ –›’‡• ‘ˆ „ƒ•‹…
therapies, we found that biological therapy with TOC, com-
pared to MT monotherapy and the combination of MT+SLZ,
Šƒ•–™‘‹’‘”–ƒ–ƒ†˜ƒ–ƒ‰‡•ǣ•‹‰‹ϐ‹…ƒ–•–ƒ„‹Ž‹–›ȋεͷͲȌ
of the clinical effect and reduction in the rate of adverse re-
’ƒ…‹‡ì‹Ž‘”Á–”Ǧ‘–‡”ƒ’‹‡…—‰Ž—…‘…‘”–‹…‘•–‡”‘‹œ‹è‹ǡ…Ÿ–è‹
‹Œ‡…ì‹‹‹–”ƒǦƒ”–‹…—Žƒ”‡†‡…‘”–‹…‘•–‡”‘‹œ‹Ǥ
‘…Ž—œ‹‹
‡”ƒ’‹ƒ„‹‘Ž‘‰‹…£…—ƒ†‡‘•–”ƒ–‘ƒ‹ƒ”‡‡ϐ‹…ƒ-
…‹–ƒ–‡Áƒ‡Ž‹‘”ƒ”‡ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ǡ…‘’ƒ”ƒ–‹˜…—‘‘–‡”ƒ-
pia MT sau tratamentul combinat MT+SLZ. Astfel, în grupul cu
–‡”ƒ’‹‡„‹‘Ž‘‰‹…£ǡ‹†‹…‡Ž‡‡†‹—ƒ•…£œ—–†‡Žƒͳǡͷ’Ÿ£
ŽƒͲǡ‹ƒ”Á‰”—’—Ž…—‘‘–‡”ƒ’‹‡•ƒ—ΪȂ†‡ŽƒʹǡͲ
è‹ʹǡͷ’Ÿ£ŽƒͳǡͲ’—…–‡Ǥ‡†—…‡”‡ƒ•…‘”—”‹Ž‘””ƒ†‹‘Ž‘‰‹…‡†‡
ƒˆ‡…–ƒ”‡ ƒ”–‹…—Žƒ”£ ƒ ˆ‘•– ƒ‹ •‡‹ϐ‹…ƒ–‹˜£ ’‡–”— ‰”—’—Ž …—
–‡”ƒ’‹‡„‹‘Ž‘‰‹…£ȋŒ‘•Žƒ͸ͻΨ’ƒ…‹‡ì‹Ȍǡ…‘’ƒ”ƒ–‹˜…—
‘‘–‡”ƒ’‹ƒ…—ȋŒ‘•ŽƒͶ͸ǡͳͷΨ’ƒ…‹‡ì‹ǡ’δͲǡͲͳȌè‹–‡-
”ƒ’‹ƒ…‘„‹ƒ–£ǡΪȋŒ‘•ŽƒͶͷΨ’ƒ…‹‡ì‹ȌǤ
Suportarea terapiei biologice TOC a fost în totalitate mult
ƒ‹„—£è‹•‡‹ϐ‹…ƒ–‹˜•Ǧƒ†‡‘•‡„‹–†‡•—’‘”–ƒ”‡ƒ‘‘–‡”ƒ-
’‹‡‹…—•ƒ—ƒ–‡”ƒ’‹‡‹…‘„‹ƒ–‡ΪǤ ”‡…˜‡ìƒ”‡ƒ…ì‹‹-
lor adverse care au necesitat întreruperea tratamentului a fost
‡Á•‡ƒ–£Žƒ„‘Žƒ˜‹‹…ƒ”‡ƒ—ˆ‘•–•—’—è‹–‡”ƒ’‹‡‹„‹‘Ž‘‰‹…‡
ȋͶΨ ’ƒ…‹‡ì‹Ȍǡ …— ‘ ”ƒ–£ •‡‹ϐ‹…ƒ–‹˜ ƒ‹ ƒ”‡ Á ‰”—’—Ž …—
‘‘–‡”ƒ’‹‡ȋͳͶΨȌè‹–‡”ƒ’‹‡…‘„‹ƒ–£Ϊȋͳ͸ΨȌǤ
‡…Žƒ”ƒì‹ƒ…‘ϐŽ‹…–—Ž—‹†‡‹–‡”‡•‡
—–‘”‹‹ †‡…Žƒ”£ Ž‹’•ƒ …‘ϐŽ‹…–‡Ž‘” †‡ ‹–‡”‡•‡ ϐ‹ƒ…‹ƒ”‡ è‹
‘Ǧϐ‹ƒ…‹ƒ”‡Ǥ
‘–”‹„—싃ƒ—–‘”‹Ž‘”
Ambii autori în mod egal au contribuit la †‡•‹‰n-ul stu-
diului, colectarea datelor, scrierea articolului. OB a efectuat
ƒƒŽ‹œƒ•–ƒ–‹•–‹…£Ǥ—–‘”‹‹ƒ—…‹–‹–苃’”‘„ƒ–˜‡”•‹—‡ƒϐ‹ƒŽ£ƒ
manuscrisului.
‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
1. Balsa A., Del Amo J., Blanco F. ‡– ƒŽǤ Prediction of functional im-
Ǥ
pairment and remission in rheumatoid arthritis patients by bio-
chemical variables and genetic polymorphisms. Š‡—ƒ–oŽo‰›
ȋšˆo”†ȌǡʹͲͳͶǢͶͻȋ͵ȌǣͶͷͺǦͶ͸͸Ǥ
ʹǤ ”‡‡†˜‡Ž† Ǥǡ ƒ›‡”
Ǥ ‘…‹Ž‹œ—ƒ„ǣ ‘†‡ ‘ˆ ƒ…–‹‘ ‹ –Š‡ –”‡ƒ–- ƒ–‘‹† ƒ”–Š”‹–‹•ǣ ƒ †‘—„Ž‡Ǧ„Ž‹†ǡ ”ƒ†‘‹•‡†ǡ —Ž–‹…‡–”‡ –”‹ƒŽǤ
ment of rheumatoid arthritis. nnǤ Š‡—Ǥ ‹•Ǥǡ ʹͲͳ͵Ǣ ͷͻ ȋͳͳȌǣ
841-849.
3. Dominick K., Ahern F., Gold C., Heller D. Health-related quality of
life among older adults with arthritis. ‡ƒŽ–Š —ƒŽ ‹ˆ‡ —–co‡•,
ʹͲͳʹǢʹȋͳȌǣͷǤ
4. Helmick C., Felson D., Lawrence R., Gabriel S., Hirsch R., Kwoh C.
‡– ƒŽǤ for the National Arthritis Data Workgroup. Estimates of the
prevalence of arthritis and other rheumatic conditions in the Uni-
ƒ…–‹‘•Ǥ–•Š‘—Ž†„‡‘–‡†–Šƒ––Š‡•‡„‡‡ϐ‹–•ƒ”‡ƒŽ•‘ƒ‹-
tained in the subsequent monitoring of the patients outside
the study (maximum follow-up was of 2 years). In our opinion,
these properties of the biological therapy are clinically impor-
tant and valuable for the patients with RA. In particular, pa-
tients’ needs may be reduced in a therapy with GCS and NSAID,
as well as with intraarticular injections of corticosteroids.
Conclusions
‹‘Ž‘‰‹…ƒŽ–Š‡”ƒ’›™‹–ŠŠƒ••Š‘™‰”‡ƒ–‡”‡ˆϐ‹…ƒ…›‹
restoring life quality versus MT monotherapy or combined
MT+SLZ treatment, so that in the biological therapy group the
average HAQ index decreased from 1.5 to 0 and in the group
™‹–Š  ‘” Ϊ ‘‘–Š‡”ƒ’› Ȃ ˆ”‘ ʹǤͲ ƒ† ʹǤͷ –‘ ͳǤͲ
points. Reduction of the radiological scores of joint damage
™ƒ• ‘”‡ •‹‰‹ϐ‹…ƒ– ˆ‘” –Š‡  „‹‘Ž‘‰‹…ƒŽ –Š‡”ƒ’› ‰”‘—’
(low KD in 69% of patients) compared with MT monotherapy
(low KD in 46.15% patients, p<0.01) and MT+SLZ combina-
tion therapy (low KD in 45% of patients).
The tolerance of TOC biological therapy was overall much
„‡––‡” ƒ† •‹‰‹ϐ‹…ƒ–Ž› †‹ˆˆ‡”‡† ˆ”‘ –Š‡ –‘Ž‡”ƒ…‡ ‘ˆ 
monotherapy or MT+SLZ combined therapy. The frequency of
adverse reactions requiring the discontinuation of the treat-
ment was negligible in patients who underwent biological
–Š‡”ƒ’›ȋͶΨ‘ˆ’ƒ–‹‡–•Ȍǡ™‹–Šƒ•‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡””ƒ–‡‹–Š‡
MT monotherapy group (14%) and MT+SLZ combined thera-
py group (16%).
‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‹‰‹–‡”‡•–•
Š‡ ƒ—–Š‘”• †‡…Žƒ”‡ –Š‡ ƒ„•‡…‡ ‘ˆ …‘ϐŽ‹…–• ‘ˆ ϐ‹ƒ…‹ƒŽ
ƒ†‘Ǧϐ‹ƒ…‹ƒŽ‹–‡”‡•–•Ǥ
Contribution of the authors
Both authors equally contributed to the study †‡•‹‰n, col-
lecting data, writing the article. OB carried out the statistical
analysis.
5. Olsen N., Stein C. New drugs for rheumatoid arthritis. Ǥ n‰ŽǤ
‡†ǤǡʹͲͳͶǢ͵ͷͲȋʹͳȌǣʹͳ͸͹Ǧʹͳ͹ͻǤ
6. Smolen J., Kalden J., Scott D. ‡– ƒŽǤˆϐ‹…ƒ…›ƒ†•ƒˆ‡–›‘ˆ–‘…‹Ž‹œ—-
mab compared with placebo and methotrexate in active rheu-
European Tocilizumab Study Group. ƒnc‡–ǡ ʹͲͳͷǢ ͵ͷ͵ ȋͻͳͶͻȌǣ
259-266.
7. American College of Rheumatology Ad Hoc Committee on Clinical
Guidelines. Guidelines for the management of rheumatoid arthri-
tis. American College of Rheumatology Ad Hoc Committee on Cli-
nical Guidelines. ”–Š”‹–‹• Š‡—ǤǡʹͲͳͷǢ͵ͻȋͷȌǣ͹ͳ͵Ǧ͹ʹʹǤ
–‡†–ƒ–‡•ǣƒ”–Ǥ”–Š”‹–‹•Ǥ Š‡—ǤǡʹͲͳ͵ǢͷͺȋͳȌǣͳͷǦʹͷǤ
44

ARTICOL DE CERCETARE RESEARCH ARTICLE

ƒ”–‹…—Žƒ”‹–£ì‹Š‹•–‘’ƒ–‘Ž‘‰‹…‡ Histopathological and immuǦ

ç‹‹—‘Š‹•–‘…Š‹‹…‡ƒŽ‡ nohistochemical peculiarities
venelor varicoase ale membruǦ of varicose veins of the lower
lui inferior limbs
Anastasia Bendelic1*†, Marius Raica2† Anastasia Bendelic1*†, Marius Raica2†
1
ƒ–‡†”ƒ †‡ ƒnƒ–o‹‡ ƒ o—Ž—‹ǡ n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ 1
Šƒ‹” oˆ Š—ƒn ƒnƒ–o›ǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn†
Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dzǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǢ PŠƒ”ƒc›ǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǢ
͸
‡’ƒ”–ƒ‡n–—Ž †‡ o”ˆoŽo‰‹‡ ‹c”o•co’‹c£ǡ ‹•c‹’Ž‹nƒ †‡ ‹•–oŽo‰‹‡ǡ ‡n–”—Ž ͸
‡’ƒ”–‡n– oˆ ‹c”o•co’‹c o”’ŠoŽo‰›ǡ ‹•c‹’Ž‹n‡ oˆ ‹•–oŽo‰›ǡ n‰‹o‰‡n‡•‹•
†‡ ‡”c‡–£”‹ Án n‰‹o‰‡n‡œ£ǡ n‹˜‡”•‹–ƒ–‡ƒ †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹c–o” ‡•‡ƒ”cŠ ‡n–‡”ǡ ‹c–o” ƒ„‡• n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›ǡ ‹‹•oƒ”ƒǡ
ƒ„‡çdz †‹n ‹‹çoƒ”ƒǡ oŸn‹ƒǤ oƒn‹ƒǤ

Data primirii manuscrisului: 05.06.2018 Manuscris received on: 05.06.2018

ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣʹͲǤͲͻǤʹͲͳͺ ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣʹͲǤͲͻǤʹͲͳͺ

Autor corespondent: Corresponding author:

nƒ•–ƒ•‹ƒ ‡n†‡Ž‹cǡ †oc–o”ƒn† nƒ•–ƒ•‹ƒ ‡n†‡Ž‹cǡ PŠ ˆ‡ŽŽo™
ƒ–‡†”ƒ †‡ ƒnƒ–o‹‡ ƒ o—Ž—‹ Šƒ‹” oˆ Š—ƒn ƒnƒ–o›
n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz ‹coŽƒ‡ ‡•–‡‹–ƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
„†Ǥ f–‡ˆƒn c‡Ž ƒ”‡ ç‹ ˆŸn–ǡ 1ͼͻǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ 1ͼͻǡ –‡ˆƒn c‡Ž ƒ”‡ •‹ ˆƒn– ƒ˜‡ǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ƒnƒ•–ƒ•‹ƒǤ„‡n†‡Ž‹c̻—•ˆǤ† ‡Ǧƒ‹Ž: ƒnƒ•–ƒ•‹ƒǤ„‡n†‡Ž‹c̻—•ˆǤ†

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

ƒ‘‡–—Žƒ…–—ƒŽǡ—‡•–‡…Žƒ”…ƒ”‡†‹‘†‹ϐ‹…£”‹Ž‡Š‹•- At the current moment, it is not clear which histopathologi-
–‘’ƒ–‘Ž‘‰‹…‡ƒŽ‡’‡”‡–‡Ž—‹˜‡‘••—–’”‹ƒ”‡ç‹Ȁ•ƒ—•‡…—†ƒ- cal changes of the venous wall are primary and/or secondary,
”‡ǡç‹…ƒ”‡†‹–”‡ƒ…‡•–‡‘†‹ϐ‹…£”‹ƒ”’—–‡ƒϐ‹†‡ϐ‹‹–‡…ƒˆƒ…–‘”‹ ƒ†™Š‹…Š‘ˆ–Š‡•‡…Šƒ‰‡•…‘—Ž†„‡†‡ϐ‹‡†ƒ•–”‹‰‰‡”ˆƒ…–‘”•
†‡…Žƒçƒ–‘”‹…‡…‘†—…Žƒƒ’ƒ”‹ì‹ƒ˜ƒ”‹…‡Ž‘”Ǥ that lead to varicose veins.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
–—†‹‡”‡ƒ‘†‹ϐ‹…£”‹Ž‘”Š‹•–‘’ƒ–‘Ž‘‰‹…‡ç‹‹—‘Š‹•–‘…Š‹-
ice ale peretelui venos prezente de-a lungul unei singure vene
•ƒˆ‡‡ †‹Žƒ–ƒ–‡ ˜ƒ”‹…‘• ç‹Ȁ•ƒ— Žƒ †‹ˆ‡”‹–‡ ‡–ƒ’‡ ‡˜‘Ž—–‹˜‡ ƒŽ‡
„‘Ž‹‹ƒ”’—–‡ƒƒ†—…‡…‘–”‹„—ì‹‹ŽƒÁì‡Ž‡‰‡”‡ƒ’ƒ–‘‰‡‹‡‹„‘Ž‹‹
venoase cronice.
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
ƒ‡–ƒ’‡Ž‡‹‹ì‹ƒŽ‡ƒŽ‡„‘Ž‹‹˜ƒ”‹…‘ƒ•‡‘†‹ϐ‹…£”‹Ž‡Š‹•–‘’ƒ-
–‘Ž‘‰‹…‡‹…Ž—†Š‹’‡”–”‘ϐ‹ƒç‹Š‹’‡”’Žƒœ‹ƒ…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡
‡–‡†‡ƒŽ‡–—‹…‹‹‡†‹‹ǡ’”‡…—ç‹Á‰”‘烔‡ƒ’‡”‡–‡Ž—‹˜‡‘•
†‹…‘–—ŽŠ‹’‡”’Žƒœ‹‡‹‹–‹ƒŽ‡Ǥ‡’ƒ”‡…£—”‘Ž’”‹‘”†‹ƒŽ
în patogenia bolii îi revine celulei musculare netede vascu-
Žƒ”‡ǡ’”‡œ‡–£•—„ˆ‘”£†‡†‘—£ˆ‡‘–‹’—”‹ǣȋͳȌ…‘–”ƒ…–‹Žǡ…—
…‹–‘’Žƒ•£„‘‰ƒ–£Á‹‘ϐ‹Žƒ‡–‡ç‹ȋʹȌ•‡…”‡–‘”†‡…‘Žƒ‰‡ǡ
‡Žƒ•–‹£ǡ’”‘–‡‘‰Ž‹…ƒ‹Ǥ
‡œ—ƒ–
Introducere. ‘ƒŽƒ ˜ƒ”‹…‘ƒ•£ •ƒ— „‘ƒŽƒ ˜‡‘ƒ•£ …”‘‹…£
poate afecta toate segmentele sistemului venos, dar interesea-
œ£…—’”‡…£†‡”‡•‹•–‡—Ž˜‡‡‹…ƒ˜‡‹ˆ‡”‹‘ƒ”‡Ǥƒ‹ˆ”‡…˜‡–ǡŽ‡-
œ‹—‹Ž‡ƒˆ‡…–‡ƒœ£˜‡‡Ž‡•—’‡”ϐ‹…‹ƒŽ‡ƒŽ‡‡„”‡Ž‘”‹ˆ‡”‹‘ƒ”‡Ǥ
‡è‹ǡƒ—ˆ‘•–’—„Ž‹…ƒ–‡—‡”‘ƒ•‡Ž—…”£”‹ƒ•—’”ƒ‘†‹ϐ‹…£”‹Ž‘”
‘”ˆ‘Ž‘‰‹…‡ ƒŽ‡ ˜‡‡Ž‘” ƒˆ‡…–ƒ–‡ †‡ „‘ƒŽƒ ˜ƒ”‹…‘ƒ•£ǡ ‡•–‡ Á…£
Research hypothesis
Study of the histopathological and immunohistochemical
changes of the venous wall present along a single varicose
saphenous vein and/or at various evolutionary stages of the
disease could contribute to understanding the pathogenesis of
the chronic venous disease.
”–‹…Ž‡Ʈ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
At the initial stages of varicose disease the histopathologi-
cal changes include hypertrophy and hyperplasia of smooth
muscule cells of the media, as well as thickening of the venous
wall due to intimal hyperplasia. It appears that primordial role
in the pathogenesis of the disease lies on the vascular smooth
—•…Ž‡…‡ŽŽ’”‡•‡–‹–Š‡ˆ‘”‘ˆ–™‘’Š‡‘–›’‡•ǣȋͳȌ…‘–”ƒ…-
–‹Ž‡ǡ ™‹–Š …›–‘’Žƒ• ”‹…Š ‹ ›‘ϐ‹Žƒ‡–• ƒ† ȋʹȌ •›–Š‡Ǧ–‹…ǡ
that secrete collagen, elastin, and proteoglycans.
Abstract
Introduction. Varicose disease or chronic venous disease
may affect all segments of the venous system but particularly
affects the system of the inferior vena cava. More frequently,
–Š‡Ž‡•‹‘•ƒˆˆ‡…–•—’‡”ϐ‹…‹ƒŽ˜‡‹•‘ˆ–Š‡Ž‘™‡”Ž‹„ǤŽ–Š‘—‰Š
there were published numerous works about morphological
‘†‹ϐ‹…ƒ–‹‘•‘ˆ˜‡‹•ƒˆˆ‡…–‡†„›–Š‡˜ƒ”‹…‘•‡†‹•‡ƒ•‡‹–‹••–‹ŽŽ
‹•–o’ƒ–ŠoŽo‰‹cƒŽ ’‡c—Ž‹ƒ”‹–‹‡• oˆ ˜ƒ”‹co•‡ ˜‡‹n•
‡…Žƒ”…ƒ”‡‡•–‡•—……‡•‹—‡ƒƒ…‡•–‘”Ž‡œ‹—‹è‹…—…‘–”‹„—‹‡
Žƒƒ’ƒ”‹ì‹ƒ˜ƒ”‹…‡Ž‘”Ǥ…‘’—Žƒ…‡•–—‹•–—†‹—ƒˆ‘•–†‡ƒ…Žƒ”‹ϐ‹…ƒ
•…Š‹„£”‹Ž‡ Š‹•–‘’ƒ–‘Ž‘‰‹…‡ è‹ ‹—‘Š‹•–‘…Š‹‹…‡ ’”‡œ‡–‡
†‡ǦƒŽ—‰—Ž—‡‹˜‡‡•ƒˆ‡‡†‹Žƒ–ƒ–‡˜ƒ”‹…‘•è‹Á˜‡‡Ž‡•ƒˆ‡‡
la diferite etape evolutive ale bolii venoase.
ƒ–‡”‹ƒŽ è‹ ‡–‘†‡Ǥ Drept obiect de sudiu au servit ve-
‡Ž‡ •ƒˆ‡‡ †‹Žƒ–ƒ–‡ ˜ƒ”‹…‘•ǡ ÁŽ£–—”ƒ–‡ …Š‹”—”‰‹…ƒŽ Á …ƒ†”—Ž
safenectomiilor. Materialul postoperator a fost colectat de la
ͺ ’ƒ…‹‡ì‹ …— ˜Ÿ”•–ƒ …—’”‹•£ Á–”‡ ͳͻ è‹ ͸ͺ †‡ ƒ‹ǡ ‹–‡”ƒì‹
’‡–”—–”ƒ–ƒ‡–…Š‹”—”‰‹…ƒŽÁ•‡…싃†‡…Š‹”—”‰‹‡˜ƒ•…—Žƒ”£
ƒ  Ƿ‹‘ˆ‡‹ ‘萇ƒ‰ƒdz †‹ Š‹è‹£—Ǥ ‘ˆ‘” …Žƒ•‹ϐ‹…£”‹‹
ƒ„‘Ž‹‹˜‡‘ƒ•‡…”‘‹…‡ǡŽ‘–—Ž†‡’ƒ…‹‡ì‹ƒˆ‘•–†‹˜‹œƒ–Á
†‘—£‰”—’—”‹ǣ•—„Ž‘–—ŽͳȂͷ’ƒ…‹‡ì‹Á•–ƒ†‹‹Ž‡…Ž‹‹‡2-3,
•—„Ž‘–—ŽʹȂ͵’ƒ…‹‡ì‹Á•–ƒ†‹‹Ž‡…Ž‹‹…‡4-6. Venele vari-
…‘ƒ•‡ƒ—ˆ‘•–ϐ‹šƒ–‡Áˆ‘”ƒŽ‹£‡—–”£ǡ‹…Ž—•‡Á’ƒ”ƒϐ‹£è‹
…‘Ž‘”ƒ–‡ ’”‹ ‡–‘†‡ †‡ …‘Ž‘”ƒ”‡ —œ—ƒŽ‡ǡ •’‡…‹ϐ‹…‡ è‹ ‹—‘-
histochimice.
‡œ—Ž–ƒ–‡Ǥ‘†‹ϐ‹…£”‹Ž‡Š‹•–‘’ƒ–‘Ž‘‰‹…‡ƒŽ‡’‡”‡–‡Ž—‹˜‡‘•
ȋ•—„Ž‘– ͳȌ ƒ— …—’”‹• Á‰”‘胔‡ƒ ‡†‹‡‹ è‹ ‹–‹‡‹ †‹ …‘–—Ž
Š‹’‡”–”‘ϐ‹‡‹è‹Š‹’‡”’Žƒœ‹‡‹…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡‡–‡†‡ǡƒ–Ÿ–Žƒ
‹˜‡Ž •—„‡†‘–‡Ž‹ƒŽǡ …Ÿ– è‹ Á –—‹…ƒ ‡†‹‡Ǥ ”‡è–‡”‡ƒ …‘’‘-
MJHS 17(3)/2018 45
unclear what is the succession of lesionss and how they contri-
bute to the development of varicose veins. The purpose of the
current research was to clarify histopathological and immuno-
Š‹•–‘…Š‡‹…ƒŽ‘†‹ϐ‹…ƒ–‹‘•’”‡œ‡–ƒŽ‘‰ƒ•‹‰Ž‡•ƒ’Š‡‘—•
vein or in the saphenous veins at various evolutionary stages
of the venous disease.
Material and methods. As object of studying served the
varicose saphenous veins surgically removed during saphenec-
tomy. Postoperative material was collected from eight patients
aged from 19 to 68 years and admitted for surgical treatment
ƒ––Š‡‡’ƒ”–‡–‘ˆ˜ƒ•…—Žƒ”•—”‰‡”›‘ˆDz‹‘ˆ‡‹‘•‡ƒ‰ƒdz
Republican Clinical Hospital, Chisinau, Republic of Moldova.
……‘”†‹‰–‘…Žƒ••‹ϐ‹…ƒ–‹‘‘ˆ–Š‡…Š”‘‹…˜‡‘—•†‹•‡ƒ•‡ǡ
–Š‡’ƒ–‹‡–•™‡”‡†‹˜‹†‡†‹–™‘•—„‰”‘—’•ǣ•—„‰”‘—’ͳȂϐ‹˜‡
patients at clinical stages CEAP2-3 ƒ†•—„‰”‘—’ʹȂ–Š”‡‡’ƒ-
tients at clinical stages CEAP4-6. Š‡˜ƒ”‹…‘•‡˜‡‹•™‡”‡ϐ‹š‡†
‹ ˆ‘”ƒŽ‹ǡ ‡„‡††‡† ‹ ’ƒ”ƒˆϐ‹ ƒ† •–ƒ‹‡† —•‹‰ ”‘—–‹‡ǡ
special and immunohistochemical staining methods.
Results. ‹•–‘’ƒ–Š‘Ž‘‰‹…ƒŽ ‘†‹ϐ‹…ƒ–‹‘• ‘ˆ ˜‡‘—• ™ƒŽŽ
(subgroup 1) comprise thickening of media and intima due
to the hypertrophy and hyperplasia of smooth muscle cells
‡–‡‹ϐ‹„”‹Žƒ”‡…‘Žƒ‰‡‹…‡ƒˆ‘•–ƒ•‘…‹ƒ–£…—…”‡è–‡”‡ƒ…‘’‘-
‡–‡‹ϐ‹„”‹Žƒ”‡‡Žƒ•–‹…‡Ǥ‡‡Ž‡•—„Ž‘–—Ž—‹ʹƒ˜‡ƒ—‹–‹ƒè‹‡-
†‹ƒÁ‰”‘胖‡†ƒ–‘”‹–£’”‡œ‡ì‡‹…‘Žƒ‰‡—Ž—‹Á…ƒ–‹–£ì‹ƒ”‹Ǥ
ƒ•…‹…—Ž‡Ž‡†‡‹‘…‹–‡ƒŽ‡‡†‹‡‹ƒ—ˆ‘•–ˆ”ƒ‰‡–ƒ–‡è‹ÁŽ‘…—‹-
–‡†‡ϐ‹„”‡Ž‡†‡…‘Žƒ‰‡Á‡š…‡•Ǥ—„Ž‘–—Žʹƒ’”‡œ‡–ƒ–ǡ†‡ƒ•‡-
‡‡ƒǡ†‡–ƒèƒ”‡ƒ‡†‘–‡Ž‹—Ž—‹è‹ÁŽ‘…—‹”‡ƒ•–”ƒ–—Ž—‹‡†‘–‡Ž‹ƒŽ
…—ϐ‹„”‡†‡…‘Žƒ‰‡Ǥ†˜‡–‹…‡ƒǡŽƒ”Ÿ†—Ž•£—ǡƒ’”‡œ‡–ƒ–—
—£”‹’—£–‘”†‡˜ƒ•‡ƒŽ‡‹…”‘…‹”…—Žƒì‹‡‹ȋ˜ƒ•ƒ ˜ƒ•o”—).
‘…Ž—œ‹‹Ǥ În stadiile clinice incipiente ale bolii venoase
…”‘‹…‡ȋ•—„Ž‘–ͳȌ’”‡†‘‹£Š‹’‡”’Žƒœ‹ƒè‹Š‹’‡”–”‘ϐ‹ƒ…‡Ž—-
lelor musculare netede ale mediei. În stadiile clinice avansate
ȋ•—„Ž‘–ʹȌ•‡†‡…Žƒè‡ƒœ£—’”‘…‡•†‡ϐ‹„”‘œƒ”‡ƒ‡†‹‡‹è‹
‹–‹‡‹ ȋϐŽ‡„‘•…Ž‡”‘œ£ȌǢ †‡—†ƒ”‡ƒ ‡†‘–‡Ž‹—Ž—‹ …‘†—…‡ǡ †‡
‘„‹…‡‹ǡŽƒˆ‘”ƒ”‡ƒ–”‘„‹Ž‘”ÁŽ—‡—Ž˜‡‡‹ȋ–”‘„‘ϐŽ‡„‹-
–£Ȍǡ‹ƒ”†‡•‹–ƒ–‡ƒ‹…”‘…‹”…—Žƒì‹‡‹Žƒ‹˜‡Ž—Žƒ†˜‡–‹…‡‹…”‡è–‡
‘†ƒ–£…—ƒ˜ƒ•ƒ”‡ƒ„‘Ž‹‹Ǥ
Cuvinte cheie: „‘ƒŽ£ ˜‡‘ƒ•£ …”‘‹…£ǡ ˜‡‡ ˜ƒ”‹…‘ƒ•‡ǡ
˜‡‡•ƒˆ‡‡ǡ‹…”‘…‹”…—Žƒì‹‡Ǥ
Introducere
‘Ž‹Ž‡˜‡‘ƒ•‡ƒ—‘‹…‹†‡ì£†‡ʹͲǦͷͲΨÁ”Ÿ†—”‹Ž‡’‘-
’—Žƒì‹‡‹ ƒ†—Ž–‡ǡ ”‡’”‡œ‡–Ÿ† —ƒ †‹–”‡ …‡Ž‡ ƒ‹ ˆ”‡…˜‡–‡
’”‘„Ž‡‡ †‡ •££–ƒ–‡ Žƒ ‹˜‡Ž ‘†‹ƒŽ ȏͳǦ͵ȐǤ ‘ˆ‘” –”ƒ–ƒ-
–‡Ž‘”†‡…Š‹”—”‰‹‡ȏͶǡͷȐǡ„‘ƒŽƒ˜‡‘ƒ•£…”‘‹…£ȋŽǤ‡‰ŽǤcŠ”oǦ
n‹c ˜‡no—• †‹•‡ƒ•‡Ȍ‡•–‡—–‡”‡…ƒ”‡…—’”‹†‡‘†‹ϐ‹…£”‹Ž‡
ˆ—…ì‹‘ƒŽ‡è‹Ȁ•ƒ—‘”ˆ‘Ž‘‰‹…‡ƒŽ‡•‹•–‡—Ž—‹˜‡‘•ǡ†‡Žƒ‘-
†‹ϐ‹…£”‹ˆ£”£‹’ƒ…–ϐ‹œ‹‘’ƒ–‘Ž‘‰‹…ȋ–‡Ž‡ƒ‰‹‡…–ƒœ‹‹•ƒ—˜‡‡ǷÁ
’Ÿœ£†‡’£‹ƒŒ‡dzȌ’Ÿ£Žƒ‘†‹ϐ‹…£”‹•‡˜‡”‡ȋ—Ž…‡”˜‡‘•ȌǤ
B–”‡ƒˆ‡…ì‹—‹Ž‡˜ƒ•…—Žƒ”‡’‡”‹ˆ‡”‹…‡ǡ„‘ƒŽƒ˜‡‘ƒ•£…”‘‹-
…£‡•–‡‘ƒˆ‡…ì‹—‡ƒ…£”‡‹•‡˜‡”‹–ƒ–‡ƒˆ‘•–—Ž––‹’è‹Á…£
‡•–‡•—„‡•–‹ƒ–£Ǥ‘ƒŽƒ˜‡‘ƒ•£…”‘‹…£‡•–‡†‡ϐ‹‹–£†‹ˆ‡”‹–ǣ
—‹‹ƒ—–‘”‹ȏͶȐ‘†‡ϐ‹‡•……ƒ‘ƒˆ‡…ì‹—‡…”‘‹…£ǡ…ƒ”ƒ…–‡”‹œƒ-
–£’”‹–”Ǧ—’”‘…‡•†‡†‡‰‡‡”ƒ”‡ƒ’‡”‡–‡Ž—‹˜‡‘•ǡƒŽì‹‹ȏ͸ǡ
͹ȐȂ…ƒ‘„‘ƒŽ£‹ϐŽƒƒ–‘”‹‡…”‘‹…£ǡ†‡–‡”‹ƒ–£†‡ƒ…ì‹—‡ƒ
’‡”•‹•–‡–£ è‹ …‘•–ƒ–£ ƒ Š‹’‡”–‡•‹—‹‹ ˜‡‘ƒ•‡ǡ …— ‹’ƒ…–
„‘–Š‘ˆ•—„‡†‘–Š‡Ž‹—Žƒ›‡”ƒ†‡†‹ƒǤ…”‡ƒ•‹‰ϐ‹„”‹ŽŽƒ”
…‘ŽŽƒ‰‡…‘’‘‡–•™ƒ•ƒ••‘…‹ƒ–‡†™‹–Š‹…”‡ƒ•‹‰ϐ‹„”‹ŽŽƒ”
elastic components. Veins of subgroup 2 had thick media and
intima because of presence of large amount of collagen. Sub-
group 2 showed detachment of endothelium and it replace-
‡–™‹–Šϐ‹„”‡•‘ˆ…‘ŽŽƒ‰‡Ǥ†˜‡–‹–‹ƒǡ‹–—”ǡ’”‡•‡–‡†ƒ
large number of microcirculatory vessels (˜ƒ•ƒ ˜ƒ•o”—).
Coclusions. At the incipient clinical stages of the chronic
venous disease predominate the hypertrophy and hyperplasia
of smooth muscle cells of the media. At the advanced stages a
process of sclerosis of media and intima starts (phlebosclero-
sis). Endothelium detachment leads to the thrombus formati-
on in the venous lumen (thrombophlebitis), but the intensity
of microcirculation at the level of adventitia increases toge-
ther with the evolution of the disease.
Key words: chronic venous disease, varicose veins, saphe-
nous veins, microcirculation.
Introduction
Venous diseases have an incidence of 20-50% among adult
population, representing one of the most common health pro-
blems in the world [1-3]. According to surgical tractates [4, 5],
chronic venous disease is a term that includes functional and/
‘” ‘”’Š‘Ž‘‰‹…ƒŽ ‘†‹ϐ‹…ƒ–‹‘• ‘ˆ –Š‡ ˜‡‘—• •›•–‡ǡ ˆ”‘
‘†‹ϐ‹…ƒ–‹‘•™‹–Š‘—–’ƒ–Š‘’Š›•‹‘Ž‘‰‹…ƒŽ‹’ƒ…–ȋ–‡Žƒ‰‹‡…–-
ƒ•‹ƒ•‘”•’‹†‡”˜‡‹•Ȍ–‘•‡˜‡”‡‘†‹ϐ‹…ƒ–‹‘•ȋ˜‡‘—•—Ž…‡”ȌǤ
Among peripheral vascular affections, chronic venous dis-
ease is a condition which severity was for a long time and is
•–‹ŽŽ —†‡”‡•–‹ƒ–‡†Ǥ Š‡ …Š”‘‹… ˜‡‘—• †‹•‡ƒ•‡ ‹• †‡ϐ‹‡†
†‹ˆˆ‡”‡–Ž›ǣ•‘‡ƒ—–Š‘”•ȏͶȐ†‡ϐ‹‡‹–ƒ•ƒ…Š”‘‹……‘†‹–‹‘
characterized as a process of degeneration of the venous wall,
‘–Š‡”•ȏ͸ǡ͹ȐȂƒ•ƒ…Š”‘‹…‹ϐŽƒƒ–‘”›†‹•‡ƒ•‡…ƒ—•‡†„›
persistent and constant venous hypertension, with a direct
impact on the morphological formations of the venous wall.
46
direct asupra f‘”ƒì‹—‹Ž‘”‘”ˆ‘Ž‘‰‹…‡†‹…‘’‘‡ìƒ’‡-
retelui venos.
”‘…‡•—Ž †‡‰‡‡”ƒ–‹˜ •ƒ— ‹ϐŽƒƒ–‘” ƒŽ ’‡”‡–‡Ž—‹ ˜‡‘•
ƒ”‡š’Ž‹…ƒƒ’ƒ”‹ì‹ƒ†‹Žƒ–ƒì‹‹Ž‘”˜‡‘ƒ•‡’‡”ƒ‡–‡Žƒ‹˜‡Ž—Ž
˜‡‡Ž‘” •—’‡”ϐ‹…‹ƒŽ‡ ȋ‡’‹ˆƒ•…‹ƒŽ‡Ȍ ƒŽ‡ ‡„”‡Ž‘” ‹ˆ‡”‹‘ƒ”‡ǡ
…— — –”ƒ‹‡…– …ƒ”ƒ…–‡”‹•–‹… •‹—‘• è‹Ȁ•ƒ— ƒ’—Žƒ”ǡ —‹–‡ Á
literatura de specialitate ˜ƒ”‹c‡Ǥ…‡•–‡†‹Žƒ–ƒì‹‹˜‡‘ƒ•‡•—–
Á•‘ì‹–‡†‡ƒŽ–‡”£”‹’ƒ”‹‡–ƒŽ‡è‹†‡–—Ž„—”£”‹†‡Š‡‘†‹ƒ‹…£
˜‡‘ƒ•£ȏͺǦͳͳȐǤ‹’—…–†‡˜‡†‡”‡…Ž‹‹…ǡ‡š‹•–£’ƒ–”—•–ƒ†‹‹
ƒŽ‡ƒˆ‡…–£”‹‹˜‡‘ƒ•‡ǡ…ƒ”ƒ…–‡”‹œƒ–‡†‡‡Ž‡‡–‡…Ž‹‹…‡’ƒ”–‹-
…—Žƒ”‡ȋ†‡Žƒ‹‘”‡è‹–”ƒœ‹–‘”‹‹ǡŽƒ•‡˜‡”‡è‹’‡”ƒ‡–‡Ȍǣ
ƒ–ƒ†‹—Ž Iǡ—‹–’”‡˜ƒ”‹…‘•ǡÁ•‘ì‹–†‡’‹…‹‘ƒ”‡‰”‡Ž‡…ƒ†‡
’Ž—„ǡ…”ƒ’‡’”‡†‘‹ƒ–‘…–—”‡ǡˆ—”‹…£–—”‹ǡ•‡-
œƒì‹ƒ†‡ƒ”•—”£Žƒ’‹…‹‘ƒ”‡•ƒ—•‡œƒì‹ƒ†‡’‹…‹‘”‘„‘•‹–Ǣ
ƒ–ƒ†‹—Ž IIȂƒ’ƒ”˜ƒ”‹…‡’‡–”ƒ‹‡…–—Ž˜‡‡Ž‘”ȋ˜‡‡˜ƒ”‹…‘ƒ-
se), asociate cu edem în regiunea gleznei;
ƒ–ƒ†‹—Ž III ‡•–‡Á•‘ì‹–†‡‘†‹ϐ‹…£”‹Žƒ‹˜‡Ž—Ž’‹‡Ž‹‹ȋ’‹‰-
mentare, eczeme);
ƒ–ƒ†‹—Ž I •‡ ƒ•‘…‹ƒœ£ …— Ž‹’‘†‡”ƒ–‘•…Ž‡”‘œ£ǡ ƒ–”‘ϐ‹‡
ƒŽ„£è‹—Ž…‡”‡˜‡‘ƒ•‡Ǥ
‘ˆ‘”…Žƒ•‹ϐ‹…£”‹‹ȋŽ‹‹…£ǡ–‹‘Ž‘‰‹…£ǡƒ–‘‹…£è‹
ƒ–‘Ž‘‰‹…£ȌȏͳʹǦͳͶȐǡ…Žƒ•‹ϐ‹…ƒ”‡Žƒ”‰”£•’Ÿ†‹–£ƒ„‘Ž‹‹˜‡‘ƒ•‡
…”‘‹…‡ǡ…Ž‹‹…‹‹„‘Ž‹‹Á…ƒ—œ£‹•‡†‹•–‹‰—”£–‘ƒ”‡Ž‡•–ƒ†‹‹ǣ
C0 Ȃˆ£”£‘†‹ϐ‹…£”‹˜‹œ‹„‹Ž‡•ƒ—’ƒŽ’ƒ„‹Ž‡†‡„‘ƒŽ£˜‡‘ƒ•£ǡ1
Ȃ–‡Ž‡ƒ‰‹‡…–ƒœ‹‹ȋδͳȌè‹Ȁ•ƒ—˜‡‡”‡–‹…—Žƒ”‡ȋͳǦ͵Ȍǡ2
Ȃ˜‡‡˜ƒ”‹…‘ƒ•‡ȋε͵Ȍǡ3 Ȃ‡†‡ǡ4 Ȃ‘†‹ϐ‹…£”‹…—–ƒƒ–‡
è‹•—„…—–ƒƒ–‡ȋ4a Ȃ’‹‰‡–ƒ”‡•ƒ—‡š‡£Ǣ4b ȂŽ‹’‘†‡”ƒ–‘-
•…Ž‡”‘œ£•ƒ—ƒ–”‘ϐ‹‡ƒŽ„£Ȍǡ5 Ȃ—Ž…‡”˜‡‘•˜‹†‡…ƒ–ǡ6 Ȃ—Ž…‡”
˜‡‘•ƒ…—–ǤŽƒ•‹ϐ‹…ƒ”‡ƒ‡–‹‘Ž‘‰‹…£ƒ„‘Ž‹‹˜‡‘ƒ•‡…—’”‹†‡ǣc
Ȃ…‘‰‡‹–ƒŽ£ǡp Ȃ’”‹ƒ”£ǡs Ȃ•‡…—†ƒ”£ȋ’‘•––”‘„‘–‹…£Ȍǡ
En Ȃˆ£”£…ƒ—œ£˜‡‘ƒ•£‹†‡–‹ϐ‹…ƒ–£ǤŽƒ•‹ϐ‹…ƒ”‡ƒƒƒ–‘‹…£‹-
…Ž—†‡ǣ s Ȃ ˜‡‡ •—’‡”ϐ‹…‹ƒŽ‡ǡ p Ȃ ˜‡‡ ’‡”ˆ‘”ƒ–‡ǡ d Ȃ ˜‡‡
profune (l. engl. †‡‡’ ˜‡‹n•), An Ȃ ˆ£”£ ‹†‡–‹ϐ‹…ƒ”‡ƒ •‡†‹—Ž—‹
˜‡‘•Ǥg‹ǡÁ…‡Ž‡†‹—”£ǡ…Žƒ•‹ϐ‹…ƒ”‡ƒ’ƒ–‘Ž‘‰‹…£Á‰Ž‘„‡ƒœ£ǣ
Pr Ȃ”‡ϐŽ—šǡo Ȃ‘„•–”—…싇ǡr,o Ȃ”‡ϐŽ—šè‹‘„•–”—…싇ǡn Ȃˆ£”£
‘†‹ϐ‹…£”‹ϐ‹œ‹‘’ƒ–‘Ž‘‰‹…‡•–ƒ„‹Ž‹–‡Ǥ
—„ ƒ•’‡…– Š‹•–‘’ƒ–‘Ž‘‰‹…ǡ ‘†‹ϐ‹…£”‹ ‘”ˆ‘Ž‘‰‹…‡ ‹…”‘-
scopice în cazul bolii venoase cronice [6, 15-27] sunt locali-
œƒ–‡Žƒ‹˜‡Ž—Ž…‡Ž‘”–”‡‹–—‹…‹ƒŽ‡’‡”‡–‡Ž—‹˜‡‘•ȋ‹–‹£ǡ‡-
†‹‡ǡƒ†˜‡–‹…‡Ȍè‹‹–‡”‡•‡ƒœ£ǡƒ‹ˆ”‡…˜‡–ǡ˜‡ƒ•ƒˆ‡£ƒ”‡Ǥ
‡è‹ǡƒ—ˆ‘•–’—„Ž‹…ƒ–‡—‡”‘ƒ•‡Ž—…”£”‹ƒ•—’”ƒ‘†‹ϐ‹…£”‹Ž‘”
‘”ˆ‘Ž‘‰‹…‡ƒŽ‡˜‡‡Ž‘”ƒˆ‡…–ƒ–‡†‡„‘ƒŽƒ˜ƒ”‹…‘ƒ•£ǡ‡•–‡Á…£
‡…Žƒ”…ƒ”‡‡•–‡•—……‡•‹—‡ƒƒ…‡•–‘”Ž‡œ‹—‹è‹…—…‘–”‹„—-
‹‡Žƒ†‡œ˜‘Ž–ƒ”‡ƒ‹•—ϐ‹…‹‡ì‡‹˜‡‘ƒ•‡…”‘‹…‡Ǥ‡ƒ•‡‡‡ƒǡ
’ƒ”–‹…—Žƒ”‹–£ì‹Ž‡‘Ž‡…—Žƒ”‡ƒŽ‡˜‡‡Ž‘”˜ƒ”‹…‘ƒ•‡ƒ—ˆ‘•–ˆ‘ƒ”-
–‡’—싐•–—†‹ƒ–‡ǡ‹ƒ”…—‘è–‹ì‡Ž‡Á†‘‡‹—•—–Žƒ…—ƒ”‡Ǥ
Scopul ƒ…‡•–—‹•–—†‹—ƒˆ‘•–†‡ƒ…Žƒ”‹ϐ‹…ƒ•…Š‹„£”‹Ž‡Š‹•–‘-
’ƒ–‘Ž‘‰‹…‡ è‹ ‹—‘Š‹•–‘…Š‹‹…‡ ’”‡œ‡–‡ †‡Ǧƒ Ž—‰—Ž —‡‹
˜‡‡•ƒˆ‡‡†‹Žƒ–ƒ–‡˜ƒ”‹…‘•è‹Á˜‡‡Ž‡•ƒˆ‡‡Žƒ†‹ˆ‡”‹–‡‡–ƒ’‡
‡˜‘Ž—–‹˜‡ ƒŽ‡ „‘Ž‹‹ ˜‡‘ƒ•‡ǡ ’”‡…— è‹ ‘†‹ϐ‹…£”‹Ž‡ ‹…”‘…‹”-
…—Žƒì‹‡‹’‡”‡–‡Ž—‹˜‡‘•ȋ˜ƒ•ƒ ˜ƒ•o”—) în cazul bolii venoase
…”‘‹…‡Ǥ ‹ ‹ˆ‘”ƒì‹‹Ž‡ ’‡ …ƒ”‡ Ž‡ ƒ˜‡ǡ •–—†‹‹ ’”‹ „‹‘’•‹‹
—Ž–‹’Ž‡‡–ƒŒƒ–‡†‹˜‡‡Ž‡˜ƒ”‹…‘ƒ•‡•—–ˆ‘ƒ”–‡’—싐‡è‹…—
…‘…Ž—œ‹‹Á…£Á†‡œ„ƒ–‡”‡Ǥ
ƒ–‡”‹ƒŽè‹‡–‘†‡
Drept obiect de studiu au servit venele safene dilatate va-
”‹…‘•ǡ ÁŽ£–—”ƒ–‡ …Š‹”—”‰‹…ƒŽ Á …ƒ†”—Ž •ƒˆ‡‡…–‘‹‹Ž‘” ȋ’”‹
Pƒ”–‹c—Žƒ”‹–£ì‹ Š‹•–o’ƒ–oŽo‰‹c‡ ƒŽ‡ ˜‡n‡Žo” ˜ƒ”‹coƒ•‡
Š‡ †‡‰‡‡”ƒ–‹˜‡ ‘” ‹ϐŽƒƒ–‘”› ’”‘…‡•• ‘ˆ –Š‡ ˜‡‘—•
wall would explain the occurrence of permanent venous dila-
–‹‘•‹–Š‡•—’‡”ϐ‹…‹ƒŽȋ‡’‹ˆƒ•…‹ƒŽȌ˜‡‹•‘ˆŽ‘™‡”Ž‹„™‹–Šƒ
characteristic sinuous and/or ampullary trajectory called in
the specialized literature ˜ƒ”‹c‡•. These venous dilations are
accompanied by parietal alterations and venous hemodynam-
ic disorders [8-11]. From a clinical point of view, there are four
stages of venous disease characterized by particular clinical
ˆ‡ƒ–—”‡•ȋˆ”‘‹‘”ƒ†–”ƒ•‹‡––‘•‡˜‡”‡ƒ†’‡”ƒ‡–Ȍǣ
ƒ–ƒ‰‡ I, called prevaricos, is accompanied by heavy legs,
predominant nocturnal leg cramps, tingling, burning
sensation or tired legs feeling;
ƒ–ƒ‰‡ II Ȃ˜ƒ”‹…‡•ƒ’’‡ƒ”ƒŽ‘‰–Š‡˜‡‹•ȋ˜ƒ”‹…‘•‡˜‡‹•Ȍ
associated with edema in the ankle region;
ƒ–ƒ‰‡ III is accompanied by skin changes (pigmentation,
eczema);
ƒ–ƒ‰‡ I is associated with lipodermatosclerosis, white
atrophy and venous ulcers.
……‘”†‹‰–‘…Žƒ••‹ϐ‹…ƒ–‹‘ȋŽ‹‹…ƒŽǡ–‹‘Ž‘‰‹…ƒŽǡƒ-
–‘‹…ƒŽƒ†ƒ–Š‘Ž‘‰‹…ƒŽȌȏͳʹǦͳͶȐǡƒ™‹†‡•’”‡ƒ†…Žƒ••‹ϐ‹…ƒ–‹‘
of the chronic venous disease, the following clinical stages
ƒ”‡ †‹•–‹‰—‹•Š‡†ǣ 0 Ȃ ‘ ˜‹•‹„Ž‡ ‘” ’ƒŽ’ƒ„Ž‡ …Šƒ‰‡• ‘ˆ –Š‡
venous disease, C1Ȃ–‡Žƒ‰‹‡…–ƒ•‹ƒȋδͳȌƒ†Ȁ‘””‡–‹…—Žƒ”
veins (1-3 mm), C2Ȃ˜ƒ”‹…‘•‡˜‡‹•ȋε͵Ȍǡ3Ȃ‡†‡ƒǡ4
Ȃ •‹ ƒ† •—„…—–ƒ‡‘—• …Šƒ‰‡• ȋ4a Ȃ ’‹‰‡–ƒ–‹‘ ‘” ‡…-
zema, C4bȂŽ‹’‘†‡”ƒ–‘•…Ž‡”‘•‹•‘”™Š‹–‡ƒ–”‘’Š›Ȍ5ȂŠ‡ƒŽ‡†
venous ulcer, C6Ȃƒ…—–‡˜‡‘—•—Ž…‡”Ǥ–‹‘Ž‘‰‹…ƒŽ…Žƒ••‹ϐ‹…ƒ–‹‘
‘ˆ˜‡‘—•†‹•‡ƒ•‡…‘’”‹•‡•ǣcȂ…‘‰‡‹–ƒŽǡpȂ’”‹ƒ”›ǡsȂ
secondary (post-thrombotic), EnȂ‘‹†‡–‹ϐ‹‡†˜‡‘—•…ƒ—•‡Ǥ
ƒ–‘‹…ƒŽ …Žƒ••‹ϐ‹…ƒ–‹‘ ‹…Ž—†‡•ǣ s Ȃ •—’‡”ϐ‹…‹ƒŽ ˜‡‹•ǡ p
Ȃ’‡”ˆ‘”ƒ–‘”˜‡‹•ǡdȂ†‡‡’˜‡‹•ǡnȂ™‹–Š‘—–˜‡‘—••‹–‡
‹†‡–‹ϐ‹…ƒ–‹‘Ǥ†ϐ‹ƒŽŽ›ǡ–Š‡’ƒ–Š‘Ž‘‰‹…ƒŽ…Žƒ••‹ϐ‹…ƒ–‹‘…‘-
’”‹•‡•ǣrȂ”‡ϐŽ—šǡoȂ‘„•–”—…–‹‘ǡr,oȂ”‡ϐŽ—šƒ†‘„•–”—…-
tion, PnȂ™‹–Š‘—–‡•–ƒ„Ž‹•Š‡†’ƒ–Š‘’Š›•‹‘Ž‘‰‹…ƒŽ…Šƒ‰‡•Ǥ
In histopathological terms, microscopic morphological
changes in the chronic venous disease [6, 15-27] are localized
at the level of the three venous (intima, media, adventitia) tu-
nics and more frequently concern with great saphenous vein.
Although, many works have been published on the morpho-
logical changes of varicose veins, it is still unclear what the
succession of these lesions is, and how they contribute to the
†‡˜‡Ž‘’‡–‘ˆ…Š”‘‹…˜‡‘—•‹•—ˆϐ‹…‹‡…›ǤŽ•‘ǡ–Š‡‘Ž‡…-
ular particularities of the varicose veins have been very little
•–—†‹‡†ƒ†–Š‡‘™Ž‡†‰‡‹–Š‡ϐ‹‡Ž†‹•‹…‘’Ž‡–‡Ǥ
The purpose of this study was to clarify the histopathologi-
cal and immunohistochemical changes present along a single
varicose saphenous vein and in the saphenous veins at vari-
ous evolutionary stages of venous disease, as well as changes
of microcirculation (˜ƒ•ƒ ˜ƒ•o”—) in chronic venous disease.
From the information we have, multiple patch biopsy studies
in the varicose veins are very few and with conclusions yet un-
der discussion.
Material and methods
As an object of studying served the varicose saphenous
veins, surgically removed during the stripping saphenectomy.
‹•–o’ƒ–ŠoŽo‰‹cƒŽ ’‡c—Ž‹ƒ”‹–‹‡• oˆ ˜ƒ”‹co•‡ ˜‡‹n•
stripping). Materialul postoperator a fost colectat de la 8 paci-
‡ì‹…—˜Ÿ”•–ƒ…—’”‹•£Á–”‡ͳͻè‹͸ͺ†‡ƒ‹ǡ‹–‡”ƒì‹’‡–”—
–”ƒ–ƒ‡– …Š‹”—”‰‹…ƒŽ Á •‡…싃 †‡ …Š‹”—”‰‹‡ ˜ƒ•…—Žƒ”£ ƒ 
Ƿ‹‘ˆ‡‹ ‘萇ƒ‰ƒdz Á Ž—‹Ž‡ ƒ”–‹‡Ǧƒ’”‹Ž‹‡ ʹͲͳ͹Ǥ ƒ…‹‡ì‹‹
ƒ—ˆ‘•–ˆƒ‹Ž‹ƒ”‹œƒì‹…—‹˜‡•–‹‰ƒì‹‹Ž‡…‡—”‡ƒœ£è‹ƒ—•‡ƒ–
acordul informat. Studiul a fost avizat de Comitetul de Eti-
…£ ƒ ‡”…‡–£”‹‹ ƒŽ   Ƿ‹…‘Žƒ‡ ‡•–‡‹ìƒ—dzǡ ”Ǥ ͵ͲȀ͵ʹ †‹
29.05.2014.
ƒ–‡”‹ƒŽ—Ž„‹‘Ž‘‰‹…ƒˆ‘•–ϐ‹šƒ–Áˆ‘”ƒŽ‹£‡—–”£†‡ͳͲΨ
’‡–”— ʹͶ †‡ ‘”‡Ǥ ‹‡…ƒ”‡ ˜‡£ •ƒˆ‡£ ÁŽ£–—”ƒ–£ ’”‹ •–”‹’-
’‹‰ƒˆ‘•–•‡…ì‹‘ƒ–£Á•‡‰‡–‡ƒ…Ÿ–‡ͳ…Ž—‰‹‡…ƒ”‡ǡ
—Ž–‡”‹‘”ǡƒ—ˆ‘•–‹…Ž—•‡Á’ƒ”ƒϐ‹£Ǥ‹ϐ‹‡…ƒ”‡„Ž‘…†‡’ƒ”ƒ-
ϐ‹£•Ǧƒ—”‡ƒŽ‹œƒ–•‡…ì‹—‹†‡͵ρ‰”‘•‹‡ǡ…ƒ”‡•Ǧƒ—‘–ƒ–
’‡ Žƒ‡ Š‹•–‘Ž‘‰‹…‡ —œ—ƒŽ‡ è‹ ’‡ Žƒ‡ •‹Žƒƒ–‡ǡ …‡ ƒ•‹‰—”£ ‘
ƒ†‡œ‹—‡•—’‡”‹‘ƒ”£Á…ƒœ—Ž…‘Ž‘”ƒì‹‹Ž‘”‹—‘Š‹•–‘…Š‹‹…‡Ǥ
‡–”—•–—†‹‡”‡ƒ•–”—…–—”‹‹‹…”‘•…‘’‹…‡ƒ˜‡‡Ž‘”•ƒˆ‡‡è‹
‘†‹ϐ‹…£”‹Ž‘” Š‹•–‘’ƒ–‘Ž‘‰‹…‡ Á …ƒœ †‡ „‘ƒŽ£ ˜ƒ”‹…‘ƒ•£ •Ǧƒ—
ˆ‘Ž‘•‹–‡–‘†‡Š‹•–‘Ž‘‰‹…‡†‡…‘Ž‘”ƒ”‡—œ—ƒŽ£ȋŠ‡ƒ–‘š‹Ž‹£Ǧ
‡‘œ‹£Ȍǡ…‘Ž‘”ƒì‹‹•’‡…‹ƒŽ‡è‹…‘Ž‘”ƒì‹‹‹—‘Š‹•–‘…Š‹‹…‡Ǥ‡…-
싗‹Ž‡ ‹‹ì‹ƒŽ‡ ƒŽ‡ ϐ‹‡…£”—‹ „Ž‘… †‡ ’ƒ”ƒϐ‹£ ƒ— ˆ‘•– …‘Ž‘”ƒ–‡
…—Š‡ƒ–‘š‹Ž‹£Ǧ‡‘œ‹£ǡ…‡Ž‡†‡‹ŒŽ‘…Ȃ…—…‘Ž‘”ƒì‹‹•’‡…‹ƒŽ‡
ȋ–”‹…”‘£ƒ••‘ǡ‘”…‡‹£è‹‹’”‡‰ƒì‹‡ƒ”‰‡–‹…£
ڏڔ‹Ȍǡ •–ƒ‹•ȋƒ••‘Ʈ•–”‹…Š”‘‡ǡ‘”…‡‹•–ƒ‹‹‰ƒ†
ڏڔ‹Ʈ••‹Ž-
‹ƒ”…‡Ž‡ƒ†‹ì‹‘ƒŽ‡ƒ—ˆ‘•–…‘Ž‘”ƒ–‡‹—‘Š‹•–‘…Š‹‹……—ƒ–‹Ǧ
͵Ͷ苃–‹ǦȽȋ„‡n†1Ͷ è‹”‡•’‡…–‹˜ǡ1ͺǡ ƒoǡ
Žo•–”—’ǡ –‘…Š‡‹…ƒŽŽ›•–ƒ‹‡†™‹–Šƒ–‹Ǧ͵Ͷƒ†ƒ–‹ǦȽȋ„‡n†1Ͷ
ƒn‡ƒ”cƒȌǤ –—†‹—Ž Š‹•–‘’ƒ–‘Ž‘‰‹… è‹ ‹—‘Š‹•–‘…Š‹‹… ƒ
Žo•–”—’, Denmark). The histo-
ˆ‘•–”‡ƒŽ‹œƒ–Á…ƒ†”—Ž‡–”—Ž—‹†‡‡”…‡–ƒ”‹Á‰‹‘‰‡‡œ£
ƒ‹˜‡”•‹–£ì‹‹†‡‡†‹…‹£è‹ ƒ”ƒ…‹‡Ƿ‹…–‘”ƒ„‡èdz†‹‹-
‹è‘ƒ”ƒǡ‘Ÿ‹ƒǤ
šƒ‹ƒ”‡ƒ ‹…”‘•…‘’‹…£ è‹ ‘„싐‡”‡ƒ ‹ƒ‰‹‹Ž‘” ƒ ˆ‘•–
‡ˆ‡…–—ƒ–£…—‹…”‘•…‘’—Ž‹‘…Ž‹’•‡ͺͲͲǡˆ‘Ž‘•‹†‘…—Žƒ”—Ž
†‡Ͷέè‹‘„‹‡…–‹˜‡Ž‡†‡ͶέǡͳͲέǡʹͲέè‹ͶͲέǤ‡Ž‡ƒ‹•‡‹ϐ‹…ƒ-
tive imagini au fost preluate cu ajutorul unei camere digitale.
—£”—Ž–‘–ƒŽ†‡‘„‹‡…–‡…‘ˆ‡…ì‹‘ƒ–‡è‹•–—†‹ƒ–‡ȋ’”‡’ƒ-
”ƒ–‡‹…”‘•…‘’‹…‡è‹‹—‘Š‹•–‘…Š‹‹…‡Ȍƒˆ‘•–†‡ʹͺʹǤ
‡œ—Ž–ƒ–‡
‘–—Ž†‡•–—†‹—ƒˆ‘•–…‘•–‹–—‹–†‹ͺ’ƒ…‹‡ì‹…—„‘ƒŽƒ˜‡-
MJHS 17(3)/2018 47
The postoperative material was collected from eight patients
aged from 19 to 68 years admitted for surgical treatment at
–Š‡ ‡’ƒ”–‡– ‘ˆ ˜ƒ•…—Žƒ” •—”‰‡”› ‘ˆ Dz‹‘ˆ‡‹ ‘•‡ƒ‰ƒdz
Republican Clinical Hospital, Chisinau, Republic of Moldova,
during March-April 2017. Patients were familiar with the fol-
lowed investigations and signed the informed consent. The
study has been approved by the Ethics Committee of ‹coŽƒ‡
‡•–‡‹–ƒn— State University of Medicine and Pharmacy, no.
30/32 of 29.05.2014.
Š‡„‹‘Ž‘‰‹…ƒŽƒ–‡”‹ƒŽ™ƒ•ϐ‹š‡†‹ͳͲؐ‡—–”ƒŽˆ‘”ƒŽ‹
for 24 hours. Each saphenous vein removed by stripping was
cut into segments of 1 cm long and subsequently embedded in
’ƒ”ƒˆϐ‹Ǥ ”‘‡ƒ…Š’ƒ”ƒˆϐ‹„Ž‘…–Š‡”‡™‡”‡•‡…–‹‘‡†•Ž‹…‡•
”ƒ‰‹‰͵Ɋ‹–Š‹…‡••ǡ™Š‹…Š™‡”‡‘—–‡†‘—•—ƒŽŠ‹•-
tological slides, and also on silanized slides providing superior
adhesion for immunohistochemical stains. To study the micro-
scopic structure of the saphenous veins and histopathological
changes in case of varicose disease, the routine (hematoxylin-
eosin), special and immunohistochemical staining methods
™‡”‡ —•‡†Ǥ Š‡ ‹‹–‹ƒŽ •‡…–‹‘• ‘ˆ ‡ƒ…Š ’ƒ”ƒˆϐ‹ „Ž‘… ™‡”‡
•–ƒ‹‡†™‹–ŠŠ‡ƒ–‘š›Ž‹Ǧ‡‘•‹ǡ–Š‡‹††Ž‡‘‡•Ȃ™‹–Š•’‡…‹ƒŽ
ver impregnation), and the additional ones were immunohis-
and 1ͺ, respectively, ƒoǡ
pathological and immunohistochemical study was conducted
ƒ––Š‡‰‹‘‰‡‡•‹•‡•‡ƒ”…Š‡–‡”‘ˆDz‹…–‘”ƒ„‡•dz‹˜‡”-
sity of Medicine and Pharmacy, Timisoara, Romania.
Microscopic examination and image acquisition was per-
formed with the Nikon Eclipse E800 microscope, using the 4x
‡›‡’‹‡…‡ƒ†ͶέǡͳͲέǡʹͲέǡƒ†ͶͲέŽ‡•‡•ǤŠ‡‘•–•‹‰‹ϐ‹-
cant images were taken with a digital camera.
The total number of objects made and studied (microsco-
pic and immunohistochemical preparations) was 282.
Results
The study group consisted of 8 patients with chronic veno-
‘ƒ•£…”‘‹…£ǣͷ’ƒ…‹‡ì‹ȂÁ•–ƒ†‹—Ž…Ž‹‹…•ƒ—2-3 (sublot —•†‹•‡ƒ•‡ǣͷ’ƒ–‹‡–•‹…Ž‹‹…ƒŽ•–ƒ‰‡‘”2-3 (subgroup
ͳȌǡ͵’ƒ…‹‡ì‹ȂÁ•–ƒ†‹‹Ž‡…Ž‹‹…‡Ǧ•ƒ—4-6 (sublot 2). ͳȌǡ͵’ƒ–‹‡–•Ȃ‹…Ž‹‹…ƒŽ•–ƒ‰‡•Ǧ‘”4-6 (subgroup 2).
ƒ‰‹‡ƒ ‘”ˆ‘Ž‘‰‹…£ ƒ ’‡”‡–‡Ž—‹ ˜‡‘• ƒŽ ˜‡‡‹ •ƒˆ‡‡
mari în cazul stadiului clinic II sau CEAP2-3 (sublot 1) în colora-
싃•–ƒ†ƒ”–ƒ’—•Á‡˜‹†‡ì£‡†‹ƒÁ‰”‘胖£ȋ ‹‰—”ƒͳƒȌǡ
ƒ…£”‡‹‰”‘•‹‡ƒ†‡˜‡‹–’”‡†‘‹ƒ–£…‘’ƒ”ƒ–‹˜…—…‡Ž‡ŽƒŽ-
–‡–—‹…‹ƒŽ‡’‡”‡–‡Ž—‹˜‡‘•Ǥ‡…‹”…—ˆ‡”‹ìƒ˜ƒ•—Ž—‹Á‰”‘èƒ-
”‡ƒ‡†‹‡‹ƒˆ‘•–ǡ†‡…‡Ž‡ƒ‹†‡•‡‘”‹ǡ—‹ˆ‘”£ǡϐ‹‹†ǡÁ—‡Ž‡
…ƒœ—”‹ǡÁ‰”‘胖£‡—‹ˆ‘”Ǥ
‘Ž‘”ƒì‹‹Ž‡ –”‹…”‘£ ƒ••‘ǡ ‘”…‡‹£ è‹ ‹’”‡‰ƒì‹ƒ ƒ”-
ڏڔ‹Ʈ• •‹Ž˜‡” ‹’”‡‰ƒ–‹‘ ƒŽŽ‘™‡†
‰‡–‹…£
ڏڔ‹ƒ—’‡”‹•‡˜ƒŽ—ƒ”‡ƒ쇕—–—Ž—‹…‘Œ—…–‹˜Ǥ‹- for connective tissue evaluation. Hypertrophy of both media
’‡”–”‘ϐ‹ƒ‡†‹‡‹ǡ†ƒ”苃‹–‹‡‹ƒ—ˆ‘•–Á•‘ì‹–‡†‡‘…”‡è–‡”‡
‹‹£•ƒ—‘†‡”ƒ–£ƒƒ–”‹…‡‹…‘Œ—…–‹˜‡ϐ‹„”‹Žƒ”‡è‹‡ϐ‹-
brilare. Fibrele de colagen, interpuse între celulele musculare
‡–‡†‡ƒŽ‡‡†‹‡‹ǡƒ—ˆ‘”ƒ–…‘”†‘ƒ‡è‹ˆƒ•…‹…—Ž‡ȋ ‹‰—”ƒͳ†ȌǤ
”‡è–‡”‡ƒ…‘’‘‡–‡‹ϐ‹„”‹Žƒ”‡…‘Žƒ‰‡‹…‡ƒˆ‘•–ƒ•‘…‹ƒ–£…—
…”‡è–‡”‡ƒ …‘’‘‡–‡‹ ϐ‹„”‹Žƒ”‡ ‡Žƒ•–‹…‡Ǥ —£”—Ž ƒ”‡ †‡
ϐ‹„”‡‡Žƒ•–‹…‡Š‹’‡”’Žƒœ‹ƒ–‡ƒ—ˆ‘”ƒ–Žƒ‡Ž‡ȋ…—ƒ•’‡…–†‡Ž‹-
‹–ƒ–£Ȍ Žƒ Ž‹‹–ƒ †‹–”‡ ‡†‹‡ è‹ ƒ†˜‡–‹…‡ǡ ‹ƒ” Á ‰”‘•‹‡ƒ
–—‹…‹‹ ‡†‹‹ ϐ‹„”‡Ž‡ ‡Žƒ•–‹…‡ Š‹’‡”’Žƒœ‹ƒ–‡ ƒ— ƒ˜—– — ƒ•’‡…–
The morphological image of the venous wall of the great
saphenous vein in the clinical stage II or CEAP2-3 (subgroup 1)
in HE standard staining revealed the thickened media (Figure
1a), the thickness of which became predominant compared
to the other venous wall tunics. On the circumference of the
vessel the thickening of the media was most often uniform,
being sometimes thickened unevenly. Masson’s trichrome,
‘”…‡‹ •–ƒ‹‹‰ ƒ†
and intima were accompanied by a minimal or moderate in-
…”‡ƒ•‹‰‘ˆϐ‹„”‹ŽŽƒ”ƒ†‘Ǧϐ‹„”‹ŽŽƒ”…‘‡…–‹˜‡–‹••—‡ƒ–”‹šǤ
‘ŽŽƒ‰‡ ϐ‹„‡”• ‹–‡”’‘•‡† „‡–™‡‡ –Š‡ •‘‘–Š —•…Ž‡ …‡ŽŽ•
of the media formed cords and bundles (Figure 1d). The in-
…”‡ƒ•‡†ϐ‹„”‹ŽŽƒ”…‘ŽŽƒ‰‡…‘’‘‡–™ƒ•ƒ••‘…‹ƒ–‡†™‹–Š–Š‡
‹…”‡ƒ•‡† ϐ‹„”‹ŽŽƒ” ‡Žƒ•–‹… …‘’‘‡–Ǥ Š‡ Žƒ”‰‡ —„‡” ‘ˆ
Š›’‡”’Žƒ•–‹…‡Žƒ•–‹…ϐ‹„‡”•ˆ‘”‡†Žƒ‡ŽŽƒ‡ȋ™‹–ŠŽ‹‹–‹‰ƒ•-
pect) at the border between the media and adventitia, and in
–Š‡–Š‹…‡••‘ˆ–Š‡‡†‹ƒ–Š‡Š›’‡”’Žƒ•–‹…‡Žƒ•–‹…ϐ‹„‡”•Šƒ†
48
fragmentat (Figura 1e). Fibrele reticulare (colagenul tip III),
…— †‹•–”‹„—싇 †‹ˆ‡”‹–£ǡ ƒ— ˆ‘•– †‡’‹•–ƒ–‡ Á ‡„”ƒƒ „ƒœƒŽ£
•—„‡†‘–‡Ž‹ƒŽ£è‹Á–—‹…ƒ‡†‹‡ǡÁŒ—”—Ž…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡
netede (Figura 1f).
‘Ž‘•‹†ƒ”‡”Ǧ—Ž…‡Ž—Ž‡Ž‘”‹‘‡’‹–‡Ž‹ƒŽ‡ǡƒ…–‹ƒ•’‡…‹ϐ‹…£
—è…Š‹—Ž—‹‡–‡†ǡƒˆ‘•–’‘•‹„‹Ž£‡˜ƒŽ—ƒ”‡ƒ…‡Ž—Ž‡Ž‘”—•…—Žƒ-
re netede din grosimea peretelui venos. Sublotul 1 a prezentat
Š‹’‡”’Žƒœ‹ƒè‹Š‹’‡”–”‘ϐ‹ƒ…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡‡–‡†‡Žƒ‹˜‡Ž
•—„‡†‘–‡Ž‹ƒŽè‹Žƒ‹˜‡Ž—Ž‡†‹‡‹Ǥƒ‹˜‡Ž•—„‡†‘–‡Ž‹ƒŽƒ…–‹ƒ
ƒ˜‡ƒ‘†‹•–”‹„—싇Š‡–‡”‘‰‡£ǡ’‡”’‡†‹…—Žƒ”’‡‡†‹‡ǡÁ–‹’
…‡Žƒ‹˜‡Ž—Ž‡†‹‡‹’”‡œ‡–ƒ‘†‹•’‘œ‹ì‹‡…‘…‡–”‹…£ÁŒ—”—Ž
lumenului (Figura 1b).
†‘–‡Ž‹—Ž˜ƒ•…—Žƒ”ƒˆ‘•–‡˜‹†‡ì‹ƒ–‹—‘Š‹•–‘…Š‹‹……—
anticorpi monoclonali CD34, care au reliefat endoteliul intact
ƒŽ‹–‹‡‹è‹‡†‘–‡Ž‹—Ž˜ƒ•‡Ž‘”ȋ ‹‰—”ƒͳ…Ȍ†‹ƒ†˜‡–‹…‡ȋ˜ƒ•ƒ
˜ƒ•o”—).
Pƒ”–‹c—Žƒ”‹–£ì‹ Š‹•–o’ƒ–oŽo‰‹c‡ ƒŽ‡ ˜‡n‡Žo” ˜ƒ”‹coƒ•‡
ƒˆ”ƒ‰‡–ƒ”›ƒ’’‡ƒ”ƒ…‡ȋ ‹‰—”‡ͳ‡ȌǤ‡–‹…—Žƒ”ϐ‹„‡”•ȋ–›’‡
III collagen) with different distribution were detected in the
subendothelial basal membrane and in the media around the
smooth muscle cells (Figure 1f).
Using actin smooth muscle antibody, a myoepithelial cells
marker, it was possible to evaluate the smooth muscle cells
from the venous wall thickness. Subgroup 1 showed hypertro-
phy and hyperplasia of smooth muscle cells at the subendo-
thelial layer and media. At the subendothelial layer, the actin
had a heterogeneous distribution, perpendicular to the media,
while at the media there was a concentric disposition around
the lumen (Figure 1b).
The vascular endothelium was stained immunohistochem-
ically with CD34 monoclonal antibodies, which revealed the
intact endothelium of the intima and the endothelium of the
vessels (Figure 1c) of the adventitia (˜ƒ•ƒ ˜ƒ•o”—).
ƒ‰‹‡ƒ ‘”ˆ‘Ž‘‰‹…£ ƒ ’‡”‡–‡Ž—‹ ˜‡‘• Á …ƒœ—Ž •–ƒ†‹‹Ž‘”
clinice III-IV sau CEAP4-6 ȋ•—„Ž‘–ʹȌƒƒ–‡•–ƒ–ƒ–Ÿ–‡†‹ƒǡ…Ÿ–è‹
‹–‹ƒÁ‰”‘胖‡ȋ ‹‰—”ƒʹƒȌǡÁ‰”‘胔‡†ƒ–‘”ƒ–£’”‡œ‡ì‡‹…‘-
Žƒ‰‡—Ž—‹Á…ƒ–‹–£ì‹ƒ”‹ȋ ‹‰—”ƒʹ†ȌǤ ƒ•…‹…—Ž‡Ž‡†‡‹‘…‹–‡
ƒŽ‡ ‡†‹‡‹ ƒ— ˆ‘•– •—„싃–‡ è‹ ˆ”ƒ‰‡–ƒ–‡ Á ‹•—Ž‡ ȋ ‹‰—”‹Ž‡
ʹ„è‹ʹ…Ȍ•ƒ—ÁŽ‘…—‹–‡†‡ϐ‹„”‡Ž‡†‡…‘Žƒ‰‡Á‡š…‡•ǤŽ£–—”‹
†‡ϐ‹„”‡Ž‡†‡…‘Žƒ‰‡Á‡š…‡•ƒ—ˆ‘•–†‡’‹•–ƒ–‡è‹ϐ‹„”‡‡Žƒ•–‹…‡
hiperplaziate.
B ƒ…‡Žƒè‹ –‹’ǡ Á •—„Ž‘–—Ž ʹ ƒ ˆ‘•– ‘„•‡”˜ƒ–£ †‡–ƒèƒ”‡ƒ
‡†‘–‡Ž‹—Ž—‹ ‹–‹‡‹ ȋ ‹‰—”ƒ ʹˆȌ è‹ ÁŽ‘…—‹”‡ƒ •–”ƒ–—Ž—‹ ‡†‘-
The morphological image of the venous wall in the clinical
stages III-IV or CEAP4-6 (subgroup 2) attested both media and
intima thickened (Figure 2a), thickening due to the presence
of large amounts of collagen (Figure 2d). Fascicles of myocytes
of the media were thinned and fragmented into islands (Fig-
—”‡•ʹ„ƒ†ʹ…Ȍ‘””‡’Žƒ…‡†„›‡š…‡••…‘ŽŽƒ‰‡ ϐ‹„‡”•ǤŽ‘‰
™‹–Š‡š…‡••…‘ŽŽƒ‰‡ϐ‹„‡”•–Š‡Š›’‡”’Žƒ•–‹…‡Žƒ•–‹…ϐ‹„‡”•™‡”‡
also detected.
At the same time, in the subgroup 2 the endothelial desqua-
mation was observed (Figure 2f) and replacement of the en-

Fig. 1 ƒ‰‹‡ƒ‘”ˆ‘Ž‘‰‹…£ƒ’‡”‡–‡Ž—‹˜‡‘•ƒŽ˜‡‡‹•ƒˆ‡‡ƒ”‹Á•–ƒ†‹—Ž…Ž‹‹…•ƒ—2-3. (a) hiperplazia mediei (HE, ×2,5); (b)

Š‹’‡”’Žƒœ‹‡—•…—Žƒ”£…—…‘Žƒ‰‡‹œƒ”‡‹‹£ȋ–‹ǦȽǡέʹǡͷȌǢȋ…Ȍ—‡”‘ƒ•‡˜ƒ•ƒ˜ƒ•‘”—Áƒ†˜‡–‹…‡ȋ–‹Ǧ͵ͶǡέʹǡͷȌǢȋ†ȌŠ‹’‡”’Žƒœ‹ƒ
ϐ‹„”‡Ž‘”†‡…‘Žƒ‰‡ƒŽ‡‡†‹‡‹ǡ†‡–ƒŽ‹—ȋ”‹…”‘£ƒ••‘ǡέͳͲȌǢȋ‡ȌŠ‹’‡”’Žƒœ‹‡†‡ϐ‹„”‡‡Žƒ•–‹…‡ǡ†‡–ƒŽ‹—ȋ”…‡‹£ǡέͳͲȌǡȋˆȌϐ‹„”‡”‡–‹…—Žƒ”‡Á
–—‹…ƒ‡†‹‡ǡ†‡–ƒŽ‹—ȋ’”‡‰ƒì‹‡ƒ”‰‡–‹…£
ڏڔ‹ǡέʹͲȌǤ
Fig. 1 Š‡ o”’ŠoŽo‰‹cƒŽ ‹ƒ‰‡ oˆ –Š‡ ˜‡no—• ™ƒŽŽ oˆ –Š‡ ‰”‡ƒ– •ƒ’Š‡no—• ˜‡‹n ‹n –Š‡ cŽ‹n‹cƒŽ •–ƒ‰‡ II o” P͸Ǧ͹ ȋ•—„‰”o—’ 1Ȍ: ȋƒȌ Š›’‡”’Žƒ•‹ƒ oˆ
‡†‹ƒ ȋǡ α͸ǤͻȌǢ ȋ„Ȍ —•cŽ‡ Š›’‡”’Žƒ•‹ƒ ™‹–Š ‹n‹ƒŽ ϔ‹„”o•‹• ȋn–‹ǦȽǡ α͸ǤͻȌǢ ȋcȌ n—‡”o—• ˜ƒ•ƒ ˜ƒ•o”— ‹n –Š‡ ƒ†˜‡n–‹–‹ƒ ȋn–‹Ǧ͹ͺǡ α͸ǤͻȌǢ
ȋ†Ȍ Š›’‡”’Žƒ•‹ƒ oˆ coŽŽƒ‰‡n ϔ‹„”‡• oˆ –Š‡ ‡†‹ƒǡ †‡–ƒ‹Ž ȋƒ••onƮ• –”‹cŠ”oǡ α1ͶȌǢǤ ȋ‡Ȍ Š›’‡”’Žƒ•‹ƒ oˆ ‡Žƒ•–‹c ϔ‹„”‡•ǡ †‡–ƒ‹Ž ȋ”c‡‹n •–ƒ‹n‹n‰ǡ α1ͶȌǢ ȋˆȌ
”‡–‹c—Žƒ” ϔ‹„”‡• ‹n –Š‡ ‡†‹ƒǡ †‡–ƒ‹Ž ȋ
ڏڔ‹Ʈ• •‹Ž˜‡” ‹’”‡‰nƒ–‹onǡ α͸ͶȌǤ
‹•–o’ƒ–ŠoŽo‰‹cƒŽ ’‡c—Ž‹ƒ”‹–‹‡• oˆ ˜ƒ”‹co•‡ ˜‡‹n• MJHS 17(3)/2018 49

Fig. 2 ƒ‰‹‡ƒ‘”ˆ‘Ž‘‰‹…£ƒ’‡”‡–‡Ž—‹˜‡‘•ƒŽ˜‡‡‹•ƒˆ‡‡ƒ”‹Á•–ƒ†‹—Ž…Ž‹‹…Ǧ•ƒ—4-6ǣȋƒȌŠ‹’‡”’Žƒœ‹ƒ‹–‹‡‹ç‹‡†‹‡‹

ȋǡέʹǡͷȌǢȋ„Ȍ‹‘…‹–‡ˆ”ƒ‰‡–ƒ–‡ȋ–‹ǦȽǡέʹǡͷȌǢȋ…Ȍ‹‘…‹–‡ˆ”ƒ‰‡–ƒ–‡ǡ†‡–ƒŽ‹—ȋ–‹ǦȽǡέͳͲȌǢȋ†Ȍ‹–‹£Á‰”‘烖£ǡƒ”…ƒ–£
…‘Žƒ‰‡‹œƒ”‡Á‹–‹£ç‹–—‹…ƒ‡†‹‡ǡ†‡–ƒŽ‹—ȋ”‹…”‘£ƒ••‘ǡέͳͲȌǢȋ‡Ȍ—‡”‘ƒ•‡˜ƒ•ƒ˜ƒ•‘”—Áƒ†˜‡–‹…‡ȋ–‹Ǧ͵ͶǡέʹǡͷȌǢȋˆȌ
†‡•…—ƒƒ”‡‡†‘–‡Ž‹ƒŽ£ǡ†‡–ƒŽ‹—ȋ–‹Ǧ͵ͶǡέʹͲȌǤ
Fig. 2 Š‡ o”’ŠoŽo‰‹cƒŽ ‹ƒ‰‡ oˆ –Š‡ ˜‡no—• ™ƒŽŽ ‹n –Š‡ cŽ‹n‹cƒŽ •–ƒ‰‡• IIIǦI o” PͺǦͼ: ȋƒȌ Š›’‡”’Žƒ•‹ƒ oˆ ‹n–‹ƒ ƒn† ‡†‹ƒ ȋǡ
α͸ǤͻȌǢ ȋ„Ȍ ˆ”ƒ‰‡n–‡† ›oc›–‡• ȋn–‹ǦȽǡ α͸ǡͻȌǢ ȋcȌ ˆ”ƒ‰‡n–‡† ›oc›–‡•ǡ †‡–ƒ‹Ž ȋn–‹ǦȽǡ α1ͶȌǢ ȋ†Ȍ –Š‹c‡n† ‹n–‹ƒǡ ƒ”‡† ‹n–‹ƒŽ
ƒn† ‡†‹ƒ ϔ‹„”o•‹•ǡ †‡–ƒ‹Ž ȋƒ••onƮ• –”‹cŠ”oǡ α1ͶȌǢ ȋ‡Ȍ n—‡”o—• ˜ƒ•ƒ ˜ƒ•o”— ‹n –Š‡ ƒ†˜‡n–‹–‹ƒ ȋn–‹Ǧ͹ͺǡ α͸ǡͻȌǢ ȋˆȌ ‡n†o–Š‡Ž‹ƒŽ
†‡•“—ƒƒ–‹onǡ †‡–ƒ‹Ž ȋn–‹Ǧ͹ͺǡ α͸ͶȌǤ

–‡Ž‹ƒŽ…—ϐ‹„”‡†‡…‘Žƒ‰‡Ǥ‡—†ƒ”‡ƒ‡†‘–‡Ž‹ƒŽ£ƒ…‘†—•Žƒ
ˆ‘”ƒ”‡ƒ–”‘„‹Ž‘”ÁŽ—‡—Ž˜ƒ•—Ž—‹ȋ–”‘„‘ϐŽ‡„‹–£ȌǤ—Ž–‹-
’Ž‡•‡‰‡–‡†‡˜‡£•ƒˆ‡£ƒ—’”‡œ‡–ƒ––”‘„‹‹Ž—‡—Ž
venos, unii dintre ei având vase nou formate. Adventicea a pre-
œ‡–ƒ–——£”‹’—£–‘”†‡˜ƒ•‡ƒŽ‡‹…”‘…‹”…—Žƒì‹‡‹ȋ˜ƒ•ƒ
˜ƒ•o”—) (Figura 2e).
†‘–Š‡Ž‹—™‹–Š…‘ŽŽƒ‰‡ϐ‹„‡”•Ǥ†‘–Š‡Ž‹ƒŽ†‡—†ƒ–‹‘Ž‡†–‘
the thrombus formation in the lumen of the vessel (thrombo-
phlebitis). Several saphenous vein segments showed thrombi
in the venous lumen, some of them having newly formed ves-
sels. Adventitia has presented an impressive number of ves-
sels of microcirculation (˜ƒ•ƒ ˜ƒ•o”—) (Figure 2e).

‹•…—ì‹‹ Discussion
–—†‹—Ž ’ƒ–‘‰‡‹‡‹ „‘Ž‹‹ ˜ƒ”‹…‘ƒ•‡ ’”‡œ‹–£ —‡”‘ƒ•‡ The study of the pathogenesis of varicose disease has many
Žƒ…—‡ǡ †‡è‹ †‡Ǧƒ Ž—‰—Ž –‹’—Ž—‹ ƒ— ˆ‘•– ‡‹•‡ —‡”‘ƒ•‡ gaps, although many hypotheses or theories have been issued
‹’‘–‡œ‡•ƒ—–‡‘”‹‹ǣ’ƒ”‹‡–ƒŽ£ǡ˜ƒŽ˜—Žƒ”£è‹ƒƒ•–‘‘–‹…£ȏͶǡͷȐǤ
‡‘”‹ƒ ‹ϐŽƒƒ–‘”‹‡ — ƒ ‰£•‹– …‘ϐ‹”ƒì‹‡ Á •–—†‹‹Ž‡ ”‡…‡–
efectuate [28].
…–—ƒŽ‡–‡ǡ Á ”ƒ’‘”– ϐ‹œ‹‘’ƒ–‘Ž‘‰‹…ǡ ‡•–‡ —ƒ‹ ”‡…—-
‘•…—–”‘Ž—Ž‹•—ϐ‹…‹‡ì‡‹˜ƒŽ˜—Žƒ”‡è‹ƒ…”‡è–‡”‹‹’”‡•‹—‹‹‹-
–”ƒ˜‡‘ƒ•‡ǡ†‹•…—ì‹‹Ž‡ϐ‹‹†ƒšƒ–‡ǡƒ‹ƒŽ‡•ǡ’‡•–ƒ„‹Ž‹”‡ƒˆƒ…–‘-
”—Ž—‹’”‹‘”†‹ƒŽÁ†‡…Žƒèƒ”‡ƒ†‹Žƒ–£”‹‹˜‡‘ƒ•‡Ǥ
‘†‹ϐ‹…£”‹Ž‡Š‹•–‘’ƒ–‘Ž‘‰‹…‡è‹‹—‘Š‹•–‘…Š‹‹…‡Žƒ‹˜‡Ž—Ž
˜‡‡Ž‘”•ƒˆ‡‡†‹Žƒ–ƒ–‡˜ƒ”‹…‘•’‘–ϐ‹”‡œ—ƒ–‡Žƒ—”£–‘ƒ”‡Ž‡ǣ
ͳȌŠ‹’‡”–”‘ϐ‹‡—•…—Žƒ”£–”ƒœ‹–‘”‹‡Žƒ‹˜‡Ž—Ž–—‹…‹‹‡-
†‹‹ǡ—”ƒ–£†‡ƒ–”‘ϐ‹‡è‹ÁŽ‘…—‹”‡ƒ’”‘‰”‡•‹˜£ƒ…‡Ž—Ž‡Ž‘”
—•…—Žƒ”‡‡–‡†‡…—ϐ‹„”‡†‡…‘Žƒ‰‡Ǣ
ʹȌÁ‰”‘胔‡ƒ’‡”‡–‡Ž—‹˜‡‘•†‹…‘–—ŽŠ‹’‡”’Žƒœ‹‡‹‹–‹-
male;
͵Ȍ†‡•…—ƒƒ”‡ƒ‡†‘–‡Ž‹ƒŽ£Ǣ
ͶȌˆ‘”ƒ”‡ƒϐ‹„”‡Ž‘”‡Žƒ•–‹…‡‰”‘ƒ•‡•—„ˆ‘”£†‡Ž‹‹–ƒ–£
ŽƒŠ‘–ƒ”—Ž†‹–”‡‡†‹‡è‹ƒ†˜‡–‹…‡Ǣ
‘˜‡”–‹‡ǣ’ƒ”‹‡–ƒŽǡ˜ƒŽ˜—Žƒ”ƒ†ƒƒ•–‘‘–‹…ȏͶǡͷȐǤϐŽƒƒ-
–‘”›–Š‡‘”›†‹†‘–ϐ‹†…‘ϐ‹”ƒ–‹‘‹”‡…‡–•–—†‹‡•ȏʹͺȐǤ
Currently, with reference to the pathophysiology, the role
‘ˆ ˜ƒŽ˜—Žƒ” ‹•—ˆϐ‹…‹‡…› ƒ† ‹…”‡ƒ•‡† ‹–”ƒ˜‡‘—• ’”‡••—”‡
is unanimously recognized, the discussions being mainly fo-
cused on establishing the primary trigger factor of the venous
dilation.
Histopathological and immunohistochemical changes in
–Š‡˜ƒ”‹…‘•‡•ƒ’Š‡‘—•˜‡‹•…ƒ„‡•—ƒ”‹œ‡†ƒ•ˆ‘ŽŽ‘™•ǣ
1) transient muscular hypertrophy of the media, followed
by atrophy and progressive replacement of venous
•‘‘–Š—•…Ž‡…‡ŽŽ•™‹–Š…‘ŽŽƒ‰‡ϐ‹„‡”•Ǣ
2) thickening of the venous wall due to the intimal hyper-
plasia;
3) desquamation of the endothelial layer;
ͶȌˆ‘”ƒ–‹‘‘ˆ–Š‹…‡Žƒ•–‹…ϐ‹„‡”•ƒ––Š‡„‘”†‡”„‡–™‡‡
media and adventitia;
50
ͷȌ…”‡è–‡”‡ƒ—£”—Ž—‹†‡˜ƒ•‡ƒŽ‡‹…”‘…‹”…—Žƒì‹‡‹Áƒ†-
ventice.
‘†‹ϐ‹…£”‹•‹‹Žƒ”‡ƒ—ˆ‘•–†‡’‹•–ƒ–‡Á‰”‡ˆ‡Ž‡˜‡‡Ž‘”•ƒ-
fene folosite pentru by-pass-ul coronarian [20, 29]. Hiperpla-
œ‹ƒ ‹–‹ƒŽ£ ’ƒ”‡ ƒ ϐ‹ ”‡œ—Ž–ƒ–—Ž ——‹ ’”‘…‡• †‡ ’”‘Ž‹ˆ‡”ƒ”‡ ƒ
ϐ‹„”‘„Žƒ•–‡Ž‘”è‹…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡‡–‡†‡ƒŽ‡‡†‹‡‹Ǥ‹’‡”-
’Žƒœ‹ƒ ‹–‹‡‹ †‡‘•–”‡ƒœ£ †‡˜‹ƒì‹‹ Á•‡ƒ–‡ — —ƒ‹ Á
†‹ˆ‡”‹–‡˜‡‡†ƒ”苆‡ǦƒŽ—‰—Ž—‡‹•‹‰—”‡˜‡‡•ƒˆ‡‡ȏʹͳǡ
ʹͻȐǤ Ž‡„‘•…Ž‡”‘œƒ•ƒ—ϐ‹„”‘œƒ‹–‹ƒŽ£”‡’”‡œ‹–£‘Á‰”‘胔‡
ϐ‹„”‘ƒ•£ƒ‹–‹‡‹è‹ƒ•–”ƒ–—Ž—‹‹–‡”ƒŽ–—‹…‹‹‡†‹‹ǡÁ…ƒ”‡
•‡’ƒ”ƒ”‡ƒ…Žƒ”£†‹–”‡‹–‹£è‹‡†‹‡†‹•’ƒ”‡Ǥ—’£—‹‹ƒ—-
–‘”‹ǡϐŽ‡„‘•…Ž‡”‘œƒ‡•–‡—ˆ‡‘‡‘„‹è—‹–ǡƒ‹ƒŽ‡•Žƒ‹˜‡-
Ž—Ž ˜‡‡Ž‘” •ƒˆ‡‡ǡ …ƒ”‡ ’‘ƒ–‡ ϐ‹ ‡š’Ž‹…ƒ–£ ’”‹ ’”‡•‹—‡ƒ Š‹-
†”‘•–ƒ–‹…£ÁƒŽ–£ȏʹͳȐǤ
ƒ”£•’—•Žƒ…”‡è–‡”‡ƒŠ‹’‡”–‡•‹—‹‹˜‡‘ƒ•‡ǡ–—‹…ƒ‡-
†‹‡ ”‡ƒ…ì‹‘‡ƒœ£ǡ Žƒ Á…‡’—–ǡ ’”‹ Š‹’‡”’Žƒœ‹ƒ …‡Ž—Ž‡Ž‘” —•-
culare netede (mai ales, ale stratului circular), care, mai apoi,
sunt supuse unui proces de sclerozare. Celulele musculare
‡–‡†‡Áè‹•…Š‹„£ˆ‡‘–‹’—Ž†‹…‘–”ƒ…–‹ŽÁ——Ž†‡•‹–‡œ£ǡ
ƒ…‡ƒ•–£•…Š‹„ƒ”‡ƒ”’—–‡ƒ†‡…Žƒèƒ—’”‘…‡•†‡ϐ‹„”‘œƒ”‡Žƒ
‹˜‡Ž—Ž‹–‹‡‹è‹‡†‹‡‹ȏͳ͸ǡͳ͹ǡʹͲǡʹ͸ǡʹ͹ȐǤ
†˜‡–‹…‡ƒǡ –—‹…ƒ ‡š–‡”£ ƒ ˜ƒ•—Ž—‹ǡ ƒ ’”‹‹– ‘ ƒ–‡ì‹‡
…‘‹•‹†‡”ƒ„‹Ž£ Á —Ž–‹‹‹ ƒ‹ ȏͳͷǡ ͵ͲȐǤ ƒ …‘ì‹‡ ‘ ’‘’—Žƒì‹‡
Š‡–‡”‘‰‡£†‡…‡Ž—Ž‡ǡ—•‹•–‡‡”˜‘•ƒ†”‡‡”‰‹…ǡ‘”‡ì‡ƒŽ‹-
ˆƒ–‹…£è‹˜ƒ•ƒ ˜ƒ•o”—ǡ‘‹…”‘…‹”…—Žƒì‹‡•’‡…‹ƒŽ‹œƒ–£ǡ…‡Œ‘ƒ…£
—”‘ŽƒŒ‘”Á„‹‘Ž‘‰‹ƒè‹’ƒ–‘Ž‘‰‹ƒ’‡”‡–‡Ž—‹˜ƒ•—Ž—‹Ǥƒ…£’‡-
”‡–‡Ž‡˜ƒ•—Ž—‹•‡Á‰”‘ƒè£ǡ˜ƒ•ƒ ˜ƒ•o”— se extind mai adânc
Á‡†‹ƒȏ͵ͲȐǤš‹•–£‘…‘”‡Žƒì‹‡•–”Ÿ•£Á–”‡‡š–‹†‡”‡ƒ˜ƒ-
•‡Ž‘”ƒ†˜‡–‹…‡ƒŽ‡è‹‡š–‹†‡”‡ƒˆ‘”£”‹‹‡‘‹–‹‡‹ǤB–”‡‰—Ž
’”‘…‡•’ƒ”‡ƒϐ‹…‘’—•†‹ʹ‡–ƒ’‡ǣȋͳȌ…”‡è–‡”‡ƒ‹–‹‡‹‹-
†‡’‡†‡–†‡ƒ‰‹‘‰‡‡œ£ȋƒn‰‹o‰‡n‡•‹•Ǧ‹n†‡’‡n†‡n– ‰”o™–Š
oˆ n‡o‹n–‹ƒȌǡ’”‘„ƒ„‹Ž…‘†—•£†‡’”‘Ž‹ˆ‡”ƒ”‡ƒ‹‘…‹–‡Ž‘”‡-
–‡†‡ƒŽ‡‡†‹‡‹è‹ȋʹȌ‘…”‡è–‡”‡†‡’‡†‡–£†‡ƒ‰‹‘‰‡‡œ£
(ƒn‰‹o‰‡n‡•‹•Ǧ†‡’‡n†‡n– ‰”o™–Š oˆ n‡o‹n–‹ƒȌǤ  †‘—ƒ ‡–ƒ’£
•‡…ƒ”ƒ…–‡”‹œ‡ƒœ£’”‹‡š–‹†‡”‡ƒ˜ƒ•‡Ž‘”†‹ƒ†˜‡–‹…‡Á–—-
‹…ƒ‡†‹‡è‹‹–‹ƒ˜ƒ•‡Ž‘”Ǥ
‘…Ž—œ‹‹
1) În stadiile clinice incipiente ale bolii venoase cronice
’”‡†‘‹£Š‹’‡”’Žƒœ‹ƒè‹Š‹’‡”–”‘ϐ‹ƒ…‡Ž—Ž‡Ž‘”—•…—Žƒ”‡‡-
tede ale mediei, mai ales, ale stratului circular.
ʹȌB•–ƒ†‹‹Ž‡…Ž‹‹…‡ƒ˜ƒ•ƒ–‡’”‘…‡•—Ž†‡ϐ‹„”‘œƒ”‡ƒ‡†‹-
‡‹†‡…Žƒè‡ƒœ£è‹—’”‘…‡•†‡ϐ‹„”‘œ£‹–‹ƒŽ£ȋϐŽ‡„‘•…Ž‡”‘œ£ȌǤ
͵Ȍ ‘†‹ϐ‹…£”‹Ž‡ Š‹•–‘’ƒ–‘Ž‘‰‹…‡ ƒŽ‡ ‡†‹‡‹ •‡ ‡š–‹†ǡ ƒ‹
–Ÿ”œ‹—ǡƒ•—’”ƒ‹–‹‡‹è‹ƒ†˜‡–‹…‡‹Ǥ
4) Denudarea endoteliului conduce la formarea trombilor
ÁŽ—‡—Ž˜‡‡‹ȋ–”‘„‘ϐŽ‡„‹–£ȌǤ
ͷȌ ‡•‹–ƒ–‡ƒ ‹…”‘…‹”…—Žƒì‹‡‹ Žƒ ‹˜‡Ž—Ž ƒ†˜‡–‹…‡‹ …”‡è–‡
‘†ƒ–£…—ƒ˜ƒ•ƒ”‡ƒ„‘Ž‹‹˜‡‘ƒ•‡…”‘‹…‡Ǥ
‡…Žƒ”ƒì‹ƒ…‘ϐŽ‹…–—Ž—‹†‡‹–‡”‡•‡
Nimic de declarat.
‘–”‹„—싃ƒ—–‘”‹Ž‘”
„‹‹ƒ—–‘”‹ƒ—…‘–”‹„—‹–Á‘†‡‰ƒŽŽƒ‡Žƒ„‘”ƒ”‡ƒè‹•…”‹-
‡”‡ƒƒ—•…”‹•—Ž—‹Ǥ—–‘”‹‹ƒ—…‹–‹–苃’”‘„ƒ–˜‡”•‹—‡ƒϐ‹ƒŽ£
a manuscrisului.
Pƒ”–‹c—Žƒ”‹–£ì‹ Š‹•–o’ƒ–oŽo‰‹c‡ ƒŽ‡ ˜‡n‡Žo” ˜ƒ”‹coƒ•‡
5) increasing number of microcirculatory vessels in the ad-
ventitia.
Similar changes have been detected in the saphenous vein
grafts used for coronary bypass [20, 29]. Intimal hyperplasia
ƒ’’‡ƒ”• –‘ „‡ –Š‡ ”‡•—Ž– ‘ˆ ƒ ’”‘Ž‹ˆ‡”ƒ–‹‘ ’”‘…‡•• ‘ˆ ϐ‹„”‘-
blasts and smooth muscle cells of the media. Intimate hyper-
’Žƒ•‹ƒ†‡‘•–”ƒ–‡••‹‰‹ϐ‹…ƒ–†‡˜‹ƒ–‹‘•‘–‘Ž›‹†‹ˆˆ‡”-
ent veins, but also across a single saphenous vein [21, 29].
Ž‡„‘•…Ž‡”‘•‹•‘”‹–‹ƒŽϐ‹„”‘•‹•‹•ƒϐ‹„”‘—•–Š‹…‡‹‰‘ˆ–Š‡
intima and inner layer of the media, in which clear separation
between the intima and media disappears. According to some
authors, phlebosclerosis is a common phenomenon, especially
in the saphenous veins, which can be explained by the high
hydrostatic pressure [21].
As a result of increasing venous hypertension, the media
reacts initially with hyperplasia of smooth muscle cells (espe-
cially of the circular layer), which then are subjected to a pro-
cess of sclerosis. Smooth muscle cells switch from contractile
to synthetic phenotype, this change could trigger a process of
ϐ‹„”‘•‹•‹–Š‡‹–‹ƒƒ†‡†‹ƒȏͳ͸ǡͳ͹ǡʹͲǡʹ͸ǡʹ͹ȐǤ
Adventitia, the outer tunic of the vessel, has received a
considerable attention in the last years [15, 30]. It contains a
heterogeneous cell population, an adrenergic nervous system,
a lymphatic network and ˜ƒ•ƒ ˜ƒ•o”—, a specialized microcir-
culation, which plays a major role in the biology and pathology
of the vessel wall. If the vessel wall thickens, the ˜ƒ•ƒ ˜ƒ•o”—
extend deeper into the media [30]. There is a close correlation
between the expansion of the vessels of the adventitia and the
extension of neointima formation. The whole process appears
–‘„‡…‘’‘•‡†‘ˆ–™‘•–ƒ‰‡•ǣȋͳȌƒ‰‹‘‰‡‡•‹•Ǧ‹†‡’‡†‡–
growth of neointima, probably driven by the proliferation of
smooth myocytes of media and (2) angiogenesis-dependent
growth of neointima. The second stage is characterized by the
expansion of the vessels from the adventitia into the media
and intima.
Conclusions
1) At the initial clinical stages of chronic venous disease
predominate the hypertrophy and hyperplasia of smooth
muscle cells, especially of the circular layer.
ʹȌ––Š‡ƒ†˜ƒ…‡†…Ž‹‹…ƒŽ•–ƒ‰‡•–Š‡’”‘…‡••‘ˆϐ‹„”‘•‹•‘ˆ
–Š‡‡†‹ƒ–”‹‰‰‡”•ƒ‹–‹ƒŽϐ‹„”‘•‹•ȋ’ŠŽ‡„‘•…Ž‡”‘•‹•ȌǤ
3) The histopathological changes of the media later extend
to intima and adventitia.
4) The endothelial desquamation leads to thrombus for-
mation in the vein lumen (thrombophlebitis).
5) The density of microcirculation at the level of the ad-
ventitia increases with the advancement of the chronic venous
disease.
‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‘ˆ‹–‡”‡•–•
Nothing to declare.
Contribution of authors
Both authors have equally contributed to preparation and
writing of the manuscript. The authors read and approved the
ϐ‹ƒŽ˜‡”•‹‘‘ˆ–Š‡ƒ—•…”‹’–Ǥ
‹•–o’ƒ–ŠoŽo‰‹cƒŽ ’‡c—Ž‹ƒ”‹–‹‡• oˆ ˜ƒ”‹co•‡ ˜‡‹n• MJHS 17(3)/2018 51

‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡• ͳͷǤƒ•‹ƒǤ ‡‘‡—Ž†‡‡‘˜ƒ•—Žƒ”œƒ”‡Ȃ—‘—ƒ•’‡…–ƒŽ’”‘„-

ͳǤ ƒ…‹—ìƒǤǡƒ…‹—ìƒǤǡƒ…‹—ìƒǤ•—ϐ‹…‹‡ìƒ˜‡‘ƒ•£…”‘‹…£ lemei maladiei varicoase recurente. ”–ƒ ‡†‹cƒǡʹͲͲͺǢͶȋ͵ͳȌǣʹͳǦ
Ȃ†‹ϐ‹…—Ž–£ì‹†‡†‹ƒ‰‘•–‹…ç‹–”ƒ–ƒ‡–Ǥ‡˜‹•–ƒ oŸn£ †‡ nƒ–oǦ 24.
‹‡ ˆ—ncì‹onƒŽ£ ç‹ cŽ‹n‹c£ǡ ƒc”oǦ ç‹ ‹c”o•co’‹c£ ç‹ †‡ n–”o’oŽo‰‹‡, ͳ͸Ǥ‘çƒ Ǥ ‡”…‡–£”‹ Š‹•–‘Ž‘‰‹…‡ǡ Š‹•–‘…Š‹‹…‡ ç‹ ‡Ž‡…–”‘‘‹…”‘-
ʹͲͲͻǢͺȋͶȌǣͷ͵ͺǦͷͶʹǤ
2. Lee A., Evans C., Allan P., Ruckley C., Fowkes F. Lifestyle factors
ƒ† –Š‡ ”‹• ‘ˆ ˜ƒ”‹…‘•‡ ˜‡‹•ǣ †‹„—”‰Š ‡‹ –—†›Ǥ
Ǥ Ž‹nǤ ’‹Ǧ at/Rezumat_Florin_Comsa.pdf
†‡‹oŽǤǡ ʹͲͲ͵Ǣ ͷ͸ ȋʹȌǣ ͳ͹ͳǦͳ͹ͻǤ Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ
•…‘’‹…‡ Á ˜‡‡Ž‡ ˜ƒ”‹…‘ƒ•‡Ǥ ‡œ£ †‡ †‘…–‘”ƒ–Ǥ ƒç‹ǡ ʹͲͳͲǤ Š––’ǣȀȀ
™™™Ǥ—ϐ‹ƒ•‹Ǥ”‘Ȁ…‘ƒŽƒ‘…–‘”ƒŽƒȀ‡œ‡‘…–‘”ƒ–Ȁ‡œ‡ΨʹͲ‘…–‘”-
ͳ͹Ǥ ‘çƒ Ǥǡ”†‡Ž‡ƒǤǡ£Ž‹‡‹Ǥǡ
‹—ç…ƒǤǡ£”—–—ǤǦǤ‡‹ϐ‹…ƒì‹ƒ
pubmed/12654412 (accesat 12/06/2017). ’”‘ϐ‹Ž—Ž—‹‘”ˆ‘Ž‘‰‹…ƒŽ˜‡‡Ž‘”˜ƒ”‹…‘ƒ•‡Á‡–‹‘’ƒ–‘‰‡‹ƒ„‘Ž‹‹˜ƒ”‹-
3. Lee A., Robertson L., Boghossian S., Allan P., Ruckley C., Fowkes F., coase.
—”nƒŽ—Ž †‡ Š‹”—”‰‹‡ǡƒç‹ǡʹͲͳͲǢ͸ȋͶȌǣͶͺͳǦͶͻʹǤŠ––’ǣȀȀŒ—”ƒŽ-
˜ƒ•Ǥ”‘‰”‡••‹‘‘ˆ˜ƒ”‹…‘•‡˜‡‹•ƒ†…Š”‘‹…˜‡‘—•‹•—ˆϐ‹-
ciency in the general population in the Edinburgh Vein Study.
Ǥ ƒ•cǤ nr%204.pdf
—”‰Ǥ ‡no—• ›’Šƒ–Ǥ ‹•o”†Ǥǡ ʹͲͳͷǢ ͵ ȋͳȌǣ ͳͺǦʹ͸Ǥ Š––’•ǣȀȀ™™™Ǥ
ncbi.nlm.nih.gov/pubmed/26993676 (accesat 12/06/2017).
ͶǤ
‡…— Ǥ ‘Ž‹Ž‡ ˜‡‘ƒ•‡ ȋ’’Ǥ ʹʹʹͶǦʹʹͶʹȌǤ Bǣ ”ƒ–ƒ– †‡ ’ƒ–oŽoǦ
‰‹‡ cŠ‹”—”‰‹cƒŽ£Ǥ —„ ”‡†ƒ…싃 Ž—‹ ‰‡Ž‡•…— Ǥ †‹–—”ƒ ‡†‹…ƒŽ£ǡ
—…—”‡ç–‹ǡʹͲͲ͵Ǥ
5. Bergan J., Bunke-Paquette N. Š‡ ‡‹n oo. 2nd edition. Oxford Uni-
versity Press, 2014, 218p. Š––’•ǣȀȀ™™™Ǥƒƒœ‘Ǥ…‘Ȁ‡‹Ǧ‘‘Ǧ
John-J-Bergan/dp/0195399633
6. Badier-Commander C., Couvelard A., Henin D., Verbeuren T., Michel
JB., Jacob M. Smooth muscle cell modulation and cytokine overpro-
duction in varicose veins. An ‹n •‹–— study.
Ǥ Pƒ–ŠoŽǤǡʹͲͲͳǢͳͻ͵ȋ͵Ȍǣ in human aorto-coronary saphenous vein graftsǤ ‹”cŠo™• ”cŠǤ 
398-407. Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ’—„‡†ȀͳͳʹͶͳͶʹʹ (acc-
esat 17/06/2017).
uldechirurgie.ro/jurnal/docs/jurnal410/art%2012_vol%206_2010_
18. Kirsch D., Schreiber J., Dienes H., Bottger T., Junginger T. Altera-
tions of the extracellular matrix of venous walls in varicose veins.
ƒ•ƒǡ ͳͻͻͻǢ ʹͺ ȋʹȌǣ ͻͷǦͻͻǤ Š––’•ǣȀȀ‡—”‘’‡’…Ǥ‘”‰Ȁƒ„•–”ƒ…–Ȁ
med/10409919 (accesat 22/09/2018).
19. Kirsch D., Wahl W., Bottger T., Junginger T. [Primary varicose
˜‡‹• Ȃ …Šƒ‰‡• ‹ –Š‡ ˜‡‘—• ™ƒŽŽ ƒ† ‡Žƒ•–‹… „‡Šƒ˜‹‘”ȐǤ ‡”
Š‹”—”‰ǤǡʹͲͲͲǢ͹ͳȋ͵Ȍǣ͵ͲͲǦ͵ͲͷǤŠ––’•ǣȀȀ‡—”‘’‡’…Ǥ‘”‰Ȁƒ„•–”ƒ…–Ȁ
med/10789047 (accesat 22/09/2018).
20. Kockx M., Cambier B., Bortier H., De Meyer G., Van Cauwelaert P.
The modulation of smooth muscle cell phenotype is an early event
Pƒ–ŠoŽǤ nƒ–Ǥ ‹•–o’ƒ–ŠoŽǤǡ ͳͻͻʹǢͶʹͲǣͳͷͷǦͳ͸ʹǤŠ––’•ǣȀȀ™™™Ǥ…„‹Ǥ
nlm.nih.gov/pubmed/1549904
7. Ibegbuna V., Delis K., Nicolaides A. Hemodynamic and clinical im-
’ƒ…– ‘ˆ •—’‡”ϐ‹…‹ƒŽǡ †‡‡’ ƒ† ’‡”ˆ‘”ƒ–‘” ˜‡‹ ‹…‘’‡–‡…‡Ǥ —”Ǥ
Ǥ ƒ•cǤ n†o˜ƒ•cǤ —”‰Ǥǡ ʹͲͲ͸Ǣ ͵ͳ ȋͷȌǣ ͷ͵ͷǦͷͶͳǤ Š––’•ǣȀȀ™™™Ǥ
ejves.com/article/S1078-5884(05)00657-X/fulltext (accesat
22/09/2018).
8. Bergan J., Pascarella L. Venous anatomy, physiology and pathophys-
ʹͳǤƒ‰‡•Ǥǡ‘”–Ǥ–‹ƒŽϐ‹„”‘•‹•ȋ’ŠŽ‡„‘•…Ž‡”‘•‹•Ȍ‹–Š‡•ƒ’Š‡-
‘—•˜‡‹‘ˆ–Š‡Ž‘™‡”Ž‹„ǣƒ“—ƒ–‹–ƒ–‹˜‡ƒƒŽ›•‹•Ǥ ‹”cŠo™• ”cŠǤ
 Pƒ–ŠoŽǤ nƒ–Ǥ ‹•–o’ƒ–ŠoŽǤǡ ͳͻͻʹǢ Ͷʹͳǣ ͳʹ͹Ǧͳ͵ͳǤ Š––’•ǣȀȀ™™™Ǥ
ncbi.nlm.nih.gov/pubmed/1514244 (accesat 22/09/2018).
22. Somers P., Knaapen M. The histopathology of varicose vein disease.
n‰‹oŽo‰›ǡʹͲͲ͸Ǣͷ͹ȋͷȌǣͷͶ͸ǦͷͷͷǤŠ––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ
‹‘Ž‘‰› ȋ’’Ǥ ͵ͻǦͶ͸ȌǤ ǣ ‡”‰ƒ
Ǥ ȋ‡†ǤȌ Š‡ ˜‡‹n „oo. Burlington, pubmed/17067976 (accesat 12/06/2017).
San Diego, London, Elsevier Academic Press, 2007. Š––’•ǣȀȀ™™™Ǥ 23. Wali M., Dewan M., Eid R. Histopathological changes in the wall of
amazon.com/Vein-Book-John-J-Bergan/dp/0195399633 (accesat varicose veins. In–Ǥ n‰‹oŽǤ ʹͲͲ͵Ǣ ʹʹ ȋʹȌǣ ͳͺͺǦͳͻ͵Ǥ Š––’•ǣȀȀ™™™Ǥ
05/06/2017)Ǥ ncbi.nlm.nih.gov/pubmed/12865886 (accesat 12/06/2017).
9. Elsharawy M., Naim M., Abdelmaguid E., Al-Mulhim A. Role of sa- ʹͶǤƒŽ‹ Ǥǡ ‹† Ǥ Šƒ‰‡• ‘ˆ ‡Žƒ•–‹… ƒ† …‘ŽŽƒ‰‡ ϐ‹„‡”• ‹ ˜ƒ”‹…‘•‡
phenous vein wall in the pathogenesis of primary varicose veins. veins. In–Ǥ n‰‹oŽǤǡ ʹͲͲʹǢ ʹͳ ȋͶȌǣ ͵͵͹Ǧ͵Ͷ͵Ǥ Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ
In–‡”ƒc–Ǥ ƒ”†‹o˜ƒ•cǤ Šo”ƒcǤ —”‰ǤǡʹͲͲ͹Ǣ͸ȋʹȌǣʹͳͻǦʹʹͶǤŠ––’•ǣȀȀ nih.gov/pubmed/12518113 (accesat 12/06/2017).
www.ncbi.nlm.nih.gov/pubmed/17669815 (accesat 12/06/2017). ʹͷǤƒŽ‹Ǥǡ‹†Ǥ–‹ƒŽ…Šƒ‰‡•‹˜ƒ”‹…‘•‡˜‡‹•ǣƒ—Ž–”ƒ•–”—…–—”ƒŽ
ͳͲǤ
ƒ…‘„•Ǥǡ†”ƒ•ƒǤǡ„‹Ǥǡƒ‡ϐ‹‡Ž†Ǥƒ–Š‘’Š›•‹‘Ž‘‰›‘ˆ˜ƒ”‹- study.
Ǥ oo–Š —•cŽ‡ ‡•Ǥǡ ʹͲͲʹǢ ͵ͺ ȋ͵Ȍǣ ͸͵Ǧ͹ͶǤ Š––’•ǣȀȀ™™™Ǥ
cose veins.
Ǥ ƒ•cǤ —”‰Ǥ ‡no—• ›’Šƒ–Ǥ ‹•o”†ǤǡʹͲͳ͹Ǣͷȋ͵ȌǣͶ͸ͲǦ ncbi.nlm.nih.gov/pubmed/12596886
467. Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ’—„‡†ȀʹͺͶͳͳ͹ͳ͸ (accesat ʹ͸ǤƒŽ‹ Ǥǡ ‹† Ǥ ‘‘–Š —•…Ž‡ …Šƒ‰‡• ‹ ˜ƒ”‹…‘•‡ ˜‡‹•ǣ ƒ —Ž-
22/09/2018). trastructural study.
Ǥ oo–Š —•cŽ‡ ‡•Ǥǡ ʹͲͲͳǢ ͵͹ ȋͷǦ͸Ȍǣ ͳʹ͵Ǧ
11. Lim C., Davies A. Pathogenesis of primary varicose veins. ”Ǥ
Ǥ 135. Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ’—„‡†Ȁͳʹͳʹ͸Ͳ͵ͻ (accesat
—”‰Ǥǡ ʹͲͲͻǢ ͻ͸ ȋͳͳȌǣ ͳʹ͵ͳǦͳʹͶʹǤ Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ 12/06/2017).
pubmed/19847861 (accesat 12/06/2017). ʹ͹Ǥ‹ƒ‘Ǥǡ—ƒ‰Ǥǡ‹Ǥǡ‹Ǥǡƒ‰ǤIn ˜‹–”o differences between
ͳʹǤ‡‡„‡Ǥǡ‡”‰ƒ
Ǥǡ‡”‰‰˜‹•–ǤǡŽ‘ˆǤǡ”‹••‘Ǥǡ
”‡‡ϐ‹‡Ž†Ǥ‡– smooth muscle cells derived from varicose veins and normal veins.
ƒŽǤŽƒ••‹ϐ‹…ƒ–‹‘ƒ†‰”ƒ†‹‰‘ˆ…Š”‘‹…˜‡‘—•†‹•‡ƒ•‡‹–Š‡Ž‘™‡”
Ǥ ƒ•cǤ —”‰ǤǡʹͲͲͻǢͷͲȋͷȌǣͳͳͶͻǦͳͳͷͶǤŠ––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ
Ž‹„•ǣƒ…‘•‡•—••–ƒ–‡‡–Ǥ—”Ǥ
Ǥ ƒ•cǤ n†o˜ƒ•cǤ —”‰., 1996; 12 gov/pubmed/19703751 (accesat 12/06/2017).
ȋͶȌǣͶͺ͹ǦͶͻʹǤŠ––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ’—„‡†ȀͺͻͺͲͶͶʹ. 28. Gomez I., Benyahia C., Le Dall J., Payré C., Louedec L. ‡– ƒŽǤ Absence
ͳ͵ǤŽÚˆǤǡ—–Š‡”ˆ‘”†Ǥǡ‡”‰ƒ
Ǥǡƒ”’‡–‹‡”Ǥǡ
Ž‘˜‹…œ‹Ǥǡ‹•–‡” ‘ˆ‹ϐŽƒƒ–‘”›…‘†‹–‹‘•‹Š—ƒ˜ƒ”‹…‘•‡•ƒ’Š‡‘—•˜‡‹•Ǥ InǦ
R. ‡– ƒŽǤ American Venous Forum International Ad Hoc Committee ϔŽƒǤ ‡•ǤǡʹͲͳ͵Ǣ͸ʹȋ͵ȌǣʹͻͻǦ͵ͲͺǤŠ––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ
ˆ‘”‡˜‹•‹‘‘ˆ–Š‡Žƒ••‹ϐ‹…ƒ–‹‘Ǥ‡˜‹•‹‘‘ˆ–Š‡…Žƒ••‹- pubmed/23238795
ϐ‹…ƒ–‹‘ˆ‘”…Š”‘‹…˜‡‘—•†‹•‘”†‡”•ǣ…‘•‡•—••–ƒ–‡‡–Ǥ
Ǥ ƒ•cǤ 29. Marti M.-C., Bouchardy B., Cox J. Aorto-coronary by-pass with
—”‰Ǥǡ ʹͲͲͶǢ ͶͲ ȋ͸Ȍǣ ͳʹͶͺǦͳʹͷʹǤ Š––’•ǣȀȀ™™™Ǥ…„‹ǤŽǤ‹ŠǤ‰‘˜Ȁ ƒ—–‘‰‡‘—• •ƒ’Š‡‘—• ˜‡‹ ‰”ƒˆ–•ǣ Š‹•–‘’ƒ–Š‘Ž‘‰‹…ƒŽ ƒ•’‡…–•Ǥ
pubmed/15622385 (accesat 22/09/2018). ‹”cŠo™• ”cŠǤ  Pƒ–ŠoŽǤ nƒ–Ǥ ‹•–o’ƒ–ŠoŽǤǡ ͳͻ͹ͳǢ ͵ͷʹǣ ʹͷͷǦʹ͸͸Ǥ
ͳͶǤƒ•’‡”…œƒ
Ǥǡ‘’ƒ…ƒǦ‡•‹ƒǤǡ”‡„‘”‘™‹…œǤȏ‡ϐ‹‹–‹‘ǡ…Žƒ•- Š––’•ǣȀȀŽ‹Ǥ•’”‹‰‡”Ǥ…‘Ȁƒ”–‹…Ž‡ȀͳͲǤͳͲͲ͹Ȁ ͲͲ͸ͲͲ͸͹ͷ
•‹ϐ‹…ƒ–‹‘ƒ††‹ƒ‰‘•‹•‘ˆ…Š”‘‹…˜‡‘—•‹•—ˆϐ‹…‹‡…›Ȃ’ƒ”–ȐǤ 30. Mulligan-Kehoe M., Simons M. ƒ•ƒ ˜ƒ•o”— in normal and diseased

‹n‡oŽǤ PoŽǤǡʹͲͳ͵ǢͺͶȋͳȌǣͷͳǦͷͷǤȏ”–‹…Ž‡‹‘Ž‹•ŠȐŠ––’•ǣȀȀ™™™Ǥ arteries. ‹”c—Žƒ–‹onǡʹͲͳͶǢͳʹͻȋʹͶȌǣʹͷͷ͹Ǧʹͷ͸͸ǤŠ––’•ǣȀȀ™™™Ǥ…„‹Ǥ
ncbi.nlm.nih.gov/pubmed/23488310 (accesat 22/09/2018). nlm.nih.gov/pubmed/24934463 (accesat 22/09/2018).
52

ARTICOL DE CERCETARE RESEARCH ARTICLE

‘•‹„‹Ž‹–£ì‹Ž‡–”ƒ–ƒ‡–—Ž—‹ The treatment possibilities

”‡…£†‡”‹Ž‘”Žƒ’ƒ…‹‡ì‹‹…— of patients with relapsed
•–ƒ†‹‹Ž‡ç‹ƒŽ‡Ž‹ˆ‘—Ž—‹ Hodgkin’s lymphoma,
Hodgkin: studiu descriptiv, stages I and II: descriptive,
retrospectiv retrospective study
Aliona Danila1* Aliona Danila1*
1
‹•c‹’Ž‹nƒ †‡ Š‡ƒ–oŽo‰‹‡ǡ ‡’ƒ”–ƒ‡n–—Ž †‡ ‡†‹c‹n£ ‹n–‡”n£ǡ n‹˜‡”•‹–ƒ–‡ƒ 1
‹•c‹’Ž‹n‡ oˆ Š‡ƒ–oŽo‰›ǡ ‡’ƒ”–‡n– oˆ ‹n–‡”nƒŽ ‡†‹c‹n‡ǡ
†‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dzǡ Š‹ç‹n£—ǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›ǡ Š‹•‹nƒ—ǡ
‡’—„Ž‹cƒ oŽ†o˜ƒǤ ‡’—„Ž‹c oˆ oŽ†o˜ƒǤ

Data primirii manuscrisului: 20.02.2018 Manuscript received on: 20.02.2018

ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣʹͷǤͲͻǤʹͲͳͺ ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣʹͷǤͲͻǤʹͲͳͺ

Autor corespondent: Corresponding author:

Ž‹onƒ ƒn‹Žƒǡ †oc–o”ƒn† Ž‹onƒ ƒn‹Žƒǡ PŠ ˆ‡ŽŽo™
‹•c‹’Ž‹nƒ †‡ Š‡ƒ–oŽo‰‹‡ ‹•c‹’Ž‹n‡ oˆ Š‡ƒ–oŽo‰›
n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz ‹coŽƒ‡ ‡•–‡‹–ƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
•–”Ǥ ‹coŽƒ‡ ‡•–‡‹ìƒn—ǡ ͹Ͷǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǡ Ǧ͸Ͷ͸ͻ ͹Ͷǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— •–”Ǥǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǡ Ǧ͸Ͷ͸ͻ
‡Ǧƒ‹Ž: †ƒn‹ŽƒǤƒŽ‹onƒ̻‰ƒ‹ŽǤco ‡Ǧƒ‹Ž: †ƒn‹ŽƒǤƒŽ‹onƒ̻‰ƒ‹ŽǤco

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

În 10-15% din cazuri de limfom Hodgkin în stadiile locale In 10-15% of cases of Hodgkin’s lymphoma in local stages
ȋ è‹ Ȍǡ †—’£ ‘„싐‡”‡ƒ ”‡‹•‹—‹Ž‘” …‘’Ž‡–‡ǡ •‡ †‡œ˜‘Ž–£ (I and II), after complete remission, relapses develop. The re-
”‡…‹†‹˜‡Ǥ ‡œ—Ž–ƒ–‡Ž‡ –”ƒ–ƒ‡–—Ž—‹ ”‡…‹†‹˜‡Ž‘”  ”£Ÿ sults of treatment of HL relapses remain unsatisfactory and
‡•ƒ–‹•ˆ£…£–‘ƒ”‡ç‹•—–’—싐•–—†‹ƒ–‡Ǥ are poorly studied.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
‡œ˜‘Ž–ƒ”‡ƒ”‡…‹†‹˜‡Ž‘”Žƒ’ƒ…‹‡ì‹‹…—‹ϐŽ—‡ì‡ƒœ£‡‰-
ƒ–‹˜ƒ•—’”ƒ†—”ƒ–‡‹˜‹‡–‹‹ç‹’”‘‰‘•–‹…—Žǡ†‡•‡‘”‹ǡ‡•–‡‡ˆƒ˜‘-
rabil.
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
Cel mai frecvent, recidivele limfomului Hodgkin s-au dez-
voltat la persoanele cu vârsta de 18-40 ani (69%), preponder-
ent, la femei (60%). Au predominat recidivele tardive (78%).
‡ƒ ƒ‹ ÁƒŽ–£ ‡ϐ‹…ƒ…‹–ƒ–‡ ƒ –”ƒ–ƒ‡–—Ž—‹ ”‡…£†‡”‹Ž‘”  ƒ
demonstrat-o programul de polichimioterapie ABVD, remi-
•‹—‹…‘’Ž‡–‡ϐ‹‹†‘„싐—–‡Á͸ͺǡͲΨ†‡…ƒœ—”‹Ǥ
‡œ—ƒ–
Introducere.‡è‹‡ϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—Ž—‹‡•–‡ÁƒŽ-
–£ǡŽƒƒ’”‘š‹ƒ–‹˜ͳͲǦͳͷΨ†‹’ƒ…‹‡ì‹‹…—Á•–ƒ†‹‹Ž‘…ƒŽ‡ǡ
†—’£‘„싐‡”‡ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡–‡ǡƒ‹†‡˜”‡‡•ƒ—ƒ‹
–ƒ”†‹˜ǡ•‡’‘–†‡œ˜‘Ž–ƒ”‡…‹†‹˜‡…ƒ”‡‹ϐŽ—‡ì‡ƒœ£‡‰ƒ–‹˜’”‘-
‰‘•–‹…—Žè‹•’‡”ƒìƒŽƒ˜‹ƒì£Ǥ
ƒ–‡”‹ƒŽ è‹ ‡–‘†‡Ǥ Studiu retrospectiv, descriptiv. Da-
–‡Ž‡ …Ž‹‹…‡ǡ Š‡ƒ–‘Ž‘‰‹…‡ è‹ ”‡œ—Ž–ƒ–‡Ž‡ –”ƒ–ƒ‡–—Ž—‹ ƒ— ˆ‘•–
Research hypothesis
The development of relapses in patients with HL adver-
sely affects the life span and the prognosis is often unfavo-
rable.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
Most frequently, recurrences of Hodgkin’s lymphoma de-
veloped in people aged 18-40 years (69%), predominantly in
women (60%). Tardive relapses prevailed (78%). The high-
‡•– –”‡ƒ–‡– ‡ˆϐ‹…ƒ…› ‘ˆ ”‡Žƒ’•‡†  ™ƒ• ’”‘˜‡ ‹ 
polychemotherapy, complete remission being achieved in
68.0% of cases.
Abstract
Introduction. Although the treatment effectiveness of HL
is high, approximately 10-15% of patients with HL in local sta-
ges, after complete remission, either earlier or later may de-
˜‡Ž‘’”‡Žƒ’•‡•–Šƒ–‡‰ƒ–‹˜‡Ž›‹ϐŽ—‡…‡–Š‡’”‘‰‘•‹•ƒ†Ž‹ˆ‡
expectancy.
Material and methods. Retrospective, descriptive study.
Clinical, haematological and treatment outcomes were studied
”‡ƒ–‡n– oˆ ”‡Žƒ’•‡† o†‰‹nǯ• Ž›’Šoƒ MJHS 17(3)/2018 53

•–—†‹ƒ–‡Žƒ͹ʹ’ƒ…‹‡ì‹…—”‡…‹†‹˜‡ƒŽ‡ǡ†‹ƒ‰‘•–‹…ƒì‹ǡ‹‹ì‹ƒŽǡ in 72 patients with HL relapses, initially diagnosed with stages

…—•–ƒ†‹‹Ž‡è‹ǡ…—”‡‹•‹—‹…‘’Ž‡–‡ǡ‘„싐—–‡†—’£–‡”ƒ’‹ƒ ƒ†ǡ™‹–Š…‘’Ž‡–‡”‡‹••‹‘ƒˆ–‡”–Š‡ϐ‹”•–ǦŽ‹‡–Š‡”ƒ’›Ǥ
†‡’”‹£Ž‹‹‡Ǥ‹ƒ‰‘•–‹…—Ž†‡ƒˆ‘•–…‘ϐ‹”ƒ–‘”ˆ‘Ž‘‰‹…ǡ Š‡†‹ƒ‰‘•‹•™ƒ•‘”’Š‘Ž‘‰‹…ƒŽŽ›…‘ϐ‹”‡†ǡƒ……‘”†‹‰
…‘ˆ‘” Žƒ•‹ϐ‹…£”‹‹ –‡”ƒì‹‘ƒŽ‡ ‹•–‘Ž‘‰‹…‡ è‹ ‹–‘Ž‘‰‹…‡ ƒ –‘ –Š‡ –‡”ƒ–‹‘ƒŽ ‹•–‘Ž‘‰‹…ƒŽ ƒ† ›–‘Ž‘‰‹…ƒŽ Žƒ••‹ϐ‹…ƒ–‹-
ƒ–‘Ž‘‰‹‹Ž‘”—‘”ƒŽ‡ƒŽ‡i‡•—–—Ž—‹‡ƒ–‘’‘‹‡–‹…è‹‹ˆƒ–‹…ǡ on of Tumor Pathology of Hematopoietic and Lymphatic Tis-
’”‘’—•£Áƒ—ŽʹͲͲͺ è‹”‡˜‹œ—‹–£Áƒ—ŽʹͲͳ͸†‡Ǥ–ƒ†‹—Ž sue, proposed in 2008 and revised in 2016 by the WHO. The
…Ž‹‹…ƒˆ‘•–†‡–‡”‹ƒ–…‘ˆ‘”Žƒ•‹ϐ‹…£”‹‹Ž‹‹…‡–‡”ƒì‹‘-
nale, adoptate în Ann-Arbor (SUA) în anul 1971. Tratamentul
ƒ …‘•–ƒ– †‹ ͸Ǧͺ …‹…Ž—”‹ †‡ ’‘Ž‹…Š‹‹‘–‡”’‹‡ †—’£ •…Š‡‡Ž‡
 ȋ†‘š‘”—„‹…‹£ǡ „Ž‡‘‹…‹£ǡ ˜‹„Žƒ•–‹£ǡ †ƒ…ƒ”„ƒœ‹£Ȍ Žƒ
ʹͺ†‡’ƒ…‹‡ì‹Ǣȋ…›…Ž‘’Š‘•’Šƒ‹†£ǡ˜‹„Žƒ•–‹£ǡ’”‡†‹-
clinical stage was determined according to the International
Ž‹‹…ƒŽ Žƒ••‹ϐ‹…ƒ–‹‘ǡ ƒ†‘’–‡† ‹ Ǧ”„‘” ȋȌ ‹ ͳͻ͹ͳǤ
The treatment consisted of 6-8 cycles of polychemotherapy
according to ABVD (doxorubicin, bleomycin, vinblastine, da-
carbazine) regimens in 28 patients; CVPP (cyclophosphamide,
•‘Ž‘ǡ’”‘…ƒ”„ƒœ‹£ȌȂŽƒʹ͹†‡„‘Žƒ˜‹ǤBͳ͹…ƒœ—”‹ǡƒˆ‘•–ƒ’Ž‹- ˜‹„Žƒ•–‹‡ǡ ’”‡†‹•‘Ž‘‡ǡ ’”‘…ƒ”„ƒœ‹‡Ȍ Ȃ ‹ ʹ͹ ’ƒ–‹‡–•Ǥ 
cat un tratament combinat (polichimioterapie cu radioterapie). 17 cases, a combined treatment (polychemotherapy with ra-
–ƒ–‹•–‹…£†‡•…”‹’–‹˜£Ǥ diotherapy) was applied. Descriptive statistics.
‡œ—Ž–ƒ–‡Ǥ ‡…£†‡”‹Ž‡ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡‹•‹—‹ …‘’Ž‡–‡ Results. Relapses in patients with complete remission
ƒŽ‡ǡ†‹ƒ‰‘•–‹…ƒì‹ǡ‹‹ì‹ƒŽǡÁ•–ƒ†‹—Žè‹ǡƒ—ƒ˜—–Ž‘…ƒ‹
frecvent la persoanele cu vârsta de 18-40 de ani (69%). Au
’”‡†‘‹ƒ–”‡…‹†‹˜‡Ž‡–ƒ”†‹˜‡ȋ͹ͺΨȌǤϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—-
Ž—‹”‡…‹†‹˜‡Ž‘”ƒˆ‘•–Œ‘ƒ•£ǡ”‡‹•‹—‹Ž‡…‘’Ž‡–‡ƒ—…‘•–‹–—‹–
†‘ƒ”ͷͶǡʹΨǤ”‘‰”ƒ—Ž†‡–”ƒ–ƒ‡–…—‘‡ϐ‹…ƒ…‹–ƒ–‡ƒ‹Á-
ƒŽ–£ƒˆ‘•–’‘Ž‹…Š‹‹‘–‡”ƒ’‹ƒ†—’£•…Š‡ƒǤ‡‹•‹—‹Ž‡
…‘’Ž‡–‡ƒ—ˆ‘•–‘„싐—–‡ǡÁƒ…‡•–…ƒœǡŽƒ͸ͺΨ†‹–”‡’ƒ…‹‡ì‹Ǥ
—’”ƒ˜‹‡ì—‹”‡ƒˆ£”£”‡…‹†‹˜‡Žƒ’ƒ…‹‡ì‹‹…—”‡‹•‹—‹…‘’Ž‡–‡
’‡•–‡ʹè‹ͷƒ‹ƒˆ‘•–†‡ͻͲΨè‹ͺͲΨǡ”‡•’‡…–‹˜Ǥ
‘…Ž—œ‹‹Ǥ”ƒ–ƒ‡–—Ž”‡…£†‡”‹Ž‘”Ž‹ˆ‘—Ž—‹‘†‰‹Á
of HL, initially diagnosed in stages I and II, occurred more
frequently in subjects aged 18-40 years (69%). Late relapses
’”‡˜ƒ‹Ž‡† ȋ͹ͺΨȌǤ Š‡ ‡ˆϐ‹…ƒ…› ‘ˆ ”‡Žƒ’•‡ –”‡ƒ–‡– ™ƒ• Ž‘™ǡ
complete remission accounting for only 54.2%. The ABVD
’‘Ž›…Š‡‘–Š‡”ƒ’› ™ƒ• –Š‡ –”‡ƒ–‡– ™‹–Š ƒ Š‹‰Š‡” ‡ˆϐ‹…ƒ…›Ǥ
Complete remission was obtained in 68% of patients. The re-
lapse-free survival in patients with complete remission over 2
and 5 years was 90% and 80%, respectively.
Conclusions. Treatment of relapsed Hodgkin’s lymphoma
in stages I-II after complete remission remains poorly effec-
•–ƒ†‹— Ǧ †—’£ ”‡‹•‹—‡ …‘’Ž‡–£ ”£Ÿ‡ ƒ ϐ‹ •Žƒ„ ‡ϐ‹…‹‡–
ȋͷͶǡʹǦ͸ͺΨȌǡ‹ƒ”•’‡”ƒìƒŽƒ˜‹ƒì£Žƒͷƒ‹‡•–‡†‡ͺͲΨǤ
Cuvinte cheie: Ž‹ˆ‘‘†‰‹ǡ”‡…£†‡”‹ǡ–”ƒ–ƒ‡–Ǥ
Introducere
‹ˆ‘—Ž ‘†‰‹ ȋȌ ‡•–‡ ‘ –—‘ƒ”‡ …ƒ”‡ •‡ †‡œ˜‘Ž–£
†‹쇕—–—ŽŽ‹ˆ‘‹†Ǥ…‡ƒ•–£ƒŽƒ†‹‡ƒˆ‡…–‡ƒœ£’‡”•‘ƒ‡Ž‡†‡
‘”‹…‡˜Ÿ”•–£ǡ‹ƒ”…—”„ƒ‹…‹†‡ì‡‹ƒ”‡ʹƒ’‘‰‡—”‹Ǥ”‹—Žƒ’‘-
‰‡—ƒ”‡Ž‘…Žƒ˜Ÿ”•–ƒ†‡Žƒͳͷƒ‹’Ÿ£Žƒʹͷ†‡ƒ‹ǡƒ’‘‹ǡ†—’£‘
•…£†‡”‡•‡‹ϐ‹…ƒ–‹˜£ǡ…—”„ƒÁ…‡’‡•£…”‡ƒ•…£†—’£ͷͲƒ‹ȏͳȐǤ
B—Ž–‹‹‹ʹͲǦ͵Ͳ†‡ƒ‹•Ǧƒ—Á„—£–£ì‹–…‘•‹†‡”ƒ„‹Ž”‡œ—Ž-
–ƒ–‡Ž‡–”ƒ–ƒ‡–—Ž—‹Žƒ„‘Žƒ˜‹‹…—†ƒ–‘”‹–£‹’Ž‡‡–£”‹‹
苇Žƒ„‘”£”‹‹’”‘‰”ƒ‡Ž‘”…‘–‡’‘”ƒ‡†‡–‡”ƒ’‹‡Ǥ’–‹‹œƒ-
”‡ƒè‹•–ƒ†ƒ”†‹œƒ”‡ƒ…Š‹‹‘–‡”ƒ’‹‡‹ƒ—…‘–”‹„—‹–Žƒ‘„싐‡”‡ƒ
——‹’”‘…‡–ÁƒŽ–ǡ†‡’Ÿ£ŽƒͻͷΨ†‡”‡‹•‹—‹…‘’Ž‡–‡Á
•–ƒ†‹‹Ž‡Ž‘…ƒŽ‡ƒŽ‡Ǥ—’”ƒ˜‹‡ì—‹”‡ƒ†‡’‡•–‡ͳͲƒ‹Žƒ’ƒ…‹-
tive (54.2%-68.0%) and life expectancy over 5 years is 80%.
Key words: Hodgkin’s lymphoma, relapses, treatment.
Introduction
Hodgkin’s lymphoma (HL) is a tumor that develops from
lymphoid tissue. This disease affects people of all ages, and the
‹…‹†‡…‡…—”˜‡Šƒ•–™‘’‡ƒ•ǤŠ‡ϐ‹”•–’‡ƒ‘……—”•‹’‡‘’Ž‡
„‡–™‡‡ͳͷƒ†ʹͷ›‡ƒ”•‘Ž†ǡ–Š‡ǡƒˆ–‡”ƒ•‹‰‹ϐ‹…ƒ–†‡…Ž‹‡
the curve starts to increase after 50 years [1].
In the last 20-30 years the treatment outcomes of patients
with HL have considerably improved due to the implementati-
on and development of contemporary therapy regimens. Opti-
mization and standardization of chemotherapy have helped to
achieve a high percentage of up to 95% of complete remission
‘ˆ‹Ž‘…ƒŽ•–ƒ‰‡•ǤŠ‡•—”˜‹˜ƒŽ‘˜‡”ͳͲ›‡ƒ”•‹–Š‡ϐ‹”•–ƒ†
‡ì‹‹Á•–ƒ†‹‹Ž‡è‹…—”‡‹•‹—‹…‘’Ž‡–‡…‘•–‹–—‹‡ͻͲΨè‹ second-stage patients with complete remission is 90% and
mai mult [2, 3]. more [2, 3].
‡è‹‡ϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—Ž—‹Á•–ƒ†‹‹Ž‡è‹‡•–‡ÁƒŽ–£ǡ
Žƒƒ’”‘š‹ƒ–‹˜ͳͲǦͳͷΨ†‹–”‡’ƒ…‹‡ì‹‹…—Á•–ƒ†‹‹Ž‡Ž‘…ƒŽ‡ǡ
†—’£‘„싐‡”‡ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡–‡•‡†‡œ˜‘Ž–£”‡…‹†‹˜‡ȏͶǦ
͹ȐǤ”‘‰‘•–‹…—ŽŽƒ’ƒ…‹‡ì‹‹…—”‡…£†‡”‹†‡•‡‘”‹‡•–‡‡ˆƒ˜‘”ƒ-
„‹Žǡ…—”‡†—…‡”‡ƒ•‡‹ϐ‹…ƒ–‹˜£ƒ•’‡”ƒì‡‹†‡˜‹ƒì£Ǥ
‡…‹†‹˜‡Ž‡  ’”‡œ‹–£ ‘ ’”‘„Ž‡£ †‡•–—Ž †‡ ‹’‘”–ƒ–£
ƒ–Ÿ–Á’Žƒ†‡†‹ƒ‰‘•–‹…ǡ…Ÿ–苆‡–”ƒ–ƒ‡–Ǥ’”‘„Ž‡£ƒ…-
–—ƒŽ£‡•–‡è‹†‡–‡”‹ƒ”‡ƒˆƒ…–‘”‹Ž‘”†‡”‹•…†‡†‡œ˜‘Ž–ƒ”‡ƒ”‡-
cidivelor, care vor contribui la individualizarea tratamentului.
Ž–Š‘—‰Š–Š‡–”‡ƒ–‡–‡ˆϐ‹…ƒ…›‹•–ƒ‰‡•ƒ†‹•Š‹‰Šǡ
approximately 10-15% of patients with HL in the local stages,
after complete remission develop relapses [4-7]. The progno-
sis in patients with relapses is often unfavorable, with a signi-
ϐ‹…ƒ–”‡†—…–‹‘‹Ž‹ˆ‡‡š’‡…–ƒ…›Ǥ
Š‡”‡Žƒ’•‡†’‘•‡•ƒ•‹‰‹ϐ‹…ƒ–’”‘„Ž‡„‘–Š‹†‹ƒ-
gnosis and treatment. The determination of relapse risk fac-
tors is a current problem since it will also help to individualize
the treatment.
B’”‡œ‡–ǡ’‡–”—•–ƒ†‹‹Ž‡è‹ƒŽ‡ǡ‡š‹•–£‘–‡†‹ì£†‡ Currently, for HL stages I and II, there is a tendency to de-
ƒ‹…è‘”ƒ‹–‡•‹–ƒ–‡ƒ’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡‹è‹”ƒ†‹‘–‡”ƒ’‹‡‹’‡- crease the intensity of polychemotherapy and radiotherapy to
–”—ƒ‡˜‹–ƒ…‘•‡…‹ì‡Ž‡‡‰ƒ–‹˜‡ƒ–Ÿ–Á’‡”‹‘ƒ†ƒ’”‡…‘…‡ǡ…Ÿ– avoid negative consequences both in the early and late stages
è‹…‡ƒ–ƒ”†‹˜£ȏͺȐǤ‡…‹ǡ•ƒ”…‹ƒ’”‹…‹’ƒŽ£‡•–‡…ƒ–”ƒ–ƒ‡–—Ž [8]. Therefore, the primary task is that the treatment perfor-
54
‡ˆ‡…–—ƒ–•£’‘•‡†‡‘‡ϐ‹…ƒ…‹–ƒ–‡ƒš‹£ǡ…—‘–‘š‹…‹–ƒ–‡‹‹-
£ȏͻȐǤ•–ˆ‡ŽǡƒŽ‡‰‡”‡ƒ–ƒ…–‹…‹‹†‡–”ƒ–ƒ‡–˜ƒϐ‹Áˆ—…싇†‡
’”‡œ‡ìƒ•ƒ—Ž‹’•ƒˆƒ…–‘”‹Ž‘”†‡”‹•…†‡†‡œ˜‘Ž–ƒ”‡ƒ”‡…‹†‹˜‡Ž‘”Ǥ
ƒ…‹‡ì‹‹…—ˆƒ…–‘”‹†‡’”‘‰‘•–‹…‡ˆƒ˜‘”ƒ„‹Ž˜‘”‡…‡•‹–ƒ
—–”ƒ–ƒ‡–ƒ‹‹–‡•‹˜ǡ…‘’ƒ”ƒ–‹˜…—…‡‹ŽƒŽì‹Ǥ
B–”ƒ–ƒ‡–—Ž”‡…‹†‹˜‡Ž‘”†‡ǡÁ—Ž–‹‹‹ƒ‹ǡ•‡—–‹Ž‹œ‡ƒœ£
’”‘‰”ƒ‡†‡–‡”ƒ’‹‡‹–‡•‹˜£…ƒ‡•…ƒŽƒ†ƒ–ȋ…›…Ž‘’-
Š‘•’Šƒ‹†£ǡ‡–‘’‘•‹†£ǡ’”‘…ƒ”„ƒœ‹£ǡ˜‹…”‹•–‹£ǡ„Ž‡‘‹…‹£ǡ
’”‡†‹•‘Ž‘Ȍ苃Ž–‡Ž‡ȏͳͲǡͳͳȐǤB…ƒœ—”‹Ž‡†‡”‡…£†‡”‹ƒǡ•‡
face accent pe doze mari de chimioterapie, cu autotransplant
•ƒ—ƒŽ‘–”ƒ•’Žƒ–ƒŽ£†—˜‡‹‘ƒ•‡Ž‘”ȏͳʹǡͳ͵ȐǤB•£ǡƒ—–‘–”ƒ•-
’Žƒ–—Žè‹ƒŽ‘–”ƒ•’Žƒ–—Ž†‡£†—˜£‘•‘ƒ•£—‡•–‡†‹•’‘‹„‹Ž
苃……‡•‹„‹ŽÁ–‘ƒ–‡…ƒœ—”‹Ž‡†‹˜ƒ”‹ƒ‘–‹˜‡Ǥ‹ƒ…‡•–‡…‘•‹-
derente, studierea rezultatelor diferitor metode de tratament
˜ƒ…‘–”‹„—‹ǡ’”‘„ƒ„‹ŽǡŽƒ‘’–‹‹œƒ”‡ƒè‹‹†‹˜‹†—ƒŽ‹œƒ”‡ƒ–‡”ƒ-
’‹‡‹’ƒ…‹‡ì‹Ž‘”…—”‡…‹†‹˜ƒ–Ǥ
ƒ–‡”‹ƒŽç‹‡–‘†‡
Design-ul studiului este unul de tip retrospectiv, descriptiv.
—ˆ‘•–•–—†‹ƒ–‡ƒ•’‡…–‡Ž‡…Ž‹‹…‡è‹”‡œ—Ž–ƒ–‡Ž‡–”ƒ–ƒ‡–—Ž—‹
Žƒ ͹ʹ †‡ ’ƒ…‹‡ì‹ …— ”‡…£†‡”‹ ƒŽ‡ ǡ †‹ƒ‰‘•–‹…ƒì‹ǡ ‹‹ì‹ƒŽǡ …—
”ƒ–ƒ‡n–—Ž ”‡c£†‡”‹Žo” Ž‹ˆo—Ž—‹ o†‰‹n
‡†•Š‘—Ž†Šƒ˜‡ƒš‹—‡ˆϐ‹…ƒ…›™‹–Š‹‹ƒŽ–‘š‹…‹–›ȏͻȐǤ
Thus, the choice of treatment tactics will depend on the pre-
sence or absence of relapse risk factors.
Patients with unfavorable prognostic factors will require
more intensive treatment than others. Intensive care pro-
grams such as Escalated BEACOPP (cyclophosphamide, etopo-
side, procarbazine, vincristine, bleomycin, prednisolone) and
others [10, 11] have been used in recent years in the treat-
ment of relapsed HL. In cases of relapsed HL, high doses of
chemotherapy, bone marrow autotransplant or allotransplant
are used [12, 13]. However, bone marrow autotransplant and
allotransplant are not available and accessible in all cases for
various reasons. For these reasons, studying the results of di-
fferent treatment methods will probably help optimize and in-
dividualize the therapy in patients with relapsed HL.
Material and methods
The study design is retrospective, descriptive. Clinical as-
pects and treatment outcomes were studied in 72 patients
with relapsed HL, initially diagnosed with stages I and II, with
…‘’Ž‡–‡”‡‹••‹‘ƒˆ–‡”–Š‡ϐ‹”•–ǦŽ‹‡–Š‡”ƒ’›Ǥ
•–ƒ†‹‹Ž‡è‹ǡ…—”‡‹•‹—‹…‘’Ž‡–‡ǡ‘„싐—–‡†—’£ϐ‹ƒŽ‹œƒ”‡ƒ
–‡”ƒ’‹‡‹†‡’”‹£Ž‹‹‡Ǥ
”‘–‘…‘Ž—Ž†‡…‡”…‡–ƒ”‡ƒ‘„싐—–ƒ˜‹œ—Ž’‘œ‹–‹˜ƒŽ‘‹–‡–—-
Ž—‹†‡–‹…£ƒ‡”…‡–£”‹‹ȋ’”‘…‡•Ǧ˜‡”„ƒŽ”Ǥ͵Ͷ†‹ͳͻǤͲ͸ǤʹͲͳͶȌǤ
”‹–‡”‹‹Ž‡†‡‹…Ž—†‡”‡Á•–—†‹—ƒ—ˆ‘•–ǣ
ƒ ˜Ÿ”•–ƒ’ƒ…‹‡–—Ž—‹ηͳͺƒ‹Ǣ
ƒ „‘Žƒ˜‹ …— ”‡…£†‡”‹ •ƒ— ƒ˜ƒ•ƒ”‡ ƒ ǡ †‹ƒ‰‘•–‹…ƒì‹ǡ
The Research Protocol has obtained the positive opinion of
the Research Ethics Committee (Minutes no. 34 of 19.06.2014).
Š‡‹…Ž—•‹‘…”‹–‡”‹ƒ‹–Š‡•–—†›™‡”‡ǣ
ƒ’ƒ–‹‡–ƒ‰‡ηͳͺ›‡ƒ”•Ǣ
ƒpatients with relapsed or progressive HL, initially dia-
gnosed in stages I and II with complete remission after
–Š‡ϐ‹”•–ǦŽ‹‡–Š‡”ƒ’›Ǣ
‹‹ì‹ƒŽǡÁ•–ƒ†‹‹Ž‡è‹ǡ…—”‡‹•‹—‹…‘’Ž‡–‡ǡ‘„싐—–‡
Ȁ’‡”ˆ‘”ƒ…‡•–ƒ–—•ζʹǢ
†—’£ϐ‹ƒŽ‹œƒ”‡ƒ–‡”ƒ’‹‡‹†‡’”‹£Ž‹‹‡Ǣ
ƒ •–ƒ–—–—Ž†‡’‡”ˆ‘”ƒì£ζʹ’—…–‡’‡•…ƒ”ƒ
ȀǢ radiotherapy;
ƒ ’ƒ…‹‡ì‹‡Ž‹‰‹„‹Ž‹’‡–”—–”ƒ–ƒ‡–—Ž…—’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡
è‹Á…‘„‹ƒì‹‡…—”ƒ†‹‘–‡”ƒ’‹‡Ǣ
ƒ ‡š‹•–‡ìƒ†ƒ–‡Ž‘”‘‹–‘”‹œ£”‹‹Á†‹ƒ‹…£Ǥ
”‹–‡”‹‹†‡‡š…Ž—†‡”‡†‹•–—†‹—ƒ—ˆ‘•–ǣ
ƒ Ž‹’•ƒ†ƒ–‡Ž‘”…ƒ”‡…‘ϐ‹”£…—…‡”–‹–—†‹‡†‹ƒ‰‘•–‹…—Ž†‡
LH;
ƒ •–ƒ–—–—Ž†‡’‡”ˆ‘”ƒì£εʹ’—…–‡’‡•…ƒ”ƒ
ȀǢ of disease, complete response (complete remission), partial
ƒ ’‹‡”†‡”‡ƒ’‘•‹„‹Ž‹–£ì‹‹‘‹–‘”‹œ£”‹‹Á†‹ƒ‹…£ƒ…ƒœ—-
lui.
ƒ”ƒ‡–”‹‹ Á”‡‰‹•–”ƒì‹ ƒ‹ •–—†‹—Ž—‹ ƒ— ˆ‘•–ǣ •‡š—Žǡ ˜Ÿ”•–ƒǡ
•–ƒ†‹—Ž„‘Ž‹‹ǡ…ƒœ—Ž†‡”£•’—•…‘’Ž‡–ȋ”‡‹•‹—‡…‘’Ž‡–£Ȍǡ
’ƒ”싃Žȋ”‡‹•‹—‡’ƒ”싃Ž£Ȍ•ƒ—†‡„‘ƒŽ£•–ƒ„‹Ž£ȋ•–ƒ„‹Ž‹œƒ”‡ƒ
’”‘…‡•—Ž—‹–—‘”ƒŽȌǡ…ƒœ—Ž†‡„‘ƒŽ£’”‘‰”‡•‹˜£ȋ–”ƒ–ƒ‡–ˆ£”£
‡ˆ‡…–Ȍǡ†—”ƒ–ƒ‘‹–‘”‹œ£”‹‹è‹…ƒœ—”‹Ž‡†‡†‡…‡•Ǥ
Din registrele medicale, au fost colectate datele retrospec-
–‹˜‡ƒŽ‡’ƒ…‹‡ì‹Ž‘”…ƒ”‡ƒ—Á†‡’Ž‹‹–…”‹–‡”‹‹Ž‡†‡‹…Ž—†‡”‡Á
perioada 01.11.2013-31.10.2017. În total, au fost documenta-
–‡͹ʹ†‡…ƒœ—”‹Ǥ‹ƒ‰‘•–‹…—Žǡ–”ƒ–ƒ‡–—Žè‹‡˜‹†‡ìƒ’ƒ…‹‡ì‹-
ƒ
ƒpatients eligible for polychemotherapy combined with
ƒavailable follow-up data.
š…Ž—•‹‘…”‹–‡”‹ƒˆ”‘–Š‡•–—†›™‡”‡ǣ
ƒŽƒ…‘ˆ†ƒ–ƒ…‘ϐ‹”‹‰–Š‡†‹ƒ‰‘•‹•‘ˆǢ
ƒECOG / WHO performance status >2;
ƒlack of available follow-up data.
Š‡’ƒ”ƒ‡–‡”•”‡…‘”†‡†‹–Š‡•–—†›™‡”‡ǣ•‡šǡƒ‰‡ǡ•–ƒ‰‡
response (partial remission) or stable disease (tumor process
stabilization), progressive illness (lack of treatment effect),
follow-up and deaths.
From the medical records, the retrospective data of pa-
tients who met the inclusion criteria within 01.11.2013 and
31.10.2017 were collected. Overall, 72 cases have been docu-
mented. The diagnosis, treatment and follow-up of the pati-
ents included in the study were performed in the Hematologic
Center and Diagnostic Consulting Center of the Oncological
Institute. The data were collected from out-patient and in-pa-
tient medical records and medical forms. The diagnosis in all
Ž‘”‹…Ž—è‹Á•–—†‹—ƒ—ˆ‘•–‡ˆ‡…–—ƒ–‡Á‡–”—Ž‡ƒ–‘Ž‘‰‹…è‹ …ƒ•‡•™ƒ•‘”’Š‘Ž‘‰‹…ƒŽŽ›…‘ϐ‹”‡†ƒ……‘”†‹‰–‘–Š‡–‡”-
Centrul Consultativ Diagnostic al Institutului Oncologic. Date- ƒ–‹‘ƒŽ‹•–‘Ž‘‰‹…ƒŽƒ†›–‘Ž‘‰‹…ƒŽŽƒ••‹ϐ‹…ƒ–‹‘‘ˆ—‘”•
Ž‡ƒ—ˆ‘•–…‘Ž‡…–ƒ–‡†‹ϐ‹è‡Ž‡†‡ƒ„—Žƒ–‘”苈‘‹Ž‡†‡‘„•‡”˜ƒ- of Hematopoietic and Lymphatic Tissue, proposed in 2008 and
싇ƒŽ‡’ƒ…‹‡ì‹Ž‘”†‹•–ƒì‹‘ƒ”Ǥ‹ƒ‰‘•–‹…—ŽǡÁ–‘ƒ–‡…ƒœ—”‹Ž‡ǡ revised by WHO in 2016 [14-16]. For this purpose, histological
ƒˆ‘•–…‘ϐ‹”ƒ–‘”ˆ‘Ž‘‰‹……‘ˆ‘”Žƒ•‹ϐ‹…£”‹‹–‡”ƒì‹‘ƒŽ‡ and immunohistochemical methods were used as well as mo-
‹•–‘Ž‘‰‹…‡è‹‹–‘Ž‘‰‹…‡ƒƒ–‘Ž‘‰‹‹Ž‘”—‘”ƒŽ‡ƒŽ‡i‡•—–—Ž—‹ noclonal antibodies (CD15, CD30) of the material obtained in
‡ƒ–‘’‘‹‡–‹…è‹‹ˆƒ–‹…ǡ’”‘’—•£ÁʹͲͲͺè‹”‡˜‹œ—‹–£Áƒ—Ž the biopsy of enlarged lymph nodes, other organs or tissues.
”‡ƒ–‡n– oˆ ”‡Žƒ’•‡† o†‰‹nǯ• Ž›’Šoƒ MJHS 17(3)/2018 55

ʹͲͳ͸†‡ȏͳͶȂͳ͸ȐǤBƒ…‡•–•…‘’ǡƒ—ˆ‘•–ˆ‘Ž‘•‹–‡‡–‘†‡ The degree of tumour spread of relapsed HL (clinical stage)

Š‹•–‘Ž‘‰‹…‡ è‹ ‹—‘Š‹•–‘…Š‹‹…‡ǡ …— —–‹Ž‹œƒ”‡ƒ †‡ ƒ–‹…‘”’‹
‘‘…Ž‘ƒŽ‹ȋͳͷǡ͵ͲȌƒŽ‡ƒ–‡”‹ƒŽ—Ž—‹‘„싐—–Žƒ„‹‘’•‹ƒ
‰ƒ‰Ž‹‘‹Ž‘”Ž‹ˆƒ–‹…‹£”‹ì‹ǡƒŽ–—‹‘”‰ƒ•ƒ—쇕—–Ǥ
”ƒ†—Ž†‡”£•’Ÿ†‹”‡ƒŽ’”‘…‡•—Ž—‹–—‘”ƒŽƒŽ”‡…‹†‹˜‡Ž‘”
†‡ȋ•–ƒ†‹—Ž…Ž‹‹…Ȍƒˆ‘•–†‡–‡”‹ƒ–…‘ˆ‘”Žƒ•‹ϐ‹…£”‹‹Ž‹-
™ƒ•†‡–‡”‹‡†ƒ……‘”†‹‰–‘–Š‡–‡”ƒ–‹‘ƒŽŽ‹‹…ƒŽŽƒ••‹ϐ‹-
cation adopted in Ann-Arbor (USA) in 1971. To determine the
extent of relapsed HL, the following examination methods have
„‡‡ —•‡†ǣ ’Š›•‹…ƒŽ ‡šƒ‹ƒ–‹‘ǡ ”ƒ†‹‘‰”ƒ’Š›ǡ —Ž–”ƒ•‘‘‰”ƒ-
phy, computed tomography, iliac bone trepanbiopsy etc.
‹…‡–‡”ƒì‹‘ƒŽ‡ǡƒ†‘’–ƒ–‡ÁǦ”„‘”ȋȌÁƒ—Žͳͻ͹ͳǤ
‡–”—†‡–‡”‹ƒ”‡ƒ‰”ƒ†—Ž—‹†‡”£•’Ÿ†‹”‡ƒ”‡…‹†‹˜‡Ž‘”ǡ
ƒ—ˆ‘•–—–‹Ž‹œƒ–‡ǣ‡šƒ‡—Žϐ‹œ‹…ǡ”ƒ†‹‘Ž‘‰‹…ǡ—Ž–”ƒ•‘‘‰”ƒϐ‹‡ǡ–‘-
‘‰”ƒϐ‹ƒ…‘’—–‡”‹œƒ–£ǡ–”‡’ƒ‘„‹‘’•‹ƒ‘•—Ž—‹‹Ž‹ƒ…‡–…Ǥ
Tratamentul a constat din 6-8 cicluri de polichimioterapie
†—’£•…Š‡‡Ž‡ȋ†‘š‘”—„‹…‹£ǡ „Ž‡‘‹…‹£,˜‹„Žƒ•–‹£ǡ
†ƒ…ƒ”„ƒœ‹£ȌŽƒʹͺ†‡’ƒ…‹‡ì‹ǡ CVPP ȋ…›…Ž‘’Š‘•’Šƒ‹†£ǡ˜‹-
„Žƒ•–‹£ǡ’”‡†‹•‘Ž‘ǡ’”‘…ƒ”„ƒœ‹£ȌȂŽƒʹ͹†‡„‘Žƒ˜‹ǤBͳ͹
cazuri, a fost aplicat un tratament combinat (polichimiotera-
pie + radioterapie). Schema de tratament ABVD a fost aplica-
–£ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡…£†‡”‹ –ƒ”†‹˜‡ǡ Žƒ …ƒ”‡ǡ ‹‹ì‹ƒŽǡ ”‡‹•‹—‡ƒ
…‘’Ž‡–£ ƒ ˆ‘•– ‘„싐—–£ †—’£ —–‹Ž‹œƒ”‡ƒ •…Š‡‡‹ ”‡•’‡…–‹˜‡
†‡ ’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡ǡ •ƒ— …— ”‡…‹†‹˜‡ ’”‡…‘…‡ǡ ƒ’£”—–‡ †—’£
ƒ’Ž‹…ƒ”‡ƒ•…Š‡‡‹ǡ•ƒ—Á…ƒœ—Ž’ƒ…‹‡ì‹Ž‘”ǡŽƒ…ƒ”‡”‡‹-
•‹—‡ƒ…‘’Ž‡–£ƒˆ‘•–‘„싐—–£†—’£ƒ’Ž‹…ƒ”‡ƒƒŽ–‘”•…Š‡‡
de polichimioterapie.
…Š‡ƒ  ƒ ˆ‘•– ƒ†‹‹•–”ƒ–£ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡…‹†‹˜‡
–ƒ”†‹˜‡ǡŽƒ…ƒ”‡”‡‹•‹—‡ƒ…‘’Ž‡–£ƒˆ‘•–‘„싐—–£–‘–†—’£
ƒ…‡ƒ•–£•…Š‡£†‡’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡ǡ•ƒ—Á…ƒœ—Ž”‡…‹†‹˜‡Ž‘”
’”‡…‘…‡ǡƒ’£”—–‡†—’£ƒ’Ž‹…ƒ”‡ƒ•…Š‡‡‹Ǥ
Tratamentul combinat a fost efectuat în cazurile când au
”£ƒ•ˆ‘…ƒ”‡”‡œ‹†—ƒŽ‡†—’£’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡ǡϐ‹‹†ƒ’Ž‹…ƒ–£
radioterapia (RT).
–ƒ–‹•–‹…£ †‡•…”‹’–‹˜£Ǥ ƒ–‡Ž‡ •—– ’”‡œ‡–ƒ–‡ †”‡’– ˜ƒŽ‘”‹
ƒ„•‘Ž—–‡è‹”‡Žƒ–‹˜‡Ǥ
‡œ—Ž–ƒ–‡
ƒ‹—Ž–†‡Œ—£–ƒ–‡†‹–”‡’ƒ…‹‡ì‹‹…—”‡…£†‡”‹ƒŽ‡ǡ†‹-
The treatment consisted of 6-8 cycles of polychemothera-
py based on ABVD regimens (doxorubicin, bleomycin, vinblas-
tine, dacarbazine) in 28 patients, CVPP (cyclophosphamide,
vinblastine, prednisolone, procarbazine) in 27 patients. In 17
cases, combined treatment (polychemotherapy + radiothera-
py) was applied. The ABVD treatment regimen was applied
to patients with late relapses, who initially had complete re-
mission after using the above mentioned polychemotherapy
regimen or with early relapses that occurred after the CVLP
regimen, or in the case of patients whose full remission was
obtained after the application of other polychemotherapy re-
gimens.
The CVLP regimen was administered to patients with late
recurrences, in whom complete remission was also obtained
after this polychemotherapy regimen, or in the case of early
recurrences following the application of the ABVD regimen.
The combined treatment was performed in cases where
residual foci after polychemotherapy remained, radiotherapy
(RT) being applied as well. Descriptive statistics. The data are
presented as absolute and relative values.
Results
More than half of patients with relapsed HL, initially dia-
gnosed in stages I-II and with complete remission after the
ϐ‹”•–Ž‹‡‘ˆ–”‡ƒ–‡–ǡ™‡”‡ͳͺǦͶͲ›‡ƒ”•‘Ž†ǤŠ‡”‡…—””‡…‡
frequency was higher in females (57%) than in males (43%)
(Table 1).
ƒ‰‘•–‹…ƒ–ǡ‹‹ì‹ƒŽǡÁ•–ƒ†‹—ŽǦè‹…—”‡‹•‹—‡…‘’Ž‡–£†—’£
prima linie de tratament, au avut vârsta de 18-40 de ani. Frec-
˜‡ìƒ”‡…‹†‹˜‡Ž‘”ƒˆ‘•–ƒ‹ÁƒŽ–£Žƒˆ‡‡‹ȋͷ͹ΨȌ†‡…Ÿ–Žƒ„£”-
„ƒì‹ȋͶ͵ΨȌȋƒ„‡Ž—ŽͳȌǤ
ƒ ƒŒ‘”‹–ƒ–‡ƒ ’ƒ…‹‡ì‹Ž‘” ȋ͹ͺΨȌ ƒ— ˆ‘•– Á”‡‰‹•–”ƒ–‡ ”‡-
cidive tardive. Recidive precoce au fost diagnosticate doar în
22% din cazuri (Tabelul 2). Atât în cazul recidivelor precoce,
…Ÿ–è‹…‡Ž‘”–ƒ”†‹˜‡ǡƒ’”‡†‘‹ƒ–ƒ˜ƒ•ƒ”‡ƒ’”‘…‡•—Ž—‹–—‘-
”ƒŽȋͶͶΨè‹͸ʹΨǡ”‡•’‡…–‹˜ȌǤ‡…‹†‹˜‡Ž‡Ž‘…ƒŽ‡ƒ—ˆ‘•–…‘•–ƒ-
–ƒ–‡ŽƒͳͷȋʹͲǡͺΨȌ„‘Žƒ˜‹Ǥ‡…£†‡”‹Ž‘…ƒŽ‡è‹ƒ˜ƒ•ƒ”‡ƒƒ—
avut loc în 15 (21%) cazuri (Tabelul 2).
Late recurrences were reported in most patients (78%).
Early recurrences were only diagnosed in 22% of cases (Table
2). Tumor progression prevailed in both early and late recur-
rences (44% and 62%, respectively). Local recurrences were
found in 15 (20.8%) patients. Local remission and progressi-
on of HL occurred in 15 (21%) cases (Table 2).
Most recurrences (86%) were diagnosed in patients with
nodular sclerosis HL. In the mixed-cellularity HL, relapses
developed in 8 (11%) patients. In patients with lymphocyte
predominant HL, recurrence was found in only 2 (3%) cases.
The staging of recurrences was performed according to

Tabelul 1. ‹•–”‹„—‹”‡ƒ’ƒ…‹‡ì‹Ž‘”…—”‡…£†‡”‹ƒŽ‡Áˆ—…싇†‡˜Ÿ”•–£è‹•‡šǤ

Table 1. ‹•–”‹„—–‹on oˆ ’ƒ–‹‡n–• ™‹–Š ”‡cc—”‡nc‡ oˆ  ƒcco”†‹n‰ –o ƒ‰‡ ƒn† ‰‡n†‡”Ǥ

ƒ–‡‰‘”‹‹†‡˜Ÿ”•–£ ‘–ƒŽ’ƒ…‹‡ì‹ǡȋΨȌ Repartizarea pe sexe / ‰‡n†‡” ”‡’ƒ”–‹–‹on

‰‡ ‰”o—’• o–ƒŽ ’ƒ–‹‡n–•ǡ n ȋάȌ £”„ƒì‹Ȁ‡n Femei / ™o‡n
ͳͺȂͶͲƒ‹Ȁ›‡ƒ”• oŽ† 50 (69%) 20 (40%) 30 (60%)
ͶͳȂ͸Ͳƒ‹Ȁ›‡ƒ”• oŽ† 20 (28%) 9 (45%) 11 (55)
>60 ani / ›‡ƒ”• oŽ† 2 (3%) 2 (100%) 0 (0%)
Total 72 (100%) 31 (43%) 41 (57%)
56 ”ƒ–ƒ‡n–—Ž ”‡c£†‡”‹Žo” Ž‹ˆo—Ž—‹ o†‰‹n

Tabelul 2.‹•–”‹„—‹”‡ƒ’ƒ…‹‡ì‹Ž‘”…—”‡…£†‡”‹Áˆ—…싇†‡’‡”‹‘ƒ†ƒƒ’ƒ”‹ì‹‡‹è‹…ƒ”ƒ…–‡”—ŽŽ‘”Ǥ
Table 2. ‹•–”‹„—–‹on oˆ ’ƒ–‹‡n–• ™‹–Š ”‡Žƒ’•‡• †‡’‡n†‹n‰ on –Š‡ occ—””‡nc‡ ’‡”‹o† ƒn† cŠƒ”ƒc–‡”Ǥ

‡”‹‘ƒ†ƒƒ’ƒ”‹ì‹‡‹ Caracterul recidivei / ”‡Žƒ’•‡ cŠƒ”ƒc–‡”

”‡…£†‡”‹Ž‘” Total ‘…ƒŽ£ǡȋΨȌ ‘…ƒŽ£…—ƒ˜ƒ•ƒ”‡ǡȋΨȌ Avansare, n (%)
‡Žƒ’•‡ occ—””‡nc‡ ocƒŽǡ n ȋάȌ ocƒŽ ™‹–Š ’”o‰”‡••‹onǡ n ȋάȌ P”o‰”‡••‹onǡ n ȋάȌ
”‡…‘…‡ȋζͳʹŽ—‹Ȍ
16 (22%) 4 (25%) 5 (31%) 7 (44%)
ƒ”Ž› ȋκ1͸ on–Š•Ȍ
ƒ”†‹˜£ȋεͳʹŽ—‹Ȍ
56 (78%) 11 (20%) 10 (18%) 35 (62%)
ƒ–‡ ȋι1͸ on–Š•Ȍ

ƒ„‡Ž—Ž͵Ǥ‹•–”‹„—‹”‡ƒ’ƒ…‹‡ì‹Ž‘”…—”‡…£†‡”‹ƒŽ‡Áˆ—…싇†‡•–ƒ†‹—Ž…Ž‹‹……‘ˆ‘”Žƒ•‹ϐ‹…£”‹‹Ž‹‹…‡
–‡”ƒì‹‘ƒŽ‡ȋǦ”„‘”ǡͳͻ͹ͳȌǤ
Table 3. ‹•–”‹„—–‹on oˆ ’ƒ–‹‡n–• ™‹–Š  ”‡Žƒ’•‡• †‡’‡n†‹n‰ on –Š‡ cŽ‹n‹cƒŽ •–ƒ‰‡ ƒcco”†‹n‰ –o –Š‡ In–‡”nƒ–‹onƒŽ Ž‹n‹cƒŽ
Žƒ••‹ϔ‹cƒ–‹on ȋnnǦ”„o”ǡ 1Ϳͽ1ȌǤ
Stadiul clinic ƒ…‹‡ì‹ǡȋΨȌ
Ž‹n‹cƒŽ •–ƒ‰‡ Pƒ–‹‡n–•ǡ n ȋάȌ
I 23 (32%)
II 22 (31%)
III 6 (8%)
IV 21 (29%)

ƒ„‡Ž—ŽͶǤ‡œ—Ž–ƒ–‡Ž‡‹‡†‹ƒ–‡ƒŽ‡–‡”ƒ’‹‡‹’ƒ…‹‡ì‹Ž‘”…—”‡…£†‡”‹ƒŽ‡Áˆ—…싇†‡‡–‘†ƒ†‡–”ƒ–ƒ‡–Ǥ
Table 4. I‡†‹ƒ–‡ –”‡ƒ–‡n– ”‡•—Ž–• ‹n ’ƒ–‹‡n–• ™‹–Š ”‡Žƒ’•‡†  †‡’‡n†‹n‰ on –Š‡ –”‡ƒ–‡n– ‡–Šo†Ǥ
Metoda de tratament ‡‹•‹—‡…‘’Ž‡–£ǡȋΨȌ ‡‹•‹—‡’ƒ”싃Ž£ǡȋΨȌ £”£‡ˆ‡…–ǡȋΨȌ
”‡ƒ–‡n– ‡–Šo† o’Ž‡–‡ ”‡‹••‹onǡ n ȋάȌ Pƒ”–‹ƒŽ ”‡‹••‹onǡ n ȋάȌ ƒc oˆ ‡ˆˆ‡c–ǡ n ȋάȌ
ABVD 19 (68%) 2 (7%) 7 (25%)
CVPP 14 (52%) 5 (18%) 8 (30%)
PChT + RT 6 (35%) 6 (35%) 5 (30%)
‘–£ǣȂ†‘š‘”—„‹…‹£ǡ„Ž‡‘‹…‹£ǡ˜‹„Žƒ•–‹£ǡ†ƒ…ƒ”„ƒœ‹£ǢȂ…‹…Ž‘ˆ‘•ˆƒ‹†£ǡ˜‹„Žƒ•–‹£ǡ’”‡†‹•‘Ž‘ǡ’”‘…ƒ”„ƒœ‹£Ǣ
ŠΪȂ’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡Ϊ”ƒ†‹‘–‡”ƒ’‹‡Ǥ
o–‡:  Ȃ †ošo”—„‹c‹n‡ǡ „Ž‡o‹c‹n‡ǡ ˜‹n„Žƒ•–‹n‡ǡ †ƒcƒ”„ƒ•‹n‡Ǣ PP Ȃ c›cŽo’Šo•’Šƒ‹†‡ǡ ˜‹n„Žƒ•–‹n‡ǡ ’”‡†n‹•oŽon‡ǡ ’”ocƒ”„ƒ•‹n‡Ǣ P
ή  Ȃ ’oŽ›cŠ‡o–Š‡”ƒ’› ή ”ƒ†‹o–Š‡”ƒ’›Ǥ

Majoritatea recidivelor (86%) au fost diagnosticate la paci- –Š‡–‡”ƒ–‹‘ƒŽŽ‹‹…ƒŽŽƒ••‹ϐ‹…ƒ–‹‘ƒ†‘’–‡†‹Ǧ”„‘”

‡ì‹‹…—˜ƒ”‹ƒ–ƒ•…Ž‡”‘œ£‘†—Žƒ”£ǤB˜ƒ”‹ƒ–ƒ‹š–Ǧ…‡Ž—Žƒ- (USA) in 1971. Thus, stage I was found in 23 (32%) patients,
”£ƒǡ”‡…‹†‹˜‡•Ǧƒ—†‡œ˜‘Ž–ƒ–ŽƒͺȋͳͳΨȌ’ƒ…‹‡ì‹Ǥƒ„‘Žƒ˜‹‹ •–ƒ‰‡Ȃ‹ʹʹȋ͵ͳΨȌ’ƒ–‹‡–•ǡ•–ƒ‰‡Ȃ‹͸ȋͺΨȌ’ƒ–‹‡–•
…—˜ƒ”‹ƒ–ƒ…—’”‡†‘‹ƒ”‡Ž‹ˆ‘‹†£ƒǡ”‡…‹†‹˜‡ƒ—ˆ‘•–…‘- ƒ†•–ƒ‰‡Ȃ‹ʹͳȋʹͻΨȌ‘ˆ…ƒ•‡•Ǥ
statate doar în 2 (3%) cazuri. The analysis of the immediate results of relapse treatment
–ƒ†‹ƒŽ‹œƒ”‡ƒ”‡…‹†‹˜‡Ž‘”ƒˆ‘•–‡ˆ‡…–—ƒ–£…‘ˆ‘”Žƒ•‹ϐ‹…£- in patients with HL stages I and II, according to the treatment
”‹‹Ž‹‹…‡–‡”ƒì‹‘ƒŽ‡ǡƒ†‘’–ƒ–‡ÁǦ”„‘”ȋȌÁƒ—Ž ‡–Š‘†ǡ•Š‘™‡†–Šƒ––Š‡‘˜‡”ƒŽŽ–Š‡”ƒ’‡—–‹…‡ˆϐ‹…ƒ…›™ƒ•͹ʹΨǤ
1971. Astfel, stadiul I a fost constatat la 23 (32%) de bolnavi, Complete remission was obtained in just over half of the pati-
•–ƒ†‹—ŽȂŽƒʹʹȋ͵ͳΨȌ†‡’ƒ…‹‡ì‹ǡ•–ƒ†‹—ŽȂŽƒ͸ȋͺΨȌ’ƒ…‹- ents (54%). The percentage of complete remission was higher
‡ì‹è‹•–ƒ†‹—ŽȂÁʹͳȋʹͻΨȌ†‡…ƒœ—”‹Ǥ in cases of the ABVD polychemotherapy (68%), as opposed to
Analiza rezultatelor imediate ale tratamentului recidivelor CVPP (52%). The ABVD polychemotherapy is considered to be
Žƒ ’ƒ…‹‡ì‹‹ …— •–ƒ†‹—Ž  è‹  ƒŽ‡ ǡ Á ˆ—…싇 †‡ ‡–‘†ƒ †‡
–”ƒ–ƒ‡–ǡƒƒ”£–ƒ–…£‡ϐ‹…ƒ…‹–ƒ–‡ƒ…—”ƒ–‹˜£‰‡‡”ƒŽ£ƒˆ‘•–†‡
͹ʹΨǤ ‡‹•‹—‹ …‘’Ž‡–‡ ƒ— ˆ‘•– ‘„싐—–‡ †‘ƒ” Žƒ ’—싐 ƒ‹
—Ž– †‡ Œ—£–ƒ–‡ †‹–”‡ ’ƒ…‹‡ì‹ ȋͷͶΨȌǤ ”‘…‡–—Ž ”‡‹•‹-
unilor complete a fost mai înalt în cazurile de utilizare a po-
Ž‹…Š‹‹‘–‡”ƒ’‹‡‹†—’£•…Š‡ƒȋ͸ͺΨȌǡ•’”‡†‡‘•‡„‹”‡†‡
 ȋͷʹΨȌǤ ‘Ž‹…Š‹‹‘–‡”ƒ’‹ƒ  ‡•–‡ …‘•‹†‡”ƒ–£ ƒ ϐ‹ ‘
•…Š‡£ƒ‹‹–‡•£Ǥ‡‹•‹—‹Ž‡…‘’Ž‡–‡†—’£–”ƒ–ƒ‡–—Ž
a more intense regimen. Complete remission after combined
chemotherapy and radiotherapy was 35% (Table 4). Radio-
therapy was applied in the regions of residual tumors after po-
lychemotherapy; however, not in a high percentage (35.3%), it
contributed to complete remission.
The analysis of the treatment outcomes in patients with
relapsed HL, initially diagnosed with stages I and II, according
–‘–Š‡”‡Žƒ’•‡•–ƒ–—•ǡˆ‘—†–Šƒ––Š‡‘˜‡”ƒŽŽ‡ˆϐ‹…ƒ…›™ƒ•Š‹‰Š‡”
”‡ƒ–‡n– oˆ ”‡Žƒ’•‡† o†‰‹nǯ• Ž›’Šoƒ MJHS 17(3)/2018 57

Tabelul 5.‡œ—Ž–ƒ–‡Ž‡‹‡†‹ƒ–‡ƒŽ‡–”ƒ–ƒ‡–—Ž—‹’ƒ…‹‡ì‹Ž‘”…—”‡…‹†‹˜‡ƒŽ‡Áˆ—…싇†‡•–ƒ†‹—Ž”‡…‹†‹˜‡‹Ǥ

Table 5. I‡†‹ƒ–‡ –”‡ƒ–‡n– ”‡•—Ž–• ‹n ’ƒ–‹‡n–• ™‹–Š ”‡Žƒ’•‡†  †‡’‡n†‹n‰ on –Š‡ ”‡Žƒ’•‡ •–ƒ‰‡.
Stadiul clinic ‡‹•‹—‡…‘’Ž‡–£ǡȋΨȌ ‡‹•‹—‡’ƒ”싃Ž£ǡȋΨȌ £”£‡ˆ‡…–ǡȋΨȌ
Clinical stage o’Ž‡–‡ ”‡‹••‹onǡ n ȋάȌ Pƒ”–‹ƒŽ ”‡‹••‹onǡ n ȋάȌ ƒc oˆ ‡ˆˆ‡c–ǡ n ȋάȌ
I 14 (61%) 2 (9%) 7 (30%)
II 13 (59%) 2 (9%) 7 (32%)
III 3 (50%) 2 (33%) 1 (17%)
IV 9 (43%) 7 (33%) 5 (24%)

Tabelul 6. ‡œ—Ž–ƒ–‡Ž‡‹‡†‹ƒ–‡ƒŽ‡–”ƒ–ƒ‡–—Ž—‹’ƒ…‹‡ì‹Ž‘”…—”‡…£†‡”‹ƒŽ‡Áˆ—…싇†‡˜Ÿ”•–£Ǥ

Table 6. I‡†‹ƒ–‡ –”‡ƒ–‡n– ”‡•—Ž–• ‹n ’ƒ–‹‡n–• ™‹–Š ”‡Žƒ’•‡†  †‡’‡n†‹n‰ on ƒ‰‡Ǥ

”—’‡†‡˜Ÿ”•–£ ‡‹•‹—‡…‘’Ž‡–£ǡȋΨȌ ‡‹•‹—‡’ƒ”싃Ž£ǡȋΨȌ £”£‡ˆ‡…–ǡȋΨȌ
‰‡ ‰”o—’• o’Ž‡–‡ ”‡‹••‹onǡ n ȋάȌ Pƒ”–‹ƒŽ ”‡‹••‹onǡ n ȋάȌ ƒc oˆ ‡ˆˆ‡c–ǡ n ȋάȌ
21-40 25 (50%) 11 (22%) 14 (28%)
41-60 12 (60%) 2 (10%) 6 (30%)
>60 2 (100%) 0 (0%) 0 (0%)

combinat chimio-radioterapeutic au constituit 35% (Tabe-
Ž—ŽͶȌǤƒ†‹‘–‡”ƒ’‹ƒƒˆ‘•–ƒ’Ž‹…ƒ–£Á”‡‰‹—‹Ž‡–—‘”‹Ž‘””‡œ‹-
†—ƒŽ‡ †—’£ ’‘Ž‹…Š‹‹‘–‡”ƒ’‹‡Ǣ –‘–—è‹ǡ Žƒ — ’”‘…‡– — ƒ”‡
ȋ͵ͷǡ͵ΨȌǡ†ƒ”ƒ…‘–”‹„—‹–Žƒ‘„싐‡”‡ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡–‡Ǥ
ƒŽ‹œƒ ”‡œ—Ž–ƒ–‡Ž‘” –”ƒ–ƒ‡–—Ž—‹ ”‡…‹†‹˜‡Ž‘” ’ƒ…‹‡ì‹Ž‘”
in stages I and II (60.9% and 59.1%), with gradual decrease in
stage IV (42.9%). Complete remission in patients with relap-
ses at stage I was recorded in 60.9% of cases, unlike stage IV
patients, in whom complete remission was obtained in only
42.9% of cases (Table 5).
…—ǡ†‹ƒ‰‘•–‹…ƒì‹ǡ‹‹ì‹ƒŽǡ…—•–ƒ†‹‹Ž‡è‹ǡÁˆ—…싇†‡•–ƒ- The study of the treatment results of relapsed HL by age
†‹—Ž”‡…‹†‹˜‡Ž‘”ǡƒ…‘•–ƒ–ƒ–…£‡ϐ‹…ƒ…‹–ƒ–‡ƒ‰‡‡”ƒŽ£ƒˆ‘•–ƒ‹ showed that the complete remission rate was slightly higher
ÁƒŽ–£Á•–ƒ†‹—Žè‹ȋ͸ͲǡͻΨè‹ͷͻǡͳΨȌǡ…—†‡•…”‡è–‡”‡–”‡’–ƒ- in the age group 41-60 years compared to patients aged 18-40
–£Á•–ƒ†‹—ŽȋͶʹǡͻΨȌǤ years (60.0% and 50,0%, respectively) (Table 6). At the age
‡‹•‹—‹Ž‡ …‘’Ž‡–‡ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡…‹†‹˜‡ •–ƒ†‹—Ž  ƒ— of 60, there were only two patients, and both had complete
fost înregistrate în 60,9% din cazuri, spre deosebire de bolna- remission. However, because of the small number of patients,
˜‹‹…—•–ƒ†‹—ŽǡŽƒ…ƒ”‡”‡‹•‹—‹Ž‡…‘’Ž‡–‡ƒ—ˆ‘•–‘„싐—–‡
doar în 42,9% din cazuri (Tabelul 5).
Studiul rezultatelor tratamentului recidivelor LH în func-
싇†‡˜Ÿ”•–£ƒƒ”ƒ–ƒ–…£”ƒ–ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡–‡‘„싐—–‡ƒ
ˆ‘•–’—싐ƒ‹ÁƒŽ–£Á‰”—’—Ž†‡˜Ÿ”•–£ͶͳǦ͸Ͳ†‡ƒ‹ǡˆƒì£†‡
’ƒ…‹‡ì‹‹…—˜Ÿ”•–ƒÁ–”‡ͳͺǦͶͲ†‡ƒ‹ȋ͸ͲǡͲΨè‹ͷͲǡͲΨǡ”‡•’‡…-
tiv) (Tabelul 6). La vârsta de peste 60 de ani, au fost doar doi
„‘Žƒ˜‹è‹Žƒƒ„‹‹ƒ—ˆ‘•–‘„싐—–‡”‡‹•‹—‹…‘’Ž‡–‡ǤB•£ǡ
†‹…ƒ—œƒ—£”—Ž—‹‹…†‡’ƒ…‹‡ì‹ǡ—‡•–‡’‘•‹„‹Ž†‡‡‹•
concluzii veridice.
—’”ƒ˜‹‡ì—‹”‡ƒˆƒ”£”‡…‹†‹˜‡’‡•–‡ʹè‹ͷƒ‹Žƒ’ƒ…‹‡ì‹‹…—
”‡‹•‹—‹…‘’Ž‡–‡ƒˆ‘•–†‡ͻͲǡ͵Ψè‹͹͹ǡͻΨǡ”‡•’‡…–‹˜Ǥ…‡•–‡
†ƒ–‡‡ƒ”ƒ–£…£Á…ƒœ—”‹Ž‡†‡‘„싐‡”‡ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡-
–‡Žƒ’ƒ…‹‡ì‹‹…—”‡…£†‡”‹ǡƒ…‡•–‡ƒ’‘–ϐ‹†‡Ž—‰£†—”ƒ–£è‹Á–”Ǧ
—’”‘…‡–†‡•–—Ž†‡ÁƒŽ–ȋ͹͹ǡͺΨȌȂ…Š‹ƒ”˜‹†‡…ƒ”‡Ǥ•–ˆ‡ŽǡÁ
…ƒœ—”‹Ž‡†‡”‡…£†‡”‹ƒŽ‡ǡ‡•–‡‡…‡•ƒ”†‡‹–‡•‹ϐ‹…ƒ––”ƒ–ƒ-
mentul cu scheme de polichimioterapie mai agresive, pentru
ƒ ‘„싐‡ ”‡‹•‹—‹ …‘’Ž‡–‡Ǥ …‡ƒ•–ƒ •‡ ”‡ˆ‡”£ǡ Á†‡‘•‡„‹ǡ Žƒ
’‡”•‘ƒ‡Ž‡ –‹‡”‡ ȋͳͺǦͶͲ ƒ‹Ȍǡ Žƒ …ƒ”‡ ”‡…£†‡”‹Ž‡ ƒ— ˆ‘•– ƒ‹
ˆ”‡…˜‡–‡è‹”‡œ—Ž–ƒ–‡Ž‡–”ƒ–ƒ‡–—Ž—‹ƒ—ˆ‘•–…—‘‡ϐ‹…ƒ…‹–ƒ–‡
ƒ‹Œ‘ƒ•£Ǥ
‹•…—ì‹‹
‹ˆ‘—Ž‘†‰‹’”‡œ‹–£‘‡‘’Žƒœ‹‡Ž‹ˆ‘’”‘Ž‹ˆ‡”ƒ–‹˜£ǡ
…—’‘–‡ì‹ƒŽÁƒŽ–†‡˜‹†‡…ƒ”‡ǡ…ƒ”ƒ…–‡”‹œƒ–£’”‹–”Ǧ‘˜ƒ”‹‡–ƒ–‡
†‡…ƒ”ƒ…–‡”‹•–‹…‹‘”ˆ‘Ž‘‰‹…‡ǡƒ‹ˆ‡•–£”‹…Ž‹‹…‡è‹†‹ˆ‡”‹–”£•-
it is not possible to make accurate conclusions.
The relapse-free survival over 2 and 5 years in patients
with complete remission was 90.3% and 77.9%, respectively.
These data show that in cases of complete remission in pati-
ents with relapses, these may be long-lasting and in a fairly
Š‹‰Š ’‡”…‡–ƒ‰‡ ȋ͹͹ǤͺΨȌ Ȃ ‡˜‡ ”‡…‘˜‡”›Ǥ Š—•ǡ ‹ …ƒ•‡• ‘ˆ
relapsed HL, it is necessary to intensify the treatment with
more aggressive polychemotherapeutic regimens, in order to
achieve complete remission. This refers, in particular, to young
people (18-40 years), where the relapses were more frequent
and the treatment outcomes were less effective.
Discussion
Hodgkin’s lymphoma presents a lymphoproliferative ne-
oplasm with a high 7 recovery potential, characterized by a
variety of morphological features, clinical manifestations and
different responses to treatment [1, 17, 18]. At present, HL
‹• …Žƒ••‹ϐ‹‡† ƒ• –™‘ †‹•–‹…– †‹•‡ƒ•‡ ‡–‹–‹‡•ǣ  Ȃ ‘†—-
Žƒ”Ž›’Š‘…›–‹…’”‡†‘‹ƒ–ƒ†Ȃ…Žƒ••‹…ƒŽȏͳͻǡ
20]. In fact, these 2 histological subtypes have different clinical
presentations, age distributions and prognoses.
The treatment outcomes have shown that people aged 18-
40 years have a less favorable prognosis. In the western coun-
tries, this disease accounts for 11% of lymphomas and has a
peak distribution in young people (25-35 years) who are able
to work [21, 22].
58 ”ƒ–ƒ‡n–—Ž ”‡c£†‡”‹Žo” Ž‹ˆo—Ž—‹ o†‰‹n

Fig. 1 ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡Žƒ͸Ͳ†‡Ž—‹ƒ’ƒ…‹‡ì‹Ž‘”…—”‡‹•‹—‡…‘’Ž‡–£†—’£’”‹ƒ”‡…£†‡”‡Ǥ
Fig. 1 Š‡ •—”˜‹˜ƒŽ ”ƒ–‡ o˜‡” ͼͶ on–Š• ‹n ’ƒ–‹‡n–• ™‹–Š co’Ž‡–‡ ”‡‹••‹on ƒˆ–‡” –Š‡ ϔ‹”•– ”‡Žƒ’•‡Ǥ

’—•Žƒ–”ƒ–ƒ‡–ȏͳǡͳ͹ǡͳͺȐǤB’”‡œ‡–ǡ‡•–‡…Žƒ•‹ϐ‹…ƒ–…ƒ Š‡•–—†›ƒŽŽ‘™‡†–‘ϐ‹†–Šƒ–”‡Žƒ’•‡†ǡ†‡˜‡Ž‘’‡†‹

†‘—£‡–‹–£ì‹†‹•–‹…–‡ƒŽ‡„‘Ž‹‹ǣȂ‘†—Žƒ”…—’”‡†‘-
‹ƒ”‡Ž‹ˆ‘…‹–ƒ”£è‹Ȃ…Žƒ•‹…ȏͳͻǡʹͲȐǤ‡ˆƒ’–ǡƒ…‡•–‡ʹ
•—„–‹’—”‹Š‹•–‘Ž‘‰‹…‡ƒ—†‹ˆ‡”‹–‡’”‡œ‡–£”‹…Ž‹‹…‡ǡ†‹•–”‹„—ì‹‹
†‡˜Ÿ”•–£è‹’”‘‰‘œ‡Ǥ
‡œ—Ž–ƒ–‡Ž‡–”ƒ–ƒ‡–—Ž—‹ƒ—ƒ”£–ƒ–…£’‡”•‘ƒ‡Ž‡‡…—˜Ÿ”-
•–ƒ†‡ͳͺǦͶͲƒ‹’”‡œ‹–£—‰”—’…——’”‘‰‘•–‹…ƒ‹’—싐
ˆƒ˜‘”ƒ„‹ŽǤB죔‹Ž‡‘…‹†‡–ƒŽ‡ǡƒ…‡ƒ•–£ƒŽƒ†‹‡‘…—’£ͳͳΨ†‹
Ž‹ˆ‘ƒ‡è‹ƒ”‡‘†‹•–”‹„—싇…——ƒ’‘‰‡—Žƒ’‡”•‘ƒ‡Ž‡–‹‡”‡
ȋʹͷǦ͵ͷ†‡ƒ‹Ȍǡƒ’–‡†‡—…£ȏʹͳǡʹʹȐǤ
B•–—†‹—Ž‡ˆ‡…–—ƒ–•Ǧƒ…‘•–ƒ–ƒ–…£”‡…£†‡”‹Ž‡…ƒ”‡•Ǧƒ—†‡œ-
patients with initially diagnosed stages I and II with complete
remission, occurred more frequently in subjects aged 18-40
years. Therefore, this age presents a risk factor for the deve-
lopment of relapses. More frequently, recurrences have de-
veloped in patients with nodular sclerosis of classical HL and
rarely in mixed-cellularity and lymphoid depletion forms, as
highlighted in our study.
The relapsed HL is a rather important problem in treat-
ment. The literature does not elucidate the treatment results
of relapses in patients with HL, local stages I and II. In most li-
˜‘Ž–ƒ–Žƒ’ƒ…‹‡ì‹‹…—†‹ƒ‰‘•–‹…ƒì‹ǡ‹‹ì‹ƒŽǡÁ•–ƒ†‹‹Ž‡è‹ terature, not only patients with relapsed HL, but also patients
cu remisiuni complete, au avut loc, mai frecvent, la persoanele with refractory HL are included, forming a single study group
…—˜Ÿ”•–ƒ†‡ͳͺǦͶͲ†‡ƒ‹Ǥ…‡ƒ•–£˜Ÿ”•–£ǡƒèƒ†ƒ”ǡ’”‡œ‹–£— [23, 24]. Typically, all stages are analyzed together, or, more
ˆƒ…–‘”†‡”‹•…†‡†‡œ˜‘Ž–ƒ”‡ƒ”‡…£†‡”‹Ž‘”Ǥƒ‹ˆ”‡…˜‡–ǡ”‡…‹†‹- commonly, only generalized stages [25, 26].
˜‡Ž‡•Ǧƒ—†‡œ˜‘Ž–ƒ–Žƒ’ƒ…‹‡ì‹‹…—˜ƒ”‹ƒ–ƒ•…Ž‡”‘œ£‘†—Žƒ”£ƒ
ˆ‘”‡‹…Žƒ•‹…‡ƒè‹”ƒ”ȂÁˆ‘”‡Ž‡‹š–Ǧ…‡Ž—Žƒ”£è‹†‡’Ž‡ì‹‡
Ž‹ˆ‘‹†£ǡ…‡‡ƒ…‡ƒˆ‘•–‡˜‹†‡ì‹ƒ–Á•–—†‹—Ž‘•–”—Ǥ
‡…‹†‹˜‡Ž‡’”‡œ‹–£‘’”‘„Ž‡£†‡•–—Ž†‡‹’‘”–ƒ–£è‹
Á’Žƒ†‡–”ƒ–ƒ‡–ǤBŽ‹–‡”ƒ–—”£—•—–‡Ž—…‹†ƒ–‡”‡œ—Ž–ƒ–‡Ž‡
–”ƒ–ƒ‡–—Ž—‹”‡…‹†‹˜‡Ž‘”…ƒ”‡ƒ—ƒ’£”—–Žƒ’ƒ…‹‡ì‹‹…—•–ƒ†‹‹Ž‡
– …ƒ „‡ ‘–‡† –Šƒ– –Š‡ –”‡ƒ–‡– ‡ˆϐ‹…ƒ…› ™ƒ• „ƒ•‡† ‘
the degree of spread of the tumor process, the age and the ap-
’Ž‹‡†’‘Ž›…Š‡‘–Š‡”ƒ’›”‡‰‹‡ǤŠ‡–”‡ƒ–‡–‡ˆϐ‹…ƒ…›™ƒ•
higher in local relapses, in patients aged 41-60 years and after
polychemotherapy administration according to the ABVD re-
gimen.
Ž‘…ƒŽ‡  è‹  ƒŽ‡ Ǥ B ƒŒ‘”‹–ƒ–‡ƒ Ž—…”£”‹Ž‘”ǡ •—– ‹…Ž—è‹ —
†‘ƒ” ’ƒ…‹‡ì‹‹ …— ”‡…£†‡”‹ ƒŽ‡ ǡ †ƒ” è‹ „‘Žƒ˜‹‹ …— ˆ‘”‡Ž‡
refractare ale maladiei, formând un singur grup de studiu [23,
ʹͶȐǤ‡‘„‹…‡‹ǡ•—–ƒƒŽ‹œƒ–‡–‘ƒ–‡•–ƒ†‹‹Ž‡Á’”‡—£•ƒ—ǡƒ‹
frecvent, doar stadiile generalizate [25, 26].
‡’‘ƒ–‡†‡‡ì‹‘ƒ–…£‡ϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—Ž—‹ƒˆ‘•–
Áˆ—…싇†‡‰”ƒ†—Ž†‡”£•’Ÿ†‹”‡ƒ’”‘…‡•—Ž—‹–—‘”ƒŽǡ˜Ÿ”-
•–£è‹•…Š‡ƒ†‡Š…ƒ”‡ƒˆ‘•–ƒ’Ž‹…ƒ–£Ǥϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ-
‡–—Ž—‹ƒˆ‘•–ƒ‹ÁƒŽ–£Á•–ƒ†‹‹Ž‡Ž‘…ƒŽ‡ƒŽ‡”‡…£†‡”‹Ž‘”ǡŽƒ
’ƒ…‹‡ì‹‹…—˜Ÿ”•–ƒ†‡ͶͳǦ͸Ͳ†‡ƒ‹è‹†—’£ƒ’Ž‹…ƒ”‡ƒŠ…‘-
form schemei ABVD.
†‡‡ì‹‘ƒ–…£ǡ‹†‹ˆ‡”‡–†‡‡–‘†ƒ†‡–”ƒ–ƒ‡–ǡ†‡
˜Ÿ”•–ƒ ’ƒ…‹‡ì‹Ž‘” •ƒ— †‡ ‰”ƒ†—Ž †‡ ”£•’Ÿ†‹”‡ ƒŽ ’”‘…‡•—Ž—‹
It should be highlighted that regardless of the treatment
method, the patients age or the degree of spread of the tumor
’”‘…‡••ǡ–Š‡–”‡ƒ–‡–‡ˆϐ‹…ƒ…›™ƒ•Ž‘™Ǥ‘’Ž‡–‡”‡‹••‹‘
was achieved only in 54.2% of cases, unlike primary patients,
where complete remission can be achieved in 90-95% [2, 3].
The relapse-free survival over 2 and 5 years after treat-
ment in patients with relapses and complete remission ac-
counted for 90.3% and 80.4%, respectively. These data indica-
–‡–Šƒ––Š‡”‡‹•ƒ‡‡†ˆ‘”ƒ‹–‡•‹ϐ‹‡†–”‡ƒ–‡–‹…ƒ•‡•‘ˆ
relapsed HL, as achieving complete remission contributes to
the recovery of these patients.
Finally, we believe that the strong point of the current stu-
dy is that the 18-40 year-old patients are at increased risk for
”‡ƒ–‡n– oˆ ”‡Žƒ’•‡† o†‰‹nǯ• Ž›’Šoƒ
–—‘”ƒŽǡ ‡ϐ‹…ƒ…‹–ƒ–‡ƒ –”ƒ–ƒ‡–—Ž—‹ ƒ ˆ‘•– Œ‘ƒ•£Ǥ ‡‹•‹—‹
…‘’Ž‡–‡ƒ—ˆ‘•–‘„싐—–‡†‘ƒ”ÁͷͶǡʹΨ†‹…ƒœ—”‹ǡ•’”‡†‡-
‘•‡„‹”‡ †‡ ’ƒ…‹‡ì‹‹ ’”‹ƒ”‹ǡ Žƒ …ƒ”‡ ”‡‹•‹—‡ƒ …‘’Ž‡–£ •‡
’‘ƒ–‡‘„싐‡ÁͻͲǦͻͷΨȏʹǡ͵ȐǤ
—’”ƒ˜‹‡ì—‹”‡ƒ ˆ£”£ ”‡…‹†‹˜‡ ’‡•–‡ ʹ è‹ ͷ ƒ‹ †—’£ –”ƒ–ƒ-
‡–—Ž‡ˆ‡…–—ƒ–Žƒ’ƒ…‹‡ì‹‹…—”‡…£†‡”‹è‹”‡‹•‹—‹…‘’Ž‡–‡
ƒ…‘•–‹–—‹–ǡ”‡•’‡…–‹˜ǡͻͲǡ͵Ψè‹ͺͲǡͶΨǤ…‡•–‡†ƒ–‡‡‹†‹…£Žƒ
‡…‡•‹–ƒ–‡ƒ‹–‡•‹ϐ‹…£”‹‹–”ƒ–ƒ‡–—Ž—‹Á…ƒœ—”‹Ž‡†‡”‡…£†‡”‹
ƒŽ‡ǡ†‡‘ƒ”‡…‡‘„싐‡”‡ƒ”‡‹•‹—‹Ž‘”…‘’Ž‡–‡…‘–”‹„—‹‡
Žƒ˜‹†‡…ƒ”‡ƒƒ…‡•–‘”’ƒ…‹‡ì‹Ǥ
B…‡Ž‡†‹—”£ǡ…‘•‹†‡”£…£’—…–‡Ž‡ˆ‘”–‡ƒŽ‡•–—†‹—-
Ž—‹’”‡œ‡–•—–…‘•–ƒ–ƒ”‡ƒˆƒ’–—Ž—‹ǡ…£‰”—’—Ž†‡’ƒ…‹‡ì‹…—
˜Ÿ”•–ƒ ͳͺǦͶͲ †‡ ƒ‹ ’”‡œ‹–£ — ”‹•… •’‘”‹– ’‡–”— †‡œ˜‘Ž–ƒ-
”‡ƒ ”‡…£†‡”‹Ž‘” ǡ …‘’ƒ”ƒ–‹˜ …— ƒŽ–‡ ˜Ÿ”•–‡Ǥ ‡ ƒ•‡‡‡ƒǡ
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”—Ž Ž—‹ ”‡–”‘•’‡…–‹˜ǡ ‡èƒ–‹‘—Ž ”‡Žƒ–‹˜ ‹… †‡ ’ƒ…‹‡ì‹ǡ Ž‹’•ƒ
’‘•‹„‹Ž‹–£ì‹‹ †‡ ˆ‘Ž‘•‹”‡ ƒ –”ƒ–ƒ‡–—Ž—‹ …— †‘œ‡ ƒ”‹ †‡ …Š‹-
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‘…Ž—œ‹‹
ͳȌ‡…£†‡”‹Ž‡Žƒ’ƒ…‹‡ì‹‹…—”‡‹•‹—‹…‘’Ž‡–‡ƒŽ‡ǡ†‹-
MJHS 17(3)/2018 59
developing relapsed HL compared to other ages. It has also
been found that ABVD has shown to be the most optimal poly-
chemotherapy regimen.
The retrospective character of the study is one of the weak
points, as well as the relatively small sample of patients, im-
possibility to use high-dose chemotherapy and autotransplant
treatment in the Republic of Moldova.
Conclusions
1) Relapses in patients with complete remission of HL,
initially diagnosed in stages I and II, occurred more fre-
quently in subjects aged 18-40 years (69%). Tardive re-
lapses prevailed (78%).
2) Š‡–”‡ƒ–‡–‡ˆϐ‹…ƒ…›‘ˆ”‡Žƒ’•‡•™ƒ•Ž‘™ǡ…‘’Ž‡–‡”‡-
mission accounting for only 54.2%.
3) The ABVD polychemotherapy had a higher treatment
‡ˆϐ‹…ƒ…›ǡ …‘’Ž‡–‡ ”‡‹••‹‘ „‡‹‰ ƒ…Š‹‡˜‡† ‹ ͸ͺΨ ‘ˆ
patients.
4) Relapse-free survival in patients with complete remis-
sion over 2 and 5 years was 90% and 80%, respectively.
ƒ‰‘•–‹…ƒì‹ǡ‹‹ì‹ƒŽǡÁ•–ƒ†‹—Žè‹ǡƒ—ƒ˜—–Ž‘…ƒ‹ˆ”‡…-
vent la persoanele cu vârsta de 18-40 de ani (69%). Au
predominat recidivele tardive (78%).
ʹȌϐ‹…ƒ…‹–ƒ–‡ƒ–”ƒ–ƒ‡–—Ž—‹”‡…‹†‹˜‡Ž‘”ƒˆ‘•–Œ‘ƒ•£ǡ”‡‹-
siunile complete au constituit doar 54,2%.
͵Ȍ ”‘‰”ƒ—Ž †‡ –”ƒ–ƒ‡– …— ‘ ‡ϐ‹…ƒ…‹–ƒ–‡ ƒ‹ ÁƒŽ–£ ƒ
ˆ‘•– ’‘Ž‹…Š‹‹‘–‡”ƒ’‹ƒ †—’£ •…Š‡ƒ Ǥ ‡‹•‹—‹-
Ž‡…‘’Ž‡–‡ƒ—ˆ‘•–‘„싐—–‡ǡÁƒ…‡•–…ƒœǡŽƒ͸ͺΨ†‹–”‡
’ƒ…‹‡ì‹Ǥ
ͶȌ —’”ƒ˜‹‡ì—‹”‡ƒ ˆ£”£ ”‡…‹†‹˜‡ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡‹•‹—‹
…‘’Ž‡–‡’‡•–‡ʹè‹ͷƒ‹ƒˆ‘•–†‡ͻͲΨè‹ͺͲΨǡ”‡•’‡…–‹˜Ǥ

‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
1. Swerdlow S., Campo E., Harris N., Pileri S., Stein H., Thiele J., Vard-
‹ƒ
Ǥ ‡†•Ǥ  Žƒ••‹ϐ‹…ƒ–‹‘ ‘ˆ —‘—”• ‘ˆ ƒ‡ƒ–‘’‘‹‡–‹…
and Lymphoid Tissues. 4th edition. IARC Press. Lyon, 2008.
2. Campo E., Swerdlow S., Harris N. ‡– ƒŽǤ Š‡ ʹͲͲͺ  Žƒ••‹ϐ‹-
…ƒ–‹‘‘ˆŽ›’Š‘‹†‡‘’Žƒ••ƒ†„‡›‘†ǣ‡˜‘Ž˜‹‰…‘…‡’–ƒ†
practical applications. Žoo†ǡʹͲͳͳǢͳͳ͹ǣͷͲͳͻǦͷͲ͵ʹǤ
3. Swerdlow S., Campo E., Pileri S. ‡– ƒŽǤ The 2016 revision of the
o—”nƒŽ oˆ ƒnc‡”, 2003; 89; 482-
‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘…Žƒ••‹ϐ‹…ƒ–‹‘‘ˆŽ›’Š‘‹†‡‘’Žƒ••Ǥ
Žoo†ǡʹͲͳ͸Ǣͳʹ͹ȋʹͲȌǣʹ͵͹ͷǦʹ͵ͻͲǤ
8. Canellos G., Mauch Peter M. Treatment of relapse of classical
Hodgkin lymphoma after initial chemotherapy. Š––’ǣȀȀ™™™Ǥ—’-
date.com/contents/treatment-of-relapse-of-classical-hodgkin-
lymphoma-after-initial-chemotherapy, 2011.
9. Dryver E., Jernstrom H., Tompkins K. ‡– ƒŽǤ Follow-up of patients
™‹–Š‘†‰‹ǯ•†‹•‡ƒ•‡ˆ‘ŽŽ‘™‹‰…—”ƒ–‹˜‡–”‡ƒ–‡–ǣ–Š‡”‘—–‹‡
CT scan is of little value. ”‹–‹•Š
486.
ͳͲǤ’‡…Š–Ǥǡ
”ƒ›ǤǡŽƒ”‡Ǥǡ‡–‘ǤϐŽ—‡…‡‘ˆ‘”‡‡š–‡•‹˜‡
4. Demina E. Limfogranulematoz. Klinicheskaya oncogematologiya.
†ǣ‘Ž‘˜ƒ Ǥǡ ‡†‹–•‹ƒǡ ʹͲͲͳǢ ͵ͳͶǦ͵ͳͷ ȏ’—„Ž‹…ƒ–‹‘ ‹ —•-
sian].
Ǥ Ž‹nǤ ncoŽǤǡ ͳͻͻͺǢ ͳ͸ǣ
ͷǤ ƒ˜ƒŽ‹ Ǥ‘†‰‹ǯ•†‡•‡ƒ•‡ǣ–”‡ƒ–‡–‘ˆ”‡Žƒ’•‡††‹•‡ƒ•‡ǤʹͲͳͶǢ
annonc.oxfordjournals. org/content/13/suppl_4/159. full.pdf
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cation in Russian].
͹Ǥ —‡ Ǥǡ ‘‹‰ Ǥ ‘†‰‹ǯ• †‹•‡ƒ•‡ǣ ƒƒ‰‡‡– ‘ˆ ϐ‹”•– ”‡-
lapse. ncoŽo‰›ǡͳͻͻ͸ǢͳͲǣʹǤ
radiotherapy and adjuvant chemotherapy on long-term outcome
‘ˆ ‡ƒ”Ž›Ǧ•–ƒ‰‡ ‘†‰‹ǯ• †‹•‡ƒ•‡ǣ ƒ ‡–ƒǦƒƒŽ›•‹• ‘ˆ ʹ͵ ”ƒ-
domised trials involving 3888 patients.
830.
ͳͳǤ‡›‡”Ǥǡ‘’’‡Ǥ‘‹–Ȁ…‘—–‡”’‘‹–ǣ‡ƒ”Ž›Ǧ•–ƒ‰‡‘†‰‹Ž›-
foma and the role of radiation therapy. ‡ƒ–oŽo‰›ǡʹͲͳʹǢͳǣ͵ͳ͵Ǧ
321.
12. Radford J. Early stage Hodgkin lymphoma. ‡ƒ–oŽǤ ncoŽǤ, 2015;
͵͵ǣͺͶǦͺ͸Ǥ
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13. Gaudio F., Giordano A., Pavone V. ‡– ƒŽǤ Outcome of very late re-
ƒˆˆ‡Ǥ‘†‰‹Ž›’Š‘ƒǣƒ—’†ƒ–‡‘‹–•„‹‘Ž‘‰›™‹–Š
lapse in patients with Hodgkin’s lymphomas. †˜ƒnc‡• ‹n ‡ƒǦ
–oŽo‰›, 2011; 6.
14. Demina E. Sovremennoe lechenie limfomi Hodjkina limfogranule-
matoza. Š––’ǣȀȀ›‘ŽǤ”—Ȁ‡†‹…Ȁƒ”–‹…Ž‡ǦͳͶʹͳͲ[publication in Rus-
sian].
15. Gillis B. Current and emerging strategies for mananging relapsed/
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obth/2012/october-2012.
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plantation after reduced intensity conditioning in patients with
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•–—†›Ȃƒ’”‘•’‡…–‹˜‡…Ž‹‹…ƒŽ–”‹ƒŽ„›–Š‡
”—’‘•’ƒ‘Ž†‡ ‘†‰‹ǯ•Ž›’Š‘ƒǣˆƒ…–•ƒ†’‡”•’‡…–‹˜‡•Ǥƒ‡ƒ–oŽ, 2007; 92
Limfomas / Transplante de Medula Osea (GES/TAMO) and the
Lymphoma Working Party of the European Group for Blood and
Marrow Transplantation. ƒ‡ƒ–oŽo‰‹cƒǡʹͲͳʹǢͻ͹Ǣʹǣ͵ͳͲǦ͵ͳ͹Ǥ
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”ƒ–ƒ‡n–—Ž ”‡c£†‡”‹Žo” Ž‹ˆo—Ž—‹ o†‰‹n
ͳͻǤƒ‹Ǥǡ
‡™‹•‹‰Š–•‹–‘…Žƒ••‹ϐ‹…ƒ–‹‘ǤŽ‹nǤ ›’Šoƒ ›‡Žoƒ, 2009;
ͻǣʹͲ͸Ǧʹͳ͸Ǥ
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 MJHS 17(3)/2018 61

ARTICOL DE CERCETARE RESEARCH ARTICLE

’–‹‹œƒ”‡ƒƒ…–‹˜‹–£ì‹‹ ’–‹‹œ‹‰–Š‡ƒ…–‹˜‹–›
ƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹Á of nurses in promoting
’”‘‘˜ƒ”‡ƒ•££–£ì‹‹ health at community
la nivel comunitar level
Angela Baroncea¹*, Tudor Grejdean¹† Angela Baroncea¹*, Tudor Grejdean¹†
΁ƒ–‡†”ƒ †‡ ‡†‹c‹n£ •oc‹ƒŽ£ ç‹ ƒnƒ‰‡‡n– •ƒn‹–ƒ” Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dzǡ ΁Šƒ‹” oˆ •oc‹ƒŽ ‡†‹c‹n‡ ƒn† Š‡ƒŽ–Š ƒnƒ‰‡‡n– Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dzǡ
n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dzǡ Š‹ç‹n£—ǡ ‹coŽƒ‡ ‡•–‡‹ìƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›ǡ Š‹è‹n£—ǡ
‡’—„Ž‹cƒ oŽ†o˜ƒǤ ‡’—„Ž‹c oˆ oŽ†o˜ƒǤ

Data primirii manuscrisului: 26.12.2016 Manuscript received on: 26.12.2016

ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣʹͲǤͲͺǤʹͲͳͺ Accepted for publication on: 20.08.2018

Autor corespondent: Corresponding author:

n‰‡Žƒ ƒ”onc‡ƒǡ †oc–o”ƒn†
ƒ–‡†”ƒ †‡ ‡†‹c‹n£ •oc‹ƒŽ£ ç‹ ƒnƒ‰‡‡n– •ƒn‹–ƒ” Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz
n‹˜‡”•‹–ƒ–‡ƒ †‡ –ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz
„†Ǥ f–‡ˆƒn c‡Ž ƒ”‡ ç‹ ˆŸn–ǡ 1ͼͻǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ƒ„ƒ”onc‡ƒ̻ƒ‹ŽǤ”—
n‰‡Žƒ ƒ”onc‡ƒǡ PŠ ˆ‡ŽŽo™
Šƒ‹” oˆ •oc‹ƒŽ ‡†‹c‹n‡ ƒn† Š‡ƒŽ–Š ƒnƒ‰‡‡n– Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz
‹coŽƒ‡ ‡•–‡‹ìƒn— –ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
–‡ˆƒn c‡Ž ƒ”‡ •‹ ˆƒn– ƒ˜‡Ǥǡ 1ͼͻǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: ƒ„ƒ”onc‡ƒ̻ƒ‹ŽǤ”—

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

‘Ž—Ž ƒ…–‹˜‹–£ì‹‹ ƒ•‹•–‡ì‹Ž‘” ‡†‹…ƒŽ‹ Á ’”‘‘˜ƒ”‡ƒ •£- The role of nurses’ activity in promoting community health
£–£ì‹‹’‘’—Žƒì‹‡‹Žƒ‹˜‡Ž…‘—‹–ƒ”ǡ†‡‘…ƒ†ƒ–£ǡ—ƒˆ‘•– ƒ––Š‡…‘—‹–›Ž‡˜‡ŽŠƒ•‘–›‡–„‡‡•—ˆϐ‹…‹‡–Ž›•–—†‹‡†
•–—†‹ƒ–•—ϐ‹…‹‡–Á…‘†‹ì‹‹Ž‡ƒ…–—ƒŽ‡ƒŽ‡•‹•–‡—Ž—‹ƒ—–‘Š–‘ under the current conditions of the national health system.
†‡•££–ƒ–‡Ǥ Research hypothesis
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
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•££–£ì‹‹’‘’—Žƒì‹‡‹Žƒ‹˜‡Ž…‘—‹–ƒ”ǡ…‘–”‹„—‹†Žƒ”‡†—-
…‡”‡ƒǡ’‡–‡”‡Ž—‰ǡƒ‘”„‹†‹–£ì‹‹‰‡‡”ƒŽ‡è‹ƒ…Š‡Ž–—‹‡Ž‹-
Ž‘”’‡–”—•££–ƒ–‡Ǥ
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹薋‹ì‹ϐ‹…‡†‹†‘‡‹—
”‘‘˜ƒ”‡ƒ•££–ƒì‹‹Á”Ÿ†—Ž’‘’—Žƒì‹‡‹ǡ’”‹‘†‹ϐ‹…ƒ-
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—‡ƒœ£ǡÁ–‹’ǡ‘”„‹†‹–ƒ–‡ƒ‰‡‡”ƒŽ£ǡˆƒ’–—”ƒ–†‡—‹-
’ƒ…–•‘…‹‘Ǧ‡…‘‘‹…’‘œ‹–‹˜Ǥ•‹•–‡ì‹‹‡†‹…ƒŽŒ‘ƒ…£—”‘Ž
‹’‘”–ƒ–Á’”‘‘˜ƒ”‡ƒ•££–£ì‹‹ǡ‹ƒ”…”‡è–‡”‡ƒ…‘’‡–‡-
쇎‘”Ž‘”Á†‘‡‹—Ž”‡•’‡…–‹˜˜ƒƒ‡Ž‹‘”ƒǡ–”‡’–ƒ–ǡ苐‹˜‡Ž—Ž
†‡‹ˆ‘”ƒ”‡ƒŽ’‘’—Žƒì‹‡‹Ǥ
‡œ—ƒ–
Introducere. „‹‡…–‹˜—Ž’”‹…‹’ƒŽƒŽ’”‘‘˜£”‹‹•££–£ì‹‹ǡ
†‡ Žƒ ‹˜‡Ž—Ž ‹†‹˜‹†—Ž—‹ è‹ ƒŽ ƒ…”‘‰”—’—Ž—‹ ˆƒ‹Ž‹ƒŽ ’Ÿ£ Žƒ
‹˜‡Ž—Ž •‘…‹‡–£ì‹‹ …‘•–£ Á ‘†‹ϐ‹…ƒ”‡ƒ …‘’‘”–ƒ‡–‡Ž‘” è‹
‘„‹…‡‹—”‹Ž‘”’‡–”—ƒŽ‡ˆƒ…‡ˆƒ˜‘”ƒ„‹Ž‡•££–£ì‹‹Ǥ‡–”—ƒ…‡ƒ•-
–ƒ ‡•–‡ ‡˜‘‹‡ †‡ –‹’ è‹ †‡ ‡†—…ƒì‹‡ ’‡”ƒ‡–£Ǥ •‹•–‡ì‹‹
‡†‹…ƒŽ‹ •—– ’‡”•‘ƒ‡Ž‡ …‡Ž‡ ƒ‹ ƒ’”‘’‹ƒ–‡ †‡ ’‘’—Žƒì‹‡ è‹
Nurses play an important role in promoting community
health at Community level, contributing to a reduction in
overall long-term morbidity and health expenditure.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
Promoting health among the population by changing atti-
tudes, beliefs, actions and behaviors diminishes over time the
overall morbidity, followed by a positive socio-economic im-
pact. Nurses play an important role in promoting health, and
‹…”‡ƒ•‹‰–Š‡‹”•‹ŽŽ•‹–Š‡ϐ‹‡Ž†™‹ŽŽƒŽ•‘‰”ƒ†—ƒŽŽ›‹’”‘˜‡
the level of information for the population.
Abstract
Introduction. The main objective of promoting health,
from individual and family macrogrup to society, is to change
behaviors and habits to make them more health-friendly.
This requires time and continuous education. Nurses are the
people closest to the population and it is necessary to involve
them more closely in the process. By systematically using
62
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intervalul de timp 2011-2014, prin colectarea datelor din li-
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pact favorabil plenar, pe termen lung, în societate. Promova-
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health promotion tools, they can help improve and strengthen
community health at the community level.
Material and methods. The study included 368 nurses,
294 expert doctors, 384 respondents from among the popula-
tion. The gathering of information was carried out in the pe-
”‹‘† ʹͲͳͳǦʹͲͳͶǡ „› …‘ŽŽ‡…–‹‰ †ƒ–ƒ ˆ”‘ •…‹‡–‹ϐ‹… Ž‹–‡”ƒ–—”‡ǡ
extracting information from medical documentation, and
questioning the target groups. In order to carry out the study,
a questionnaire assessing the level of knowledge in the pro-
motion of community health at the community level was de-
veloped and then applied, a questionnaire assessing the level
of knowledge of nurses in promoting the health of the popula-
tion; a questionnaire assessing the contribution of nurses in
promoting community-based health at Community level, as
seen by experts, as well as the record of individual working
time.
Results. This research has highlighted the indisputable role
of nurses in promoting health at Community level. Although a
•‹‰‹ϐ‹…ƒ–ƒ‘—–‘ˆ–‹‡‹•†‡˜‘–‡†–‘Š‡ƒŽ–Š’”‘‘–‹‘ƒ…-
–‹˜‹–‹‡•ǡ–Š‡‹•—ˆϐ‹…‹‡–Ž‡˜‡Ž‘ˆ‘™Ž‡†‰‡‹–Š‡ϐ‹‡Ž††‘‡•‘–
allow the creation of a long-term, favorable plenary in society.
The professional promotion of healthy lifestyles, by altering
attitudes, beliefs and people’s behaviors, reduces long-term
morbidity, followed by a corresponding reduction in health
expenditure.
Conclusions. —”•‡•ǡ„‡‡ϐ‹–‹‰ˆ”‘…‘–‹—‡†’”‘•’‡…-
tive medical training in health promotion and health educa-
tion, can help optimize the promotion of the health of the
population by promoting a healthy lifestyle, can help patients
identify risks of health behavior, to understand what is hap-
pening, to become aware of the need to comply with treat-
ment recommendations and healthy lifestyle rules to prevent
consequences and complications. The introduction of the po-
•‹–‹‘ ‘ˆ Ƿ‡†‹…ƒŽ ƒ••‹•–ƒ–  ‹ Š‡ƒŽ–Š ’”‘‘–‹‘dz ‹ –Š‡ 
staff would be another method for this purpose.
Key words: optimizing health promotion, the contribution
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‡†‹…ƒŽ£…‘–‹—£’”‘•’‡…–‹˜£Ǥ
Introducere
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ì£ǡ‘’—‡”‡ˆƒì£†‡”‡…‘ƒ†£”‹Ž‡†ƒ–‡Ǥ…‡•–ˆ‡‘‡ƒˆ‘•–
of nurses in health promotion, prospective medical training.
Introduction
Health promotion requires a multidimensional approach
to improving health, wich includes educational activities, pro-
moting behavioral and lifestyle changes, policies and legisla-
tive measures [1, 2].
An important contribution to health promotion lies with
nurses, who are key people in that sense, being a provider of
guideline values, necessary for health. The population is gen-
erally receptive to health information [3].
Although health promotion provides information and ad-
vice to the public, there is a tendency to reluctantly oppose
these recommendations. This phenomenon has been found
in interdisciplinary sociological studies, in that sanogenic ap-
proaches often remain without a palpable outcome. One ex-
planation would be that the population is not fully aware of
the risks of continuing an unhealthy way of life and the ben-
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mentale pozitive [3, 4].
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ƒ–Žƒ臆‹ìƒ†‹ͳͻ‹—‹‡ʹͲͳʹǤ–—†‹—Ž‡•–‡†‡–‹’†‡•…”‹’–‹˜Ǥ
‘Ž——Ž‡èƒ–‹‘ƒ‡Ž‘”ƒˆ‘•–†‡–‡”‹ƒ–ǡ—–‹Ž‹œŸ†ˆ‘”—Žƒ
‹”‡˜‘…ƒ„‹Ž‹–£ì‹‹•‡Ž‡…–‹˜‡ǤB„ƒœƒˆ‘”—Ž‡‹”‡•’‡…–‹˜‡ǡ•Ǧƒ…ƒŽ…—-
Žƒ– ˜‘Ž——Ž ‡èƒ–‹‘—Ž—‹ ”‡’”‡œ‡–ƒ–‹˜ǡ †ƒ–‡Ž‡ ‘„싐—–‡ ϐ‹‹†ǣ
͵ͺͶ †‡ ”‡•’‘†‡ì‹ Ȃ †‹ ”Ÿ†—Ž Ž‘…—‹–‘”‹Ž‘”ǡ ͵ͷʹ Ȃ ƒ•‹•–‡ì‹
‡†‹…ƒŽ‹ è‹ ʹͻͶ †‡ ‡†‹…‹ •’‡…‹ƒŽ‹è–‹ ȋ‡š’‡”ì‹ȌǤ ‡•’‡…–‹˜ǡ ƒ—
ˆ‘•–Á”‘Žƒì‹͵͸ͺ†‡ƒ•‹•–‡ì‹‡†‹…ƒŽ‹ǡʹͻͶ†‡‡†‹…‹•’‡…‹ƒ-
MJHS 17(3)/2018 63
Therefore, the information provided by medical staff, in
particular, community health nurses in health promotion is a
long-term investment with no immediate visible results [5, 6].
Health promotion must become an effective tool of prophylax-
is, with a systematic use of the means, techniques and meth-
ods necessary to develop responsible sanogenic behaviors [3].
Of the above, the health of the population is far from opti-
mal and the rate of morbidity and mortality that can be avoid-
ed remains high. The most important determinants of health
are social and economic conditions, alongside working and liv-
ing conditions. Other causes that affect health include smok-
ing, irrational eating, physical activity, alcohol consumption,
and the attitude of people towards themselves and others. It is
therefore necessary to take effective measures to prevent the
causes of illnesses and to promote a healthy lifestyle [3].
As prerequisites for the study on the promotion of commu-
nity health by nurses at the community level, they have con-
tinued to increase the secondary morbidity of the way of life,
the low level of sanitary knowledge of the population. An addi-
tional argument, is also the lack of the nurse’s role in promot-
‹‰Š‡ƒŽ–Š‹–Š‡‡ƒŽ–Š‡–‡”•ǡ”‡•’‡…–‹˜‡Ž›Ȃ–Š‡…‘–‹—‹‰
medical training of nurses, based on prospective education.
Based on the above, we set out to assess the contribution
of nurses in promoting health at Community level to identify
opportunities for optimizing those activities.
Material and methods
The research took place in CEMCPMFSM (Center for Con-
tinuing Medical Education of Medical and Pharmaceutical Staff
™‹–Š‡†‹—†—…ƒ–‹‘ȌǡŠǡǡ‹…‘Žƒ‡‡•–‡‹ìƒ—dzǡƒ†
‡ƒŽ–Š‡–‡”•Ž‹è…ƒ‹ǡ‡Ž‡è‡—ƒ†‹”—‹ìƒȋ™Š‹…Š–Š‡”‡ˆ‘”‡
reprezent, the North, Center and South regions of the Republic
of Moldova). The selection criteria of the mentioned localities
ƒ”‡ –Š‡ ˆ‘ŽŽ‘™‹‰ǣ Š‘‘‰‡‡‘—• ’‘’—Žƒ–‹‘ǡ Š‘‘‰‡‡‘—•
health indicators, nursing, physician assurance, health promo-
tion training for medical staff.
Š‡ ‡•‡ƒ”…Š –Š‹…• ‘‹––‡‡ ‘ˆ –Š‡ Š Ƿ‹…‘Žƒ‡
‡•–‡‹–ƒ—dz‡†‘”•‡†–Š‡”‡•‡ƒ”…Š’”‘–‘…‘Žǡ™Š‹…Š™ƒ•‡š-
amined at the meeting on June 19, 2012. The study is descrip-
tive.
The volume of samples was determined using the selec-
tive irrevocability formula. Based on this formula, the volume
of the representative sample was calculated, the data being
‘„–ƒ‹‡†ǣ ͵ͺͶ ”‡•’‘†‡–• Ȃ ƒ‘‰ –Š‡ ‹Šƒ„‹–ƒ–•ǡ ͵ͷʹ Ȃ
nurses and 294 specialists (experts). Therefore, 368 nurses,
294 specialists and 384 inhabitants of the respective locali-
ties were enrolled. Some of the primary data were taken or
‡š–”ƒ…–‡† ˆ”‘ ‘ˆϐ‹…‹ƒŽ •–ƒ–‹•–‹…•ǡ ’‘’—Žƒ–‹‘ ”‡…‘”†• ȋˆ‘”
166/e), outpatient medical records (form 025/e), statistical
”‡…‘”†• ‘ˆ †‡ϐ‹‹–‹˜‡ †‹ƒ‰‘•‹• ȋ ‘” ͲʹͷǦʹȀ‡Ȍǡ –Š‡ Š‡ƒŽ–Š
promotion records and reports, the centralized statistical
evaluation registers of the National Center for Health Man-
agement, as well as the data from the National Center for
Health Management (2011-2014), the National Bureau of
Statistics (2011-2014).
The activity of nurses in the promotion of the health of
64
Ž‹è–‹è‹͵ͺͶ†‡Ž‘…—‹–‘”‹ƒ‹Ž‘…ƒŽ‹–£ì‹Ž‘””‡•’‡…–‹˜‡Ǥ’ƒ”–‡†‹
†ƒ–‡Ž‡’”‹ƒ”‡ƒ—ˆ‘•–’”‡Ž—ƒ–‡•ƒ—‡š–”ƒ•‡†‹•–ƒ–‹•–‹…‹Ž‡‘ϐ‹-
…‹ƒŽ‡ǡ”‡‰‹•–”‡Ž‡†‡‡˜‹†‡ì£ƒ’‘’—Žƒì‹‡‹ȋˆ‘”—Žƒ”—Žͳ͸͸Ȁ‡Ȍǡϐ‹-
臎‡‡†‹…ƒŽ‡ƒŽ‡„‘Žƒ˜‹Ž‘”†‡ƒ„—Žƒ–‘”ȋˆ‘”—Žƒ”—ŽͲʹͷȀ‡Ȍǡ
–‹…Š‡–‡Ž‡•–ƒ–‹•–‹…‡†‡‡˜‹†‡ì£ƒ†‹ƒ‰‘•–‹…—Ž—‹†‡ϐ‹‹–‹˜ȋˆ‘”—-
Žƒ”—ŽͲʹͷǦʹȀ‡Ȍǡ”‡‰‹•–”‡Ž‡è‹”ƒ’‘ƒ”–‡Ž‡ƒ…–‹˜‹–£ì‹Ž‘”†‡’”‘‘-
˜ƒ”‡ƒ•££–£ì‹‹ǡ”‡‰‹•–”‡Ž‡…‡–”ƒŽ‹œƒ–‡†‡‡˜ƒŽ—ƒ”‡•–ƒ–‹•–‹…£ƒŽ‡
‡–”—Ž—‹ƒì‹‘ƒŽ†‡ƒƒ‰‡‡–Á££–ƒ–‡ǡ ’”‡…—è‹ date
†‹ ƒ—ƒ”—Ž ‡–”—Ž—‹ ƒì‹‘ƒŽ †‡ ƒƒ‰‡‡– Á ££–ƒ–‡
ȋ’‡”‹‘ƒ†ƒʹͲͳͳǦʹͲͳͶȌǡƒ—ƒ”—Ž‹”‘—Ž—‹ƒì‹‘ƒŽ†‡–ƒ–‹•–‹…£
(perioada 2011-2014).
 ˆ‘•– ƒƒŽ‹œƒ–£ ƒ…–‹˜‹–ƒ–‡ƒ ƒ•‹•–‡ì‹Ž‘” ‡†‹…ƒŽ‹ Á ’”‘-
‘˜ƒ”‡ƒ •££–£ì‹‹ ’‘’—Žƒì‹‡‹ǡ ƒ— ˆ‘•– ‡˜ƒŽ—ƒì‹ ‹†‹…ƒ–‘”‹‹ †‡
•££–ƒ–‡ǡ ƒ……‡•‹„‹Ž‹–ƒ–‡ƒ Žƒ •‡”˜‹…‹‹Ž‡ ‡†‹…ƒŽ‡ǡ ‹˜‡Ž—Ž †‡ …—-
‘è–‹ì‡ƒŽ’‘’—Žƒì‹‡‹è‹ƒŽƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹Á’”‘‘˜ƒ”‡ƒ
•££–£ì‹‹Ǥˆ‘•–…—ƒ–‹ϐ‹…ƒ–£ǡ†‡ƒ•‡‡‡ƒǡ’”‹’”‹•ƒ‘’‹‹‡‹
‡š’‡”ì‹Ž‘”ǡ…‘–”‹„—싃ƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹Á’”‘‘˜ƒ”‡ƒ•£-
£–£ì‹‹ǡ„—‰‡–—Ž†‡–‹’ǡ…‘•–Ǧ‡ϐ‹…‹‡ìƒϐ‹ƒ…‹ƒ”£ƒƒ•‹•–‡ì‹Ž‘”
‡†‹…ƒŽ‹Á’”‘‘˜ƒ”‡ƒ•££–£ì‹‹Ǥˆ‘•–ƒƒŽ‹œƒ–…ƒ†”—ŽŽ‡‰‹•-
Žƒ–‹˜ƒŽ’”‘‘˜£”‹‹•££–£ì‹‹Žƒ‹˜‡Ž…‘—‹–ƒ”Ǥ
’–‹‹œƒ”‡ƒ ƒc–‹˜‹–£ì‹‹ ƒ•‹•–‡n싎o” ‡†‹cƒŽ‹ Án ’”oo˜ƒ”‡ƒ •£n£–£ì‹‹
the population was analyzed, also the health indicators, ac-
cessibility to health services, the level of knowledge of the
population and nurses in the promotion of health. The con-
tribution of nurses to health promotion, the time budget,
the cost-effectiveness of nurses in health promotion has also
„‡‡“—ƒ–‹ϐ‹‡†‹–Š‡Ž‹‰Š–‘ˆ‡š’‡”–‘’‹‹‘ǤŠ‡Ž‡‰‹•Žƒ–‹˜‡
framework of health promotion at the community level has
been analyzed.
In the next segment of research, we have estimated the
work time spent by nurses in promoting community health at
the community level, by utilizing ǡǡIn†‹˜‹†—ƒŽ ™o” –‹‡ •Š‡‡–dz
in the order of succession of health promotion actions taken
over a day, week, month and year. After processing chrono-
metric strings, we have completed the analysis and descrip-
tion of the results obtained according to the Order of the Min-
istry of Health no. 400 ǡǡn –Š‡ o”‰ƒn‹œƒ–‹on oˆ Š‡ƒŽ–Š ‡†—cƒ–‹on
ƒn† Š‡ƒŽ–Š ’”oo–‹on ƒc–‹˜‹–‹‡•dz and Annex no. 8 to the Order
ǡǡ’’”oš‹ƒ–‡ no”• ˆo” cƒŽc—Žƒ–‹n‰ –‹‡ ˆo” Š‡ƒŽ–Š ‡†—cƒ–‹on
ƒn† ’”oo–‹n‰ Š‡ƒŽ–Š› Ž‹ˆ‡•–›Ž‡• ˆo” Š‡ƒŽ–Š ™o”‡”•dz. The calcu-
lation formula for the time budget was developed by Professor
ƒ—”£–‘”—Ž•‡‰‡–ƒŽ…‡”…‡–£”‹‹ǡƒˆ‘•–‡•–‹ƒ––‹’—Ž†‡
—…£ …‘•—ƒ– †‡ …£–”‡ ƒ•‹•–‡ì‹‹ ‡†‹…ƒŽ‹ Á ’”‘‘˜ƒ”‡ƒ
•££–£ì‹‹’‘’—Žƒì‹‡‹Žƒ‹˜‡Ž…‘—‹–ƒ”ǡ—–‹Ž‹œŸ†ǡǡ oƒ‹ƒ †‡ ˆoǦ
–o‰”ƒϔ‹‡”‡ ‹n†‹˜‹†—ƒŽ£ ƒ –‹’—Ž—‹ †‡ —nc£dz în ordinea succesi-
—‹‹ƒ…ì‹—‹Ž‘”†‡’”‘‘˜ƒ”‡ƒ•££–£ì‹‹”‡ƒŽ‹œƒ–‡’‡’ƒ”…—”•—Ž
—‡‹œ‹Ž‡ǡ•£’–£Ÿ‹ǡŽ—£è‹ƒǤ—’£’”‡Ž—…”ƒ”‡ƒ苔—”‹Ž‘”…”‘-
‘‡–”‹…‡ǡ ƒ ˆ‘•– ‡ˆ‡…–—ƒ–£ ƒƒŽ‹œƒ è‹ †‡•…”‹‡”‡ƒ ”‡œ—Ž–ƒ–‡Ž‘”
‘„싐—–‡…‘ˆ‘””†‹—Ž—‹‹‹•–‡”—Ž—‹££–£ì‹‹”ǤͶͲͲǡǡ—
’”‹˜‹”‡ Žƒ o”‰ƒn‹œƒ”‡ƒ ƒc–‹˜‹–£ì‹Žo” †‡ ‡†—cƒì‹‡ ’‡n–”— •£n£–ƒ–‡
è‹ ’”oo˜ƒ”‡ ƒ •£n£–£ì‹‹dz苐‡šƒ”ǤͺŽƒ”†‹ǡǡo”ƒ–‹˜‡Ž‡
ƒ’”oš‹ƒ–‹˜‡ †‡ cƒŽc—Žƒ”‡ ƒ –‹’—Ž—‹ ’‡n–”— ”‡ƒŽ‹œƒ”‡ƒ ƒc–‹˜‹–£Ǧ
싎o” †‡ ‡†—cƒì‹‡ ’‡n–”— •£n£–ƒ–‡ è‹ ’”oo˜ƒ”‡ ƒ o†—Ž—‹ •£n£Ǧ
–o• †‡ ˜‹ƒì£ ’‡n–”— Ž—c”£–o”‹‹ ‡†‹cƒŽ‹dzǤˆ‘•–ƒ’Ž‹…ƒ–£ˆ‘”—Žƒ
Ǥ”‹•ƒ…ƒ”—ǡ•—„•‡“—‡–Ž›ƒ‡†‡†ƒ†—•‡†„›–Š‡ƒ—–Š‘”•ǣ
TK/P = TM + TS +TE + Tf+ TÎ / 60 (1)
where,
ȀP Ȃ–‘–ƒŽ–‹‡•’‡–‘’”‘‘–‹‰Š‡ƒŽ–ŠǢ
 Ȃ–Š‡–‹‡•’‡–‘’”‘‘–‹‰ƒŠ‡ƒŽ–Š›™ƒ›‘ˆŽ‹ˆ‡Ǣ
S Ȃ–Š‡–‹‡•’‡–‘’”‘‘–‹‰Š‡ƒŽ–Š›Ž‹ˆ‡•–›Ž‡•Ǣ
E Ȃ–‹‡•’‡–‘Š‡ƒŽ–Š‡†—…ƒ–‹‘Ǣ
fȂ–‹‡•’‡–‹Š‡ƒŽ–Š•…Š‘‘Ž•Ǣ
ÎȂ–‹‡ƒŽŽ‘…ƒ–‡†ˆ‘”Š‡ƒŽ–Š…ƒ”‡Ǣ
ͼͶȂ–”ƒ•ˆ‘”ƒ–‹‘ˆƒ…–‘”‘ˆ†—”ƒ–‹‘•‹Š‘—”•Ǥ
Formula (1) allowed the determination of time spent on
health promotion.
†‡…ƒŽ…—Žƒ„—‰‡–—Ž—‹†‡–‹’ǡ‡Žƒ„‘”ƒ–£†‡…£–”‡’”‘ˆ‡•‘”—ŽǤ
”‹•£…ƒ”—ǡ—Ž–‡”‹‘”‘†‹ϐ‹…ƒ–£è‹—–‹Ž‹œƒ–£†‡ƒ—–‘”‹ǣ
TK/P = TM + TS +TE + Tg+ TÎ / 60 (1)
unde,
‘”†‡”–‘†‡–‡”‹‡–Š‡ϐ‹ƒ…‹ƒŽ…‘–”‹„—–‹‘ƒ†…‘•–Ǧ
‡ˆˆ‡…–‹˜‡‡•• ‘ˆ ƒ —”•‡ ‹ ’”‘‘–‹‰ Š‡ƒŽ–Šǡ –Š‡ ϐ‹ƒ…‹ƒŽ
contribution resulting from the full professional activity of a
‘Ž†‘˜ƒ „—†‰‡– ™‘”‡” ™ƒ• …ƒŽ…—Žƒ–‡†ǡ ϐ‹”•–ǡ ƒ……‘”†‹‰ –‘
–Š‡ˆ‘”—Žƒǣ
ȀP Ȃ–‹’—Ž–‘–ƒŽƒ…‘”†ƒ–’‡–”—’”‘‘˜ƒ”‡ƒ•££–£ì‹‹Ǣ
 Ȃ –‹’—Ž ƒ…‘”†ƒ– ’‡–”— ’”‘‘˜ƒ”‡ƒ ‘†—Ž—‹ •££–‘•
†‡˜‹ƒì£Ǣ
S Ȃ –‹’—Ž ƒ…‘”†ƒ– ’‡–”— ’”‘‘˜ƒ”‡ƒ ——‹ •–‹Ž †‡ ˜‹ƒì£
•££–‘•Ǣ
E Ȃ–‹’—Žƒ…‘”†ƒ–’‡–”—‡†—…ƒì‹ƒ’‡–”—•££–ƒ–‡Ǣ
gȂ–‹’—Ž’‡–”‡…—–Á腑Ž‹†‡•££–ƒ–‡Ǣ
ÎȂ–‹’—ŽƒŽ‘…ƒ–’‡–”—Á‰”‹Œ‹”‹†‡•££–ƒ–‡Ǣ
ͼͶȂ…‘‡ϐ‹…‹‡–—Ž†‡–”ƒ•ˆ‘”ƒ”‡ƒŽ†—”ƒ–‡Ž‘”Á‘”‡Ǥ
Formula (1) a permis determinarea bugetului de timp
ƒ…‘”†ƒ–’”‘‘˜£”‹‹•££–£ì‹‹Ǥ
‡–”—†‡–‡”‹ƒ”‡ƒ…‘–”‹„—싇‹ϐ‹ƒ…‹ƒ”‡è‹…‘•–Ǧ‡ϐ‹…‹‡-
샗—‹ƒ•‹•–‡–‡†‹…ƒŽÁ’”‘‘˜ƒ”‡ƒ•££–£ì‹‹ǡƒˆ‘•–…ƒŽ…—-
Žƒ–£ǡƒ‹Á–Ÿ‹ǡ…‘–”‹„—싃ϐ‹ƒ…‹ƒ”£”‡œ—Ž–ƒ–£†‹ƒ…–‹˜‹–ƒ–‡ƒ
’”‘ˆ‡•‹‘ƒŽ£ ‹–‡‰”ƒŽ£ ƒ ——‹ Ž—…”£–‘” „—‰‡–ƒ” †‹ ‡’—„Ž‹…ƒ
‘Ž†‘˜ƒ†—’£ˆ‘”—Žƒǣ
αȂȋΪȀȌȋʹȌ
where,
Ȃ–Š‡…Ž‡ƒŽƒ„‘”‹…‘‡‘ˆƒ„—†‰‡–™‘”‡”Ǣ
PIBȂƒ—ƒŽ‰”‘••†‘‡•–‹…’”‘†—…–Ǣ
SȂƒ˜‡”ƒ‰‡ƒ—ƒŽ•ƒŽƒ”›Ǣ
Ȃ–Š‡ƒ—ƒŽƒ˜‡”ƒ‰‡‘ˆ–Š‡—„‡”‘ˆ™‘”‡”•Ǥ
‘™‹‰–Š‡ϐ‹ƒ…‹ƒŽ…‘–”‹„—–‹‘ƒ†ˆ—ŽŽ…‘•–Ǧ‡ˆˆ‡…–‹˜‡-
‡••ǡ –Š‡ ϐ‹ƒ…‹ƒŽ …‘–”‹„—–‹‘ ƒ† …‘•–Ǧ‡ˆˆ‡…–‹˜‡‡•• ‘ˆ ƒ
nurse in the promotion of health at Community level for one
day, week, month and year was calculated.
Descriptive statistics. Data are presented in absolute and
”‡Žƒ–‹˜‡ϐ‹‰—”‡•Ǥ
Results
The analysis of age structure of the population of the three
‡ƒŽ–Š ‡–‡”• ȋȌ Šƒ• ›‹‡Ž†‡† –Š‡ ˆ‘ŽŽ‘™‹‰ ”‡•—Ž–•ǣ 
αȂȋΪȀȌȋʹȌ Ž‹ç…ƒ‹ Ȃ ™‘”‹‰ ’‘’—Žƒ–‹‘ ͺͷǤͲΨǡ …Š‹Ž†”‡ Ȃ ͳͷǤͲΨǤ 
unde, ‡Ž‡ç‡— Ȃ ™‘”‹‰ ’‘’—Žƒ–‹‘ ͺ͸ǤͲΨǡ …Š‹Ž†”‡ Ȃ ͳͶǤͲΨǤ 
Ȃ˜‡‹–—Ž…—”ƒ–ƒŽ—…‹‹——‹Ž—…”£–‘”„—‰‡–ƒ”Ǣ ‹”—‹ìƒȂ™‘”‹‰’‘’—Žƒ–‹‘ͺ͹ǤͲΨǡ…Š‹Ž†”‡Ȃͳ͵ǤͲΨǤ
’–‹‹œ‹n‰ –Š‡ ™o” oˆ n—”•‡• ‹n ’”oo–‹n‰ Š‡ƒŽ–Š
PIBȂ’”‘†—•—Ž‹–‡”„”—–ƒ—ƒŽǢ
SȂ•ƒŽƒ”‹—Ž‡†‹—ƒ—ƒŽǢ
Ȃ‡†‹ƒƒ—ƒŽ£ƒ—£”—Ž—‹†‡Ž—…”£–‘”‹Ǥ
—‘•…Ÿ† …‘–”‹„—싃 ϐ‹ƒ…‹ƒ”£ è‹ …‘•–Ǧ‡ϐ‹…‹‡ìƒ ’”‘ˆ‡-
•‹‘ƒŽ£‹–‡‰”ƒŽ£ǡƒˆ‘•–…ƒŽ…—Žƒ–£…‘–”‹„—싃è‹…‘•–Ǧ‡ϐ‹…‹‡ìƒ
ϐ‹ƒ…‹ƒ”£ƒ——‹ƒ•‹•–‡–‡†‹…ƒŽÁ’”‘‘˜ƒ”‡ƒ•££–£ì‹‹Žƒ
‹˜‡Ž…‘—‹–ƒ”–‹’†‡‘œ‹ǡ•£’–£Ÿ£ǡŽ—£è‹ƒǤ
–ƒ–‹•–‹…£†‡•…”‹’–‹˜£Ǥƒ–‡Ž‡•—–’”‡œ‡–ƒ–‡•—„ˆ‘”£†‡
…‹ˆ”‡ƒ„•‘Ž—–‡è‹”‡Žƒ–‹˜‡Ǥ
‡œ—Ž–ƒ–‡
ƒƒƒŽ‹œƒ•–”—…–—”‹‹’‡˜Ÿ”•–‡ƒ’‘’—Žƒì‹‡‹†‹…‡Ž‡–”‡‹‡-
–”‡†‡•££–ƒ–‡ȋȌƒ—ˆ‘•–‘„싐—–‡—”£–‘ƒ”‡Ž‡”‡œ—Ž–ƒ–‡ǣ
Ž‹è…ƒ‹Ȃ’‘’—Žƒì‹‡ƒ’–£†‡—…£ͺͷǡͲΨǡ…‘’‹‹ȂͳͷǡͲΨǤ
‡Ž‡è‡—Ȃ’‘’—Žƒì‹‡ƒ’–£†‡—…£ͺ͸ǡͲΨǡ…‘’‹‹ȂͳͶǡͲΨǤ
‹”—‹ìƒȂ’‘’—Žƒì‹‡ƒ’–£†‡—…£ͺ͹ǡͲΨǡ…‘’‹‹Ȃͳ͵ǡͲΨǤ
’”‡˜ƒŽƒ–‰”—’—Ž†‡˜Ÿ”•–£†‡ͶͲǦ49 de ani, cu o pondere
†‡ʹͺǡͻΨǡ—”ƒ–†‡‰”—’—Ž†‡˜Ÿ”•–£†‡͸Ͳ†‡ƒ‹è‹ƒ‹—Ž–ǡ
…—ʹ͹ǡͶΨǤ‡Ž‘…—Ž–”‡‹ǡ•Ǧƒ’Žƒ•ƒ–‰”—’—Ž†‡˜Ÿ”•–£†‡͵ͲǦ͵ͻ†‡
MJHS 17(3)/2018 65
The 40-49 age group prevailed, with a weight of 28.9%, fol-
lowed by the age group of 60 years and older, by 27.4%. On
the third place, the age group was 30-39 years old with 18.0%,
–Š‡ˆ‘—”–Š’Žƒ…‡Ȃ–Š‡ƒ‰‡‰”‘—’ͷͲǦͷͻ›‡ƒ”•™‹–Šͳ͹Ǥ͵ΨǤŠ‡
lowest was the age group up to 18 years old, with a percentage
of only 8.4%.
Full-time studies had 57.5% of respondents, 26.6% of sec-
‘†ƒ”› ‡†—…ƒ–‹‘ǡ ‹…‘’Ž‡–‡ •‡…‘†ƒ”› ‡†—…ƒ–‹‘ Ȃ ͶǤͺΨǡ
Š‹‰Š‡” ‡†—…ƒ–‹‘ Ȃ ͸ǤͶΨǡ ƒ† ‹…‘’Ž‡–‡ Š‹‰Š‡” ‡†—…ƒ–‹‘
4.7%.
‡‰ƒ”†‹‰ ‡†‹…ƒŽ •–ƒˆϐ‹‰ǡ –Š‡ „‡•– ”‡•—Ž–• ™ƒ• •Š‘™
„›Ž‹ç…ƒ‹ǡ™Š‡”‡–Š‡•–ƒˆϐ‹‰™‹–Šˆƒ‹Ž›†‘…–‘”•…‘•–‹-
–—–‡†ͺ͵ǤͲΨǡƒ†™‹–Š—”•‡•ȂͳͲͲΨǢ‹‡Ž‡ç‡—ǡ•–ƒˆϐ‹‰
™‹–Šˆƒ‹Ž›†‘…–‘”•™ƒ•ͻͷǤͲΨǡƒ†™‹–Š—”•‡•ȂͻͲǤͲΨǢ‹
‹”—‹ìƒǡ•–ƒˆϐ‹‰™‹–Šˆƒ‹Ž›†‘…–‘”•™ƒ•ͻͷǤͲΨǡƒ†™‹–Š
—”•‡•ȂͻͶǤͲΨǤ
The distribution of deaths according to the most frequent
‘•‘Ž‘‰‹…ƒŽ ˆ‘”• ™‡”‡ǣ …ƒ”†‹‘˜ƒ•…—Žƒ” †‹•‡ƒ•‡• Ȃ ͺͳͶǤͻΩ
’‡” ͳͲǡͲͲͲ ’‘’—Žƒ–‹‘ ‹  Ž‹ç…ƒ‹ǡ ͹ͻͷǤͲΩ Ȃ ‹ 
ƒ‹…—ͳͺǡͲΨǡ’‡Ž‘…—Ž’ƒ–”—Ȃ‰”—’—Ž†‡˜Ÿ”•–£†‡ͷͲǦ59 de ani,
…—ͳ͹ǡ͵ΨǤ‡Žƒ‹‹…ƒˆ‘•–‰”—’—Ž†‡˜Ÿ”•–£’Ÿ£Žƒͳͺƒ‹ǡ
’‘†‡”‡ƒƒ…‡•–—‹ƒϐ‹‹††‡†‘ƒ”†‡ͺǡͶΨǤ
–—†‹‹ ‡†‹‹ …‘’Ž‡–‡ ƒ— ƒ˜—– ͷ͹ǡͷΨ †‹–”‡ ”‡•’‘†‡ì‹ǡ
•–—†‹‹‡†‹‹†‡•’‡…‹ƒŽ‹–ƒ–‡Ȃʹ͸ǡ͸Ψǡ•–—†‹‹‡†‹‹‹…‘’Ž‡–‡Ȃ
ͶǡͺΨǡ•–—†‹‹•—’‡”‹‘ƒ”‡Ȃ͸ǡͶΨè‹•–—†‹‹•—’‡”‹‘ƒ”‡‹…‘’Ž‡–‡
4,7%.
Referitor la asigurarea cu personal medical, cel mai bine
•Ǧƒ’”‡œ‡–ƒ–Ž‹è…ƒ‹ǡ—†‡ƒ•‹‰—”ƒ”‡ƒ…—‡†‹…‹†‡ˆƒ‹-
Ž‹‡ƒ…‘•–‹–—‹–ͺ͵ǡͲΨǡ‹ƒ”…—ƒ•‹•–‡ì‹‡†‹…ƒŽ‹ȂͳͲͲΨǢÁ
‡Ž‡è‡—ǡƒ•‹‰—”ƒ”‡ƒ…—‡†‹…‹†‡ˆƒ‹Ž‹‡ƒˆ‘•–†‡ͻͷǡͲΨǡ‹ƒ”
…— ƒ•‹•–‡ì‹ ‡†‹…ƒŽ‹ Ȃ  ͻͲǡͲΨǢ Á  ‹”—‹ìƒǡ ƒ•‹‰—”ƒ”‡ƒ …—
‡†‹…‹†‡ˆƒ‹Ž‹‡ƒˆ‘•–†‡ͻͷǡͲΨǡ‹ƒ”…—ƒ•‹•–‡ì‹‡†‹…ƒŽ‹Ȃ
94,0%.
‹•–”‹„—싃†‡…‡•‡Ž‘”Áˆ—…싇†‡…‡Ž‡ƒ‹ˆ”‡…˜‡–‡ˆ‘”-
‡‘•‘Ž‘‰‹…‡ǡƒ—ˆ‘•–ǣƒˆ‡…ì‹—‹…ƒ”†‹‘˜ƒ•…—Žƒ”‡ȂͺͳͶǡͻΩŽƒ
ͳͲǤͲͲͲ ’‘’—Žƒì‹‡ Á  Ž‹è…ƒ‹ǡ ͹ͻͷǡͲΩ Ȃ Á  ‹”—‹ìƒ è‹
͹ͺͺǡͲΩ Ȃ Á  ‡Ž‡è‡—Ǥ ‡ Ž‘…—Ž †‘‹ •Ǧƒ— ’Žƒ•ƒ– ƒˆ‡…ì‹—‹Ž‡
–”ƒ…–—Ž—‹†‹‰‡•–‹˜ǡ…—‘’‘†‡”‡†‡ʹ͵ʹǡͺΩÁŽ‹è…ƒ‹ǡ†‡
ͳͺͶǡͶΩȂÁ‡Ž‡è‡—苆‡ͳ͹͸ǡͲΩȂÁ‹”—‹ìƒǤ‡Ž‘…—Ž
–”‡‹ȂƒŽƒ†‹‹Ž‡‘…‘Ž‘‰‹…‡ǡ…ƒ”‡ƒ—Á”‡‰‹•–”ƒ–ÁŽ‹è…ƒ‹‘
’‘†‡”‡†‡ͳͺ͸ǡͲΩǡÁ‡Ž‡è‡—Ȃͳ͸ͺǡͶΩǡÁ‹”—‹ìƒȂ
ͳͷͶǡ͸ΩǤ‡Ž‘…—Ž’ƒ–”—•Ǧƒ—’Žƒ•ƒ–ƒˆ‡…ì‹—‹Ž‡–”ƒ…–—Ž—‹”‡•’‹-
”ƒ–‘”ǡ…—‘’‘†‡”‡†‡ͳ͸ʹǡͻΩÁŽ‹è…ƒ‹ǡ†‡ͳͶ͹ǡͶΩȂÁ
‡Ž‡è‡—苆‡ͳ͵ʹǡͷΩȂÁ‹”—‹ìƒǤ
‹•–”‹„—싃ƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹’‡‰”—’—”‹†‡˜Ÿ”•–£ƒˆ‘•–
‡n‡”ƒŽ no™Ž‡†‰‡ ‡˜‡Ž oˆ
†‡ǣʹͻ†‡ƒ‹ȂʹͳǡͲΨǡ͵ͲǦ͵ͻ†‡ƒ‹Ȃʹ͵ǡͲΨǡͶͲǦͶͻ†‡ƒ‹Ȃ
ʹͲǡͲΨǡͷͲǦͷͻ†‡ƒ‹ȂʹʹΨǡ’‡•–‡͸Ͳ†‡ƒ‹ȂͳͶǡͲΨǤ
‡‹ƒ‹—Žì‹ƒ•‹•–‡ì‹‡†‹…ƒŽ‹ȋ͵͵ǡͲΨȌƒ—ƒ˜—–—•–ƒ‰‹—
†‡—…£†‡ͳͳǦʹͲ†‡ƒ‹Ǣ͵ʹǡͲΨȂ†‡’‡•–‡ʹͲƒ‹ǢʹͷǡͲΨȂ
͸ǦͳͲ ƒ‹ǡ ‹ƒ” ͳͲǡͲΨ Ȃ ’Ÿ£ Žƒ ͷ ƒ‹Ǥ ƒ–‡‰‘”‹ƒ •—’‡”‹‘ƒ”£ †‡
…‘’‡–‡ì£’”‘ˆ‡•‹‘ƒŽ£ƒ—†‡ì‹—–Ǧ‘ͺͲǡͲΨ†‹–”‡ƒ•‹•–‡ì‹‹
medicali.
‹•–”‹„—싃‡†‹…‹Ž‘”Ǧ•’‡…‹ƒŽ‹è–‹ȋ‡š’‡”ì‹Ȍ’‡‰”—’‡†‡˜Ÿ”-
•–£ƒˆ‘•–ǣ’Ÿ£Žƒʹͻ†‡ƒ‹ȂͲǡʹΨǡ͵ͲǦ͵ͻ†‡ƒ‹Ȃ͵ͺǡʹΨǡͶͲǦͶͻ
†‡ƒ‹ȂʹͶǡͺΨǡͷͲǦͷͻ†‡ƒ‹ȂʹͷǡͻΨǡ’‡•–‡͸Ͳ†‡ƒ‹ȂͳͲǡͻΨǤ
 ‡š’‡”‹‡ì£ †‡ —…£ †‡ ’Ÿ£ Žƒ ͷ ƒ‹ ƒ— ƒ˜—–Ǧ‘ ͵ǡͲΨ
‹”—‹ìƒƒ†͹ͺͺǤͲΩȂ‹‡Ž‡ç‡—Ǥ•‡…‘†’Žƒ…‡™‡”‡
–Š‡†‹‰‡•–‹˜‡–”ƒ…–†‹•‡ƒ•‡•ǡ™‹–Šƒ™‡‹‰Š–‘ˆʹ͵ʹǤͺΩ‹
Ž‹ç…ƒ‹ǡ‘ˆͳͺͶǤͶΩȂ‹‡Ž‡ç‡—ƒ†‘ˆͳ͹͸ǤͲΩȂ‹
‹”—‹ìƒǤŠ‹”†’Žƒ…‡Ȃ‘…‘Ž‘‰‹…ƒŽ†‹•‡ƒ•‡•ǡ™Š‹…Š”‡…‘”†‡†‹
Ž‹ç…ƒ‹ƒ™‡‹‰Š–‘ˆͳͺ͸ǤͲΩǡ‹‡Ž‡ç‡—Ȃͳ͸ͺǤͶΩǡ‹
‹”—‹ìƒȂͳͷͶǤ͸ΩǤ–Š‡ˆ‘—”–Š’Žƒ…‡™‡”‡–Š‡”‡•’‹”ƒ-
–‘”›–”ƒ…–†‹•‡ƒ•‡•ǡ™‹–Šƒ™‡‹‰Š–‘ˆͳ͸ʹǤͻΩ‹Ž‹ç…ƒ‹ǡ‘ˆ
ͳͶ͹ǤͶΩȂ‹‡Ž‡ç‡—ƒ†‘ˆͳ͵ʹǤͷΩȂ‹‹”—‹ìƒǤ
Š‡ †‹•–”‹„—–‹‘ ‘ˆ —”•‡• „› ƒ‰‡ ‰”‘—’ ™ƒ• ʹͻ ›‡ƒ”• Ȃ
ʹͳǤͲΨǡ͵ͲǦ͵ͻ›‡ƒ”•Ȃʹ͵ǤͲΨǡͶͲǦͶͻ›‡ƒ”•ȂʹͲǤͲΨǡͷͲǦͷͻ›‡ƒ”•
ȂʹʹΨǡ‘˜‡”͸Ͳ›‡ƒ”•ȂͳͶǤͲΨǤ
Most nurses (33.0%) had work experience of 11-20 years;
͵ʹǤͲΨȂ‘˜‡”ʹͲ›‡ƒ”•ǢʹͷǤͲΨȂ͸ǦͳͲ›‡ƒ”•ǡƒ†ͳͲǤͲΨȂ—’–‘
5 years. The upper category of professional competence was
held by 80.0% of the nurses.
The distribution of specialist physicians (experts) by age
‰”‘—’™ƒ•ǣ—’–‘ʹͻ›‡ƒ”•ȂͲǤʹΨǡ͵ͲǦ͵ͻ›‡ƒ”•Ȃ͵ͺǤʹΨǡͶͲǦͶͻ
›‡ƒ”•ȂʹͶǤͺΨǡͷͲǦͷͻ›‡ƒ”•ȂʹͷǤͻΨǡ‘˜‡”͸Ͳ›‡ƒ”•ȂͳͲǤͻΨǤ
Work experience of up to 5 years had 3.0% of physicians,
͸ǦͳͲ ›‡ƒ”• Ȃ ͳͶΨǡ ͳͳǦʹͲ ›‡ƒ”• Šƒ† ͷͶǤͲΨǡ ‘˜‡” ʹͲ ›‡ƒ”• Ȃ
29.0%. The upper professional competence category was 73%
of the doctors.
According to the Ƿ˜‡”ƒŽŽ ••‡••‡n– ScƒŽ‡ oˆ Po’—Žƒ–‹on ‹n
‡ƒŽ–Š P”oo–‹on ScƒŽ‡dz, 62.0% of respondents had an insuf-
ϐ‹…‹‡–Ž‡˜‡Žǡ͵ͺΨȂƒ……‡’–ƒ„Ž‡Ǥ
The ǷScƒŽ‡ oˆ ••‡••‹n‰ –Š‡
—”•‡• ‹n ‡ƒŽ–Š P”oo–‹ondz ‹†‡–‹ϐ‹‡†ƒ‹•—ˆϐ‹…‹‡–Ž‡˜‡Ž‘ˆ
knowledge in 53.5% of the assessed persons, the rest demon-
•–”ƒ–‹‰ƒ•—ˆϐ‹…‹‡–Ž‡˜‡Ž‘ˆ‹ˆ‘”ƒ–‹‘Ǥ
The contribution of nurses to health promotion, in the
view of experts, was satisfactory in 42.2% of cases, mediocre
Ȃ͵ͺǤͶΨǡ—•ƒ–‹•ˆƒ…–‘”›ȂͳͻǤͶΨǤ
According to the calculations performed, a nurse gave, on
average, per day, 59 min 10 sec to health promotion. This time
has been used for the following activities, in terms of dura-
–‹‘ǣͳͷ‹ȋʹͷǤͶΨȌȂǷ‡ƒŽ–Š ScŠooŽdz. Ƿ‡ƒŽ–Š E†—cƒ–‹ondz and
Ƿ‡ƒŽ–Š ƒ”‡dz were allocated 12 minutes and 5 seconds per
66
†‹–”‡‡†‹…‹ǡ†‡͸ǦͳͲƒ‹ȂͳͶΨǡ†‡ͳͳǦʹͲ†‡ƒ‹ƒ—ƒ˜—–Ǧ‘
ͷͶǡͲΨǡ †‡ ’‡•–‡ ʹͲ †‡ ƒ‹ Ȃ ʹͻǡͲΨǤ ƒ–‡‰‘”‹ƒ •—’‡”‹‘ƒ”£ †‡
…‘’‡–‡ì£’”‘ˆ‡•‹‘ƒŽ£ƒ—†‡ì‹—–Ǧ‘͹͵Ψ†‹–”‡‡†‹…‹Ǥ
Conform ǡǡScƒŽ‡‹ †‡ ‡˜ƒŽ—ƒ”‡ ƒ n‹˜‡Ž—Ž—‹ ‰‡n‡”ƒŽ †‡ c—noèǦ
–‹nì‡ ƒ ’o’—Žƒì‹‡‹ Án ’”oo˜ƒ”‡ƒ •£n£–£ì‹‹dzǡ—‹˜‡Ž‹•—ϐ‹…‹‡–
ŽǦƒ—ƒ˜—–͸ʹǡͲΨ†‹–”‡”‡•’‘†‡ì‹ǡƒ……‡’–ƒ„‹ŽȂ͵ͺΨǤ
ǡǡScƒŽƒ †‡ ‡˜ƒŽ—ƒ”‡ ƒ n‹˜‡Ž—Ž—‹ ‰‡n‡”ƒŽ †‡ c—no薋nì‡ ƒ ƒ•‹•Ǧ
–‡n싎o” ‡†‹cƒŽ‹ Án ’”oo˜ƒ”‡ƒ •£n£–£ì‹‹ dz ƒ‹†‡–‹ϐ‹…ƒ–—‹˜‡Ž
‹•—ϐ‹…‹‡–ƒŽ…—‘è–‹ì‡Ž‘”Žƒͷ͵ǡͷΨ†‹–”‡’‡”•‘ƒ‡Ž‡‡˜ƒŽ—-
ƒ–‡ǡ”‡•–—Ž†‡‘•–”Ÿ†—‹˜‡Ž•—ϐ‹…‹‡–†‡‹ˆ‘”ƒ”‡Ǥ
‘–”‹„—싃ƒ•‹•–‡ì‹Ž‘”‡†‹…ƒŽ‹Á’”‘‘˜ƒ”‡ƒ•££–£ì‹‹ǡ
Á˜‹œ‹—‡ƒ‡š’‡”ì‹Ž‘”ǡƒˆ‘•–•ƒ–‹•ˆ£…£–‘ƒ”‡ÁͶʹǡʹΨ†‹…ƒœ—”‹ǡ
‡†‹‘…”£Ȃ͵ͺǡͶΨǡ‡•ƒ–‹•ˆ£…£–‘ƒ”‡ȂͳͻǡͶΨǤ
Conform calculelor efectuate, un asistent medical a acor-
†ƒ–ǡÁ‡†‹‡ǡ’‡œ‹ǡͷͻ‹ͳͲ•‡…’”‘‘˜£”‹‹•££–£ì‹‹Ǥ…‡•–
–‹’ƒˆ‘•–—–‹Ž‹œƒ–’‡–”——”£–‘ƒ”‡Ž‡ƒ…–‹˜‹–£ì‹ǡÁ•‡•—Ž†—-
”ƒ–‡‹ǣͳͷ‹ȋʹͷǡͶΨȌȂǷgcoŽ‹‹ †‡ •£n£–ƒ–‡dz. ǷE†—cƒì‹ƒ ’‡n–”—
’–‹‹œƒ”‡ƒ ƒc–‹˜‹–£ì‹‹ ƒ•‹•–‡n싎o” ‡†‹cƒŽ‹ Án ’”oo˜ƒ”‡ƒ •£n£–£ì‹‹
day (20.4% of each time). Ƿ‹ˆ‡•–›Ž‡dz and Ƿ‹ˆ‡•–›Ž‡dz were each
allocated 10 minutes each (16.9% of each time).
Within one year, the total time budget provided by the
health care assistant for health promotion was 15,620 min-
utes, which was used for Health Schools (3,960 min, 25.4%);
3.190 minutes (20.4% of each time) were allocated for the ac-
tivities in the Health Education and Healthcare Departments
ƒ†ʹǡ͸ͶͲ‹—–‡•ȋͳ͸ǤͻΨ‘ˆ‡ƒ…Š–‹‡ȌȂǷ‹˜‹n‰ ƒnn‡”dz and
Ƿ‹ˆ‡•–›Ž‡dz.
Š‡ϐ‹ƒ…‹ƒŽ‹’ƒ…–‘ˆ–Š‡Š‡ƒŽ–Š’”‘‘–‹‘‘ˆ–Š‡’‘’—Žƒ-
tion at the community level of a nurse was 15,620 lei per year;
on a national scale, the respective activity saved the health
budget 69,321,560 lei.
Discussion
In the Republic of Moldova, in the study of the issue of
Š‡ƒŽ–Š ’”‘‘–‹‘ ƒ† Š‡ƒŽ–Š ‡†—…ƒ–‹‘ …‘–”‹„—–‡†ǣ ƒŠ-
•£n£–ƒ–‡dz è‹ǷÎn‰”‹Œ‹”‹ ‡†‹cƒŽ‡dzƒ—ƒ˜—–ƒŽ‘…ƒ–‡…Ÿ–‡ͳʹ‹è‹ͷ
•‡…’‡œ‹ȋ…Ÿ–‡ʹͲǡͶΨ†‹–‹’ǡϐ‹‡…ƒ”‡ȌǤǷo†—Ž †‡ ˜‹ƒì£dzè‹ǷS–‹Ǧ
Ž—Ž †‡ ˜‹ƒì£dzƒ—ƒ˜—–ƒŽ‘…ƒ–‡ǡϐ‹‡…ƒ”‡ǡ…Ÿ–‡ͳͲ‹ȋ…Ÿ–‡ͳ͸ǡͻΨ
†‹–‹’ϐ‹‡…ƒ”‡ȌǤ
În decurs de un an, „—‰‡–—Ž†‡–‹’–‘–ƒŽƒ…‘”†ƒ–†‡…£–”‡
ƒ”‡Ž Ǥǡ 셑 Ǥǡ ‡”„—Ž‡…‘ Ǥ ȋ’–‹‹œƒ”‡ƒ ƒc–‹˜‹–£ì‹Žo” †‡
’”oϔ‹Žƒš‹‡ ƒ ƒŽƒ†‹‹Žo” è‹ ’”oo˜ƒ”‡ ƒ •£n£–£ì‹‹ Žƒ n‹˜‡Ž—Ž ƒ•‹•Ǧ
–‡n쇋 ‡†‹cƒŽ‡ ’”‹ƒ”‡ǡ Š‹è‹n£—ǡ ͸Ͷ1ͽ); Spinei L., Gaberi C.
(P”o‰”ƒ‡Ž‡ †‡ ”‡†—c‡”‡ ƒ ”‹•c—”‹Žo” ƒ•—’”ƒ •£n£–£ì‹‹ ’‡”•oƒǦ
n‡Žo” cƒ”‡ ‹nŒ‡c–‡ƒœ£ †”o‰—”‹ Án ‡’—„Ž‹cƒ oŽ†o˜ƒǡ Š‹è‹n£—ǡ
ƒ•‹•–‡–—Ž‡†‹…ƒŽ’”‘‘˜£”‹‹•££–£ì‹‹ƒ…‘•–‹–—‹–ͳͷǤ͸ʹͲ†‡
minute, care a fost utilizat pentru ǷgcoŽ‹Ž‡ †‡ •£n£–ƒ–‡dz (3.960
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Š‹†—Ž •’‡c‹ƒŽ‹•–—Ž—‹Ǥ o”ƒ”‡ƒ
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development and implementation of a Pedagogical Future
Training Model in Health Care Training and Health Education
of the Population at the community level in the continuing
medical training of nurses will enable nurses to develop skills
‹ ’”‘‘–‹‰ Š‡ƒŽ–Š› „‡Šƒ˜‹‘”ǡ –Š‡ ‹ϐŽ—‡…‡ „› ™Š‹…Š –Š‡
community member forms an alternative future, to develop
an action plan to design the key aspects of health education,
’–‹‹œ‹n‰ –Š‡ ™o” oˆ n—”•‡• ‹n ’”oo–‹n‰ Š‡ƒŽ–Š MJHS 17(3)/2018 67

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$ REVIEW ARTICLE

Mecanismele etiopatogenetice Current etiopathogenetic

‹’Ž‹…ƒ–‡Á†‡œ˜‘Ž–ƒ”‡ƒ mechanisms involved in the
–‹”‘‹†‹–‡‹ƒ—–‘‹—‡ǣ•‹–‡œ£ development of autoimmune
ƒ”ƒ–‹˜£†‡Ž‹–‡”ƒ–—”£ thyroiditis: narrative review
Stela Vudu2*†, Carolina Piterschi2†, Lorina Vudu1,2†, Stela Vudu2*†, Carolina Piterschi2†, Lorina Vudu1,2†,
Larisa Zota1† Larisa Zota1†
1
ƒ–‡†”ƒ †‡ ‡n†oc”‹noŽo‰‹‡ǡ n‹˜‡”•‹–ƒ–‡ƒ †‡ S–ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ 1
Šƒ‹” oˆ ‡n†oc”‹noŽo‰›ǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn†
Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—Dzǡ Š‹è‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǢ PŠƒ”ƒc›ǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǢ
͸
ƒ„o”ƒ–o”—Ž †‡ ‡n†oc”‹noŽo‰‹‡ǡ n‹˜‡”•‹–ƒ–‡ƒ †‡ S–ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ ͸
ƒ„o”ƒ–o”› oˆ ‡n†oc”‹noŽo‰›ǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡
Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—Dzǡ Š‹è‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǤ ƒn† PŠƒ”ƒc›ǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǤ

Data primirii manuscrisului: 02.05.2018 Manuscript received on: 02.05.2018

ƒ–ƒƒ……‡’–£”‹‹•’”‡’—„Ž‹…ƒ”‡ǣʹ͸ǤͲͻǤʹͲͳͺ ……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣʹ͸ǤͲͻǤʹͲͳͺ

Autor corespondent: Corresponding author:

S–‡Žƒ —†—ǡ †oc–o”ƒn† S–‡Žƒ —†—ǡ PŠ ˆ‡ŽŽo™
ƒ„o”ƒ–o”—Ž †‡ ‡n†oc”‹noŽo‰‹‡ ƒ„o”ƒ–o”› oˆ ‡n†oc”‹noŽo‰›
n‹˜‡”•‹–ƒ–‡ƒ †‡ S–ƒ– †‡ ‡†‹c‹n£ ç‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹–ìƒn—Dz ‹coŽƒ‡ ‡•–‡‹–ƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
„†Ǥ f–‡ˆƒn c‡Ž ƒ”‡ ç‹ SˆŸn–ǡ 1ͼͻǡ Š‹ç‹n£—ǡ ‡’—„Ž‹cƒ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ 1ͼͻǡ S–‡ˆƒn c‡Ž ƒ”‡ •‹ Sˆƒn– ƒ˜‡Ǥǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒ
‡Ǧƒ‹Ž: •–‡ŽŽƒǤ˜—†—̻‰ƒ‹ŽǤco ‡Ǧƒ‹Ž: •–‡ŽŽƒǤ˜—†—̻‰ƒ‹ŽǤco

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

B—Ž–‹‹‹ƒ‹ǡ†ƒ–‘”‹–£…‡”…‡–£”‹Ž‘”Á†‘‡‹—ǡƒ—ƒ’£”—– New data have recently emerged about the etiopathogen-
noi date despre etiopatogenia tiroiditei autoimune, astfel esis of autoimmune thyroiditis, thus leading to a new diagnos-
Ž£•Ÿ†Ž‘…’‡–”—‘‘—£ƒ„‘”†ƒ”‡†‹ƒ‰‘•–‹…£ç‹–‡”ƒ’‡—–‹…£ tic and therapeutic approach of the patient with Hashimoto’s
ƒ’ƒ…‹‡–—Ž—‹…—–‹”‘‹†‹–£ƒ•Š‹‘–‘Ǥ thyroiditis.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
Prezentarea mecanismelor etiopatogenetice contempo-
rane ale tiroiditei autoimune.
‘—–ƒ–‡ƒƒ†—•£Ž‹–‡”ƒ–—”‹‹疋‹ì‹ϐ‹…‡†‹†‘‡‹—
 ˆ‘•– ‡ˆ‡…–—ƒ–£ •‹•–‡ƒ–‹œƒ”‡ƒ ‹ˆ‘”ƒì‹‡‹ ”‡ˆ‡”‹–‘ƒ”‡ Žƒ
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ƒ…‘”†ƒ–£ †ƒ–‡Ž‘” ”‡…‡–‡ †‡•’”‡ ”‘Ž—Ž  ç‹ ƒ ‹…”‘„‹‘–‡‹Ǥ
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în domeniu.
‡œ—ƒ–
Introducere.‹”‘‹†‹–ƒƒ—–‘‹—£ƒ”‡‘’”‡˜ƒŽ‡ì£ÁƒŽ–£Ǥ
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Ž£•Ÿ†ǡ ƒ•–ˆ‡Žǡ Ž‘… †‡†‡œ„ƒ–‡”‹Á …‡‡ƒ…‡’”‹˜‡è–‡ ƒ„‘”†ƒ”‡ƒ
…Ž‹‹…£ƒƒ…‡•–‘”’ƒ…‹‡ì‹ǤB—Ž–‹—Ž–‹’ǡ•‡˜‘”„‡è–‡–‘–ƒ‹
—Ž–†‡•’”‡‹ϐŽ—‡ìƒ”‡…‡’–‘”‹Ž‘”ǡƒ‹…”‘„‹‘–‡‹ƒ•—’”ƒ
‡…ƒ‹•‡Ž‘” ‡–‹‘’ƒ–‘‰‡‡–‹…‡ †‹ –‹”‘‹†‹–ƒ ƒ—–‘‹—£Ǥ •–-
Research hypothesis
Presentation of the contemporary etiopathogenetic mecha-
nisms of autoimmune thyroiditis.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
The systematization of information on the etiopathogen-
esis of autoimmune thyroiditis has been carried out, with par-
ticular attention given to recent data on the role of TLRs and
microbiota. A limited number of studies are currently availa-
ble on this subject, so a review article presents the latest data,
™Š‹…Š…ƒ•‡”˜‡ƒ•ƒ‹’—Ž•‡ˆ‘”‡™”‡•‡ƒ”…Š‹–Š‡ϐ‹‡Ž†Ǥ
Abstract
Introduction. Autoimmune thyroiditis has a high preva-
lence. Clinical manifestations of hypothyroidism due to Hashi-
moto thyroiditis are not always improved by levothyroxine
treatment, thus causing debate on the clinical approach of
–Š‡•‡ ’ƒ–‹‡–•Ǥ ƒ–‡Ž›ǡ ”‡•‡ƒ”…Š‡• ‹ –Š‡ ϐ‹‡Ž† •—‰‰‡•– ‘ŽŽǦ
Ž‹‡”‡…‡’–‘”•ǡ–Š‡‹…”‘„‹‘–ƒ‹ϐŽ—‡…‡–Š‡‡–‹‘’ƒ–Š‘‰‡‡–‹…
mechanisms of autoimmune thyroiditis. Thus, recent data
E–‹o’ƒ–Šo‰‡n‡–‹c ‡cŠƒn‹•• ‹n˜oŽ˜‡† ‹n –Š‡ †‡˜‡Žo’‡n– oˆ ƒ—–o‹—n‡ –Š›”o‹†‹–‹•
fel, datele recente ar putea, în viitorul apropiat, schimba mo-
†—Ž †‡ ƒ„‘”†ƒ”‡ ƒ ’ƒ…‹‡–—Ž—‹ …— –‹”‘‹†‹–£ ƒ—–‘‹—£ Ȃ †‡ Žƒ
–‡•–‡Ž‡†‹ƒ‰‘•–‹…‡’Ÿ£Žƒ’”‹…‹’‹‹Ž‡†‡–”ƒ–ƒ‡–ǤBƒ…‡•–£
lucrare, ne-am propus sa facem review-ul datelor din literatu-
”£”‡ˆ‡”‹–‘ƒ”‡Žƒ‡…ƒ‹•‡Ž‡†‡†‡œ˜‘Ž–ƒ”‡ƒŽ‡–‹”‘‹†‹–‡‹ƒ—-
toimune.
ƒ–‡”‹ƒŽ è‹ ‡–‘†‡Ǥ Pentru a selecta datele din literatu-
”£ǡƒˆ‘Ž‘•‹–„ƒœƒ†‡†ƒ–‡—„‡†ǡ—–‹Ž‹œŸ†…—˜‹–‡Ž‡…Š‡‹‡
Ƿƒ—–o‹—n‡ –Š›”o‹†‹–‹•dz, Ƿdz, Ƿ‹c”o„‹o–ƒdz. Astfel, a fost sin-
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‡œ—Ž–ƒ–‡Ǥ Mecanismele patogenetice contemporane din
–‹”‘‹†‹–ƒƒ—–‘‹—£•—–‹‹…”‹ƒ‘Ž‡…—Žƒ”£ǡƒ…–‹˜ƒ”‡ƒƒ”-
torului, apoptoza celulelor tiroidiene. Studiile recente evi-
†‡ì‹ƒœ£”‘Ž—Ž‹…”‘„‹‘–‡‹è‹ƒŽƒ…–‹˜£”‹‹ƒ„‡”ƒ–‡ƒ•‹•–‡—Ž—‹
‹—Á£•…—–Á’ƒ–‘‰‡‹ƒ–‹”‘‹†‹–‡‹ƒ—–‘‹—‡Ǥ
‘…Ž—œ‹‹Ǥ—‘ƒè–‡”‡ƒ‘‹Ž‘”‡…ƒ‹•‡‡–‹‘’ƒ–‘‰‡‡–‹-
…‡Á–‹”‘‹†‹–ƒƒ—–‘‹—£˜ƒ‘ˆ‡”‹ǡÁ˜‹‹–‘”ǡ’‘•‹„‹Ž‹–ƒ–‡ƒ—‡‹
‘‹ƒ„‘”†£”‹†‹ƒ‰‘•–‹…‡è‹–‡”ƒ’‡—–‹…‡ƒ’ƒ…‹‡–—Ž—‹…—Š‹’‘-
tiroidie.
Cuvinte cheie:–‹”‘‹†‹–£ƒ—–‘‹—£ǡǡ‹…”‘„‹‘–£Ǥ
Introducere
‹”‘‹†‹–ƒ ƒ—–‘‹—£ ȋȌ ‡•–‡ …‡ƒ ƒ‹ ˆ”‡…˜‡– Á–ŸŽ‹–£
’ƒ–‘Ž‘‰‹‡ ƒ—–‘‹—£ ƒ –‹”‘‹†‡‹ǡ …ƒ”ƒ…–‡”‹œƒ–£ ’”‹ ‹ϐ‹Ž–”ƒ”‡ƒ
MJHS 17(3)/2018 69
could in the near future change the approaches to proper di-
agnostic tests and treatment principles of the patient with au-
toimmune thyroiditis. In this paper we intend to review the
literature in terms of mechanisms of development of autoim-
mune thyroiditis.
Material and methods. The PubMed database was used
in order to select the data from the literature, using the key-
words Dzƒ—–o‹—n‡ –Š›”o‹†‹–‹•dz, Dzdz, Dz‹c”o„‹o–ƒdz. Thus, the
information containing the data on the etiopathogenesis of au-
toimmune thyroiditis was retained.
Results. Contemporary pathogenetic mechanisms of auto-
immune thyroiditis are molecular mimicry, bystander activa-
tion, and thyroid cell apoptosis. Recent studies highlight the
role of microbiota and aberrant activation of the innate im-
mune system in the pathogenesis of autoimmune thyroiditis.
Conclusions. Knowing the new etiopathogenetic mecha-
nisms in autoimmune thyroiditis will in the future provide the
possibility of a new diagnostic and therapeutic approach of
the patient with hypothyroidism.
Key words: autoimmune thyroiditis, TLR, microbiota.
Introduction
Autoimmune thyroiditis (AT) is the most common autoim-
mune pathology of the thyroid, characterized by lymphocytic
Ž‹ˆ‘…‹–ƒ”£ ƒ 쇕—–—Ž—‹ –‹”‘‹†‹ƒ ȏͳȐǤ †‹…ƒ–‘”‹‹ „‹‘…Š‹‹…‹ ƒ‹
ƒŽƒ†‹‡‹ •—– ƒ–‹…‘”’‹‹ Á’‘–”‹˜ƒ –‹”‡‘’‡”‘š‹†ƒœ‡‹ è‹ –‹”‡‘-
globulinei. TA poate evolua spre hipotiroidie, necesitând tra-
–ƒ‡– †‡ •—„•–‹–—싇 …— Ž‡˜‘–‹”‘š‹£Ǥ ‘ˆ‘” †ƒ–‡Ž‘” —†—
ǤȋʹͲͳͶȌǡʹǦ͸Ψ†‹’‘’—Žƒì‹‡•—ˆ‡”£†‡Š‹’‘–‹”‘‹†‹‡ȏʹȐǡƒŒ—-
‰Ÿ† ’Ÿ£ Žƒ ͻǡͷΨ †‹ ’‘’—Žƒì‹ƒ ƒ†—Ž–£ǡ …‘ˆ‘” †ƒ–‡Ž‘” Ž—‹
‘ŽŽ‘™‡ŽŽ
Ǥ èǤ ƒǤ ȏ͵ȐǤ ‹”‘‹†‹–ƒ ƒ—–‘‹—£ •‡ Á–ŸŽ‡è–‡ǡ ƒ‹ J. ‡– ƒŽǤ [3]. Autoimmune thyroiditis occurs more frequently in
ˆ”‡…˜‡–ǡŽƒˆ‡‡‹†‡…Ÿ–Žƒ„£”„ƒì‹ǡ‹ƒ””ƒ’‘”–—Ž‡•–‡†‡͹ǣ͵ȏͶȐǤ
Sunt câteva mecanisme etiopatogenetice recunoscute în
†‡œ˜‘Ž–ƒ”‡ƒ ǡ …ƒ”‡ ‹’Ž‹…£ ƒ–Ÿ– Ž‹ˆ‘…‹–‡Ž‡ ǡ …Ÿ– è‹ Ǥ ‹-
ˆ‘…‹–‡Ž‡ƒŽ‡…‡Ž—Ž‡Ž‘”–‹”‘‹†‹‡‡•—–ƒ…–‹˜ƒ–‡è‹•‡…”‡–£ƒ–‹-
…‘”’‹–‹”‘‹†‹‡‹ǡ‹ƒ”Ž‹ˆ‘…‹–‡Ž‡•‡…”‡–£…‹–‘‹‡ǡŒ‘ƒ…£—”‘Ž
Áˆ‘”ƒ”‡ƒ†‡ƒ–‹…‘”’‹ǡÁƒ’‘’–‘œƒ…‡Ž—Ž‡Ž‘”–‹”‘‹†‹‡‡è‹Á
”‡‰Žƒ”‡ƒ”£•’—•—Ž—‹‹—Ž‘…ƒŽȏͷȐǤ
Obiectivul acestui articol a fost prezentarea mecanismelor
patogenetice contemporane ale tiroiditei autoimune.
ƒ–‡”‹ƒŽç‹‡–‘†‡
—”•ƒ†‡…£—–ƒ”‡ƒˆ‘•–„ƒœƒ†‡†ƒ–‡‘Ž‹‡—„‡†ȋ•‡”-
‹ϐ‹Ž–”ƒ–‹‘‘ˆ–Š›”‘‹†–‹••—‡ȏͳȐǤ‹‘…Š‡‹…ƒŽ‹†‹…ƒ–‘”•‘ˆ–Š‡
disease are antibodies against thyroid peroxidase and thyro-
globulin. AT may evolve to hypothyroidism, requiring levothy-
roxine substitution treatment. According to Vudu L. (2014),
2-6% of the population suffer from hypothyroidism [2], reach-
ing up to 9.5% of the adult population, according to Hollowell
™‘‡–Šƒ‹‡ǡƒ†–Š‡”ƒ–‹‘‹•͹ǣ͵ȏͶȐǤ
There are several etiopathogenetic mechanisms recog-
nized in AT development, involving both B and T lymphocytes.
Thyroid cells B lymphocytes are activated and secrete thyroid
antibodies. Cytokine-secreting T lymphocytes play a role in
antibody formation, in thyroid cell apoptosis and in regulating
local immune response [5].
The purpose of this article is to present the contemporary
pathogenetic mechanisms of autoimmune thyroiditis.
Material and methods
The search source was the PubMed online database (Na-
˜‹…‹—Ž‹„”£”‹‡‹ƒì‹‘ƒŽ‡†‡‡†‹…‹£ƒ•–‹–—‹–—Ž—‹ƒì‹‘ƒŽ
†‡££–ƒ–‡ƒŽ–ƒ–‡Ž‘”‹–‡ǢS ƒ–‹onƒŽ ‹„”ƒ”› oˆ ‡†‹c‹n‡ǡ
ƒ–‹onƒŽ In•–‹–—–‡ oˆ ‡ƒŽ–Š) [6]. Articolele au fost selectate în
baza cuvintelor cheie Ƿƒ—–o‹—n‡ –Š›”o‹†‹–‹•dz, Ƿdz, Ƿ‹c”oǦ
„‹o–ƒdz, publicate in perioada anilor 2000-2017. De asemenea,
ƒ…£—–ƒ–•—”•‡Ž‡„‹„Ž‹‘‰”ƒϐ‹…‡ƒŽ‡ƒ”–‹…‘Ž‡Ž‘”‹†‡–‹ϐ‹…ƒ–‡’”‹
ƒ…‡ƒ•–£…£—–ƒ”‡è‹Ž‡Ǧƒ•‡Ž‡…–ƒ–’‡…‡Ž‡…‘•‹†‡”ƒ–‡”‡Ž‡˜ƒ–‡Ǥ
—ˆ‘•–”‡ì‹—–‡–‹–Ž—”‹Ž‡…‡’—–‡ƒ—…‘ì‹‡‹ˆ‘”ƒì‹‡†‡•’”‡
’ƒ–‘‰‡‹ƒ–‹”‘‹†‹–‡‹ƒ—–‘‹—‡ǡ”‘Ž—Ž‹…”‘„‹‘–‡‹è‹‹ϐŽƒƒì‹‡‹
•—„…Ž‹‹…‡Á†‡œ˜‘Ž–ƒ”‡ƒ–‹”‘‹†‹–‡‹ƒ—–‘‹—‡Ǥƒ–‡Ž‡‘„싐—–‡
ƒ— ˆ‘•– •‹•–‡ƒ–‹œƒ–‡ǡ ƒƒŽ‹œƒ–‡ è‹ ’”‡œ‡–ƒ–‡ •—„ ˆ‘”ƒ —‡‹
sinteze narative.
tional Medicine Library of the United States National Insti-
tutes of Health) [6]. The articles were selected based on the
keywords Dzƒ—–o‹—n‡ –Š›”o‹†‹–‹•dz, Dzdz, Dz‹c”o„‹o–ƒdz, pub-
lished during the period 2000-2017. We have also searched
ˆ‘” –Š‡ „‹„Ž‹‘‰”ƒ’Š‹… •‘—”…‡• ‘ˆ ƒ”–‹…Ž‡• ‹†‡–‹ϐ‹‡† „› –Š‹•
search and selected those that were considered relevant. The
titles that could contain information about autoimmune thy-
roid disease pathogenesis, the role of microbiota and subclini-
…ƒŽ‹ϐŽƒƒ–‹‘‹–Š‡†‡˜‡Ž‘’‡–‘ˆƒ—–‘‹—‡–Š›”‘‹†-
itis were retained. The data obtained were systematized and
analyzed.
70
‡œ—Ž–ƒ–‡
P”‡Ž—c”ƒ”‡ƒ ‹nˆo”ƒì‹‡‹
B „ƒœƒ †‡ †ƒ–‡ —„‡† ƒ— ˆ‘•– ‰£•‹–‡ ͵ͳʹ ƒ”–‹…‘Ž‡ …ƒ”‡
ƒ—…‘”‡•’—•…”‹–‡”‹‹Ž‘”†‡…£—–ƒ”‡ǡ’—„Ž‹…ƒ–‡Á–”‡ƒ‹‹ʹͲͲͲ
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†‡”ƒ–‡…ƒϐ‹‹†’”‘„ƒ„‹Ž”‡Ž‡˜ƒ–‡–‡‡‹ƒ…‡•–—‹”‡˜‹‡™Ǥ—ˆ‘•–
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textul integral al tuturor articolelor. De asemenea, am consul-
–ƒ–•—”•‡Ž‡„‹„Ž‹‘‰”ƒϐ‹…‡ƒŽ‡ƒ”–‹…‘Ž‡Ž‘”‹†‡–‹ϐ‹…ƒ–‡’”‹…£—–ƒ-
”‡ƒ”‡•’‡…–‹˜£è‹Ž‡Ǧƒ•‡Ž‡…–ƒ–’‡…‡Ž‡…‘•‹†‡”ƒ–‡’‡”–‹‡–‡Ǥ
‹”‘‹†‹–ƒƒ—–‘‹—£‡•–‡—ƒ†‹…‡Ž‡ƒ‹ˆ”‡…˜‡–‡…ƒ—œ‡
ƒŽ‡Š‹’‘–‹”‘‹†‹‡‹’”‹ƒ”‡ȏ͹ȐǤƒ•‡…ƒ”ƒ…–‡”‹œ‡ƒœ£…Ž‹‹…’”‹
‡—ǦǡŠ‹’‡”Ǧ•ƒ—Š‹’‘–‹”‘‹†‹‡ǡ…—•ƒ—ˆ£”£‰—è£Ǥ‹•–‘Ž‘‰‹…ǡ•‡†‡-
•…”‹‡‹ϐ‹Ž–”ƒì‹ƒŽ‹ˆ‘‹†£ƒ–‹”‘‹†‡‹ǡ…ƒ”‡‹…Ž—†‡…‡Ž—Ž‡è‹ǡè‹
†‹•–”—‰‡”‡ˆ‘Ž‹…—Žƒ”£ǤƒŒ‘”‹–ƒ–‡ƒ’ƒ…‹‡ì‹Ž‘”ƒ——–‹–”—…”‡•-
cut de anticorpi împotriva antigenilor tiroidieni.
Câteva mecanisme patogenetice au fost descrise în pato-
‰‡‡œƒǤ‹‹…”‹ƒ‘Ž‡…—Žƒ”£‹’Ž‹…£”£•’—•—Ž‹—Žƒ—
ƒ–‹‰‡•–”£‹…ƒ”‡ǡ•–”—…–—”ƒŽǡ‡•–‡ƒ•‡££–‘”…—•—„•–ƒìƒ
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’—•—Žƒ–‹…‘”’‹Ž‘”è‹…‡Ž—Ž‡Ž‘”ƒŽ‡‰ƒœ†‡‹è‹’‘ƒ–‡ƒ˜‡ƒŽ‘…
‘ ”‡ƒ…싇 ‹…”—…‹èƒ–£ …— ’”‘–‡‹ƒ †‡ 葅 –‡”‹… ƒ ‰ƒœ†‡‹ ȏͺȐǤ
ƒ…£’”‘–‡‹ƒ‹ƒ–£‡•–‡—ƒ–‹‰‡–‹”‘‹†‹ƒǡ’‘ƒ–‡ƒ’£”‡ƒ
tiroidita.
Activarea martorului este detectarea unui virus în celulele
–‹”‘‹†‹‡‡ǡ…ƒ”‡’‘ƒ–‡’”‘˜‘…ƒ‡Ž‹„‡”ƒ”‡ƒŽ‘…ƒŽ£†‡…‹–‘‹‡è‹
ƒ…–‹˜ƒ”‡ƒ…‡Ž—Ž‡Ž‡Ž‘”–‹”‘‹†‹‡‡•’‡…‹ϐ‹…‡ȏͻȐǤ
Antigenele HLA clasa II sunt prezente pe celulele tiroidiene
ˆ‘Ž‹…—Žƒ”‡ƒŽ‡’ƒ…‹‡ì‹Ž‘”…—ǡ†ƒ”—苃Ž‡…‡Ž‘”ˆ£”£ǡ苃—
rolul de celule prezentatoare de antigen [10]. Câteva consta-
–£”‹•—•ì‹ƒ…‡ƒ•–£‹’‘–‡œ£ǣ
ƒinterferonul gamma poate induce moleculele MHC clasa
II pe celulele foliculare tiroidiene [11];
ƒ…‡Ž—Ž‡Ž‡ ˆ‘Ž‹…—Žƒ”‡ –‹”‘‹†‹‡‡ǡ …ƒ”‡ ‡š’”‹£ ‘Ž‡…—Ž‡
MHC de clasa II, pot prezenta antigenele peptidice virale
celulelor T umane clonate [12].
Apoptoza celulelor tiroidiene este fenomenul patologic
principal din TA.
‡Ž—Ž‡Ž‡ ‡’‹–‡Ž‹ƒŽ‡ –‹”‘‹†‹‡‡ ‘”ƒŽ‡ ‡š’”‹£ ”‡…‡’–‘”—Ž
ƒ’‘’–‘œ‡‹ ƒ•ǡƒ…–‹˜ƒ”‡ƒ…£”—‹ƒƒ”’—–‡ƒ…‘–”‹„—‹Žƒ†‹•–”—‰‡-
‡cƒn‹•‡Ž‡ ‡–‹o’ƒ–o‰‡n‡–‹c‡ ‹’Ž‹cƒ–‡ Án †‡œ˜oŽ–ƒ”‡ƒ –‹”o‹†‹–‡‹ ƒ—–o‹—n‡
Results
Inˆo”ƒ–‹on ’”oc‡••‹n‰
A number of 312 articles matching the search criteria were
found in the PubMed database and published between 2000
and 2017. A number of 123 articles were considered likely to
be relevant to this review, after the titles analysis. The articles
in English have been selected. Access to the full test of all ar-
ticles has been obtained. We also looked at the bibliographic
•‘—”…‡• ‘ˆ –Š‡ ƒ”–‹…Ž‡• ‹†‡–‹ϐ‹‡† „› –Š‹• •‡ƒ”…Š ƒ† •‡Ž‡…–‡†
those that were considered pertinent.
Autoimmune thyroiditis is one of the most common causes
of primary hypothyroidism [7]. It is characterized clinically
by eu-, hyper- or hypothyroidism, with or without goiter. The
Š‹•–‘Ž‘‰›†‡•…”‹„‡•Ž›’Š‘‹†‹ϐ‹Ž–”ƒ–‹‘‘ˆ–Š‡–Š›”‘‹†ǡ™Š‹…Š
includes B and T cells and follicular destruction. Most patients
have high antibody titers against thyroid antigens.
Several pathogenetic mechanisms have been described in
the pathogenesis of AT. Molecular mimicry involves the im-
mune response to a foreign antigen that is structurally similar
to the endogenous substance. During a bacterial infection, the
response of the host include antibodies and T cells response
and a cross reaction with the host’s thermal shock protein
may occur [8]. If the mimic protein is a thyroid antigen, thy-
roiditis may occur.
Bystander activation is the detection of a virus in thyroid
cells, which may cause local cytokine release and activation of
•’‡…‹ϐ‹…–Š›”‘‹†…‡ŽŽ•ȏͻȐǤ
Class II HLA antigens are present on follicular thyroid cells
of patients with AT, but not healthy people, and play the role
‘ˆƒ–‹‰‡’”‡•‡–‹‰…‡ŽŽ•ȏͳͲȐǤ‡˜‡”ƒŽϐ‹†‹‰••—’’‘”––Š‹•
Š›’‘–Š‡•‹•ǣ
ƒ interferon gamma can induce MHC class II molecules on
thyroid follicular cells [11];
ƒ thyroid follicular cells expressing MHC class II molecules
may present the viral peptide viruses to cloned human T
cells [12].
Apoptosis of thyroid cells is the primary pathological phe-
nomenon of AT. Normal thyroid epithelial cells express the Fas
apoptosis receptor, activation of which could contribute to the
destruction of AT characteristic follicular cells [13]. IL-1 pro-
”‡ƒ…‡Ž—Ž‡Ž‘”ˆ‘Ž‹…—Žƒ”‡…ƒ”ƒ…–‡”‹•–‹…‡ȏͳ͵ȐǤǦͳǡ’”‘†—•£†‡
…‡Ž—Ž‡Ž‡ǡ‹†—…‡‡š’”‹ƒ”‡ƒŽ‹‰ƒ†—Ž—‹ ƒ•è‹ǡƒ•–ˆ‡Žǡ’”‘˜‘ƒ…£
auto-apoptoza [14].
Triggerii TA sunt aportul excesiv de iod [15], unele medi-
…ƒ‡–‡è‹‹ˆ‡…ì‹‹ȏͳ͸Ȑǡ‹…”‘…Š‹‡”‹•—Žˆ‡–ƒŽȏͳ͹Ȑǡ•ƒ”…‹ƒ
è‹•‡š—Žˆ‡‹‹ȏͳͺȐǡ•–”‡•—Žǡ•—•…‡’–‹„‹Ž‹–ƒ–‡ƒ‰‡‡–‹…£ȏͳͻȐǤ
B’‘ϐ‹†ƒ’”‡˜ƒŽ‡ì‡‹ÁƒŽ–‡ǡ‡…ƒ‹•‡Ž‡‡–‹’ƒ–‘‰‡‡–‹…‡
ale maladiei nu sunt pe deplin elucidate.
În ultimii ani, apar tot mai multe date despre noi mecanis-
‡‹’Ž‹…ƒ–‡Á’ƒ–‘‰‡‡œƒǡ…—ƒ”ϐ‹”‘Ž—Ž‹…”‘„‹‘–‡‹è‹
”‘Ž—ŽǤ–—†‹‹Ž‡”‡…‡–‡ƒ—†‡‘•–”ƒ–”‘Ž—Žƒ…–‹˜£”‹‹ƒ„‡-
”ƒ–‡ƒ•‹•–‡—Ž—‹‹—Á£•…—–Á’ƒ–‘‰‡‡œƒǤ‡•–‡
‘ ˆƒ‹Ž‹‡ †‡ ͳͲ ”‡…‡’–‘”‹ ƒ‹ •—’”ƒˆ‡ì‡‹ …‡Ž—Žƒ”‡ǡ …ƒ”‡ǡ Á’”‡-
duced by T cells induces expression of the Fas ligand and thus
causes auto-apoptosis [14].
AT triggers are excessive iodine intake [15], some drugs
and infections [16], fetal microchimerism [17], pregnancy and
female sex [18], stress, genetic susceptibility [19].
Despite the high prevalence, the etiopathogenetic mecha-
nisms of the disease are not fully elucidated. In recent years,
there is growing evidence of new mechanisms involved in AT
pathogenesis, such as the role of the microbiota and the role of
TLRs. Recent studies have demonstrated the role of aberrant
activation of the innate immune system in the pathogenesis of
AT. TLR is a family of 10 cell surface receptors, which together
with IL-1 receptors form the superfamily of the ‹n–‡”Ž‡—‹nǦ1
—£ …— ”‡…‡’–‘”‹‹ Ǧͳǡ ˆ‘”‡ƒœ£ •—’‡”ˆƒ‹Ž‹ƒ Ƿ‹n–‡”Ž‡—‹nǦ1 ”‡c‡’–o” Ȁ –oŽŽǦŽ‹‡ ”‡c‡’–o” [20]. TLRs are so named for their
”‡c‡’–o” Ȁ –oŽŽǦŽ‹‡ ”‡c‡’–o”dzȏʹͲȐǤ•—–—‹ì‹ƒ•–ˆ‡Ž’‡- similarity to Toll, a ”o•o’Š‹Žƒ receptor that is crucial in pro-
tru similitudinea lor cu Toll, un receptor al Drosophilei, care tecting against fungal infection [21]. These receptors protect
E–‹o’ƒ–Šo‰‡n‡–‹c ‡cŠƒn‹•• ‹n˜oŽ˜‡† ‹n –Š‡ †‡˜‡Žo’‡n– oˆ ƒ—–o‹—n‡ –Š›”o‹†‹–‹•
‡•–‡…”—…‹ƒŽÁ’”‘–‡…싃Á’‘–”‹˜ƒ‹ˆ‡…싇‹ˆ—‰‹…‡ȏʹͳȐǤ…‡è–‹
”‡…‡’–‘”‹ ’”‘–‡Œ‡ƒœ£ ƒ‹ˆ‡”‡Ž‡ †‡ ‹…”‘‘”‰ƒ‹•‡ǡ ’”‘-
˜‘…Ÿ† ”ƒ•’—•—Ž •‹•–‡—Ž—‹ ‹— Á£•…—– ȏʹʹȐǤ £•’—•—Ž
‹— Á£•…—– ƒ…–‹˜‡ƒœ£ ‰‡‡Ž‡ ’‡–”— …Ÿ–‡˜ƒ …‹–‘‹‡ ‹ϐŽƒ-
ƒ–‘”‹‹è‹‡•–‡‡•‡ì‹ƒŽ’‡–”—†‡œ‘Ž–ƒ”‡ƒ‹—‹–£ì‹‹ƒ†ƒ’–‹˜‡
ƒ–‹‰‡Ǧ•’‡…‹ϐ‹…‡ǡƒ–Ÿ–—‘”ƒŽ‡ǡ…Ÿ–è‹…‡Ž—Žƒ”‡ȏʹ͵ȐǤ•—–
prezente în monocite, macrofagi, celule imune. TLR3, care me-
†‹ƒœ£”£•’—•—Žƒ–‹˜‹”ƒŽȏʹͶȐǡ‡•–‡’”‡œ‡–ǡ’”‡’‘†‡”‡–ǡÁ
…‡Ž—Ž‡Ž‡†‡†”‹–‹…‡Ȃ…‡Ž—Ž‡’”‡œ‡–ƒ–‘ƒ”‡†‡ƒ–‹‰‡ǡ…ƒ”‡’”‘-
…‡•‡ƒœ£ǡƒ’‘‹’”‡œ‹–£’‡’–‹†‡Ž‡ƒ–‹‰‡‹…‡…‡Ž—Ž‡Ž‘”Ž‹ˆ‘‹†‡
din organele limfoide [25]. Recent, TLR3 au fost descrise pe
celulele nonimune, în asociere cu maladiile autoimune. TLR3
din celulele beta ale pancreasului sunt implicate în patogene-
œƒ‹•—Ž‹‹–‡‹è‹†‹ƒ„‡–—Ž—‹†‡–‹’ͳȏʹ͸Ȑè‹ǡƒ‹‘—ǡÁ–‹”‘‹†‹–ƒ
ƒ—–‘‹—£ȏʹ͹ȐǤ
—£”–‘–ƒ‹ƒ”‡†‡†‘˜‡œ‹•—‰‡”‡ƒœ£‹’Ž‹…ƒ”‡ƒ‹-
croorganismelor comensale nepatogene în dezvoltarea tiroi-
†‹–‡‹ƒ•Š‹‘–‘ǡ’”‹‹†—…‡”‡ƒ”£•’—•—”‹Ž‘”‹—‡’”‘‹ϐŽƒ-
ƒ–‘”‹‹Žƒ‰ƒœ†£Ǥ–—†‹‹Ž‡ƒ”ƒ–£”‘Ž—Ž…”‹–‹…ƒŽ‹…”‘„‹‘–‡‹‹–‡•-
tinale comensale în dezvoltarea bolilor autoimune. Microbiota
‹–‡•–‹ƒŽ£‡•–‡…‘’—•£†‹’‡•–‡ͳʹͲͲ†‡•’‡…‹‹†‡„ƒ…–‡”‹‹
ƒƒ‡”‘„‡è‹ƒ‡”‘„‡ǡ„ƒ…–‡”‹‘ˆƒ‰‹ǡ˜‹”—è‹è‹ˆ—‰‹ȏʹͺȐǤ…‡ƒ•–£
’‘’—Žƒì‹‡†‡„ƒ…–‡”‹‹‡•–‡”‡’”‡œ‡–ƒ–£ǡ’”‡’‘†‡”‡–ǡ†‡•’‡-
ciile Bƒc–‡”‹o‹†‡–‡•, ‹”‹c—–‡•, c–‹no„ƒc–‡”‹ƒ, P”o–‡o„ƒc–‡”‹ƒ
苇””—co‹c”o„‹ƒ. Un studiu, publicat recent în Š›”o‹†ǡƒ”ƒ–£
…£ ’ƒ…‹‡ì‹‹ …—  ƒ— ‘ ‹…”‘„‹‘–£ ‹–‡•–‹ƒŽ£ ƒ‹ ˜ƒ”‹ƒ–£ è‹
ƒ‹ „‘‰ƒ–£ ȋȽǦ†‹˜‡”•‹–ƒ–‡Ȍ †‡…Ÿ– ’‡”•‘ƒ‡Ž‡ •££–‘ƒ•‡ ȏʹͻȐǤ
Specia ‹”‹c—–‡• ‡”ƒ ƒ‹ ƒ„—†‡–£ǡ ‹ƒ” Bƒc–‡”o‹†‡–‡• mai
’—싐ƒ„—†‡–£ǡ…‡‡ƒ…‡‡•–‡…ƒ”ƒ…–‡”‹•–‹…‹…”‘„‹‘–‡‹‰ƒœ†‡‹
•££–‘ƒ•‡ǡ †ƒ” •‡ Á–ŸŽ‡è–‡ è‹ Á ‘„‡œ‹–ƒ–‡ǡ è‹ Žƒ •—„‹‡…ì‹‹ …—
sindromul colonului iritabil [30]. Conform rezultatelor acelu-
‹ƒè‹•–—†‹—ǡPƒ”ƒ„ƒc–‡”o‹†‡•è‹Pƒ”ƒ’”‡˜o–‡ŽŽƒƒ—ˆ‘•–•…£œ—–‡Žƒ
’ƒ…‹‡ì‹‹…—ǤB•–—†‹‹Ž‡ƒ–‡”‹‘ƒ”‡ǡ•Ǧƒ…‘•–ƒ–ƒ–…£ƒ…‡•–‡
•’‡…‹‹ƒ——”‘Ž‹’‘”–ƒ–Á‡ì‹‡”‡ƒ•££–£ì‹‹—ƒ‡Ǥ”‹
—”ƒ”‡ǡŽƒ’ƒ…‹‡ì‹‹…—ǡ‹˜‡Ž—”‹Ž‡•…£œ—–‡ƒŽ‡ƒ…‡•–‘”ƒ’‘–
conduce la distrugerea barierei mucoase intestinale, ducând
Žƒ–”ƒ•Ž‘…ƒ”‡ƒ„ƒ…–‡”‹‹Ž‘”苃’”‘†—•‡Ž‘”ƒ…‡•–‘”ƒ’”‹„ƒ”‹-
‡”ƒ —…‘ƒ•‡‹ è‹ǡ ’”‹ —”ƒ”‡ǡ Žƒ ƒ…–‹˜ƒ”‡ƒ ”£•’—•—Ž—‹ ‹—
ȏ͵ͳȐǤ Ž–‡ •’‡…‹‹ ƒ— ˆ‘•–ǡ †‡ ƒ•‡‡‡ƒǡ …”‡•…—–‡ Žƒ ’ƒ…‹‡ì‹‹
…— ǣ BŽƒ—–‹ƒ, o”‡ƒ, Žo•–”‹†‹— •‡n•— •–”‹c–o 1, ƒ‡o’Š‹Ǧ
Ž—•, E—„ƒc–‡”‹— ŠƒŽŽ‹‹ ‰”o—’, E—„ƒc–‡”‹— ”—‹nƒn–‹— ‰”oǦ
—’, o•‡„—”‹ƒ, B—–›”‹c‹cocc—•, S–”‡’–ococc—•, —•‹cƒ–‡n‹„ƒc–‡”,
nƒ‡”o•–‹’‡•, o„o—–•‹ƒ, o’”ococc—• ͸ è‹ S—„†oŽ‹‰”ƒn—Ž—
ȏʹͻȐǤB•–—†‹‹Ž‡ƒ–‡”‹‘ƒ”‡ǡƒ„—†‡ìƒ…”‡•…—–£ƒƒ…‡•–‘”•’‡-
…‹‹•Ǧƒ†‘˜‡†‹–ƒϐ‹Ž‡‰ƒ–£†‡„‘Ž‹Ž‡ƒ—–‘‹—‡•ƒ—‹ϐŽƒƒ–‘”‹‹Ǥ
B•…Ž‡”‘œƒ—Ž–‹’Ž£ȏ͵ʹǡ͵͵Ȑǡ†‹ƒ„‡–—Ž†‡–‹’ͳȏ͵Ͷǡ͵ͷǡ͵͸Ȑǡ„‘-
Ž‹Ž‡”‡—ƒ–‹…‡ȏ͵͹ǡ͵ͺȐǡ’”‡…—è‹Á‘„‡œ‹–ƒ–‡ȏ͵ͻǡͶͲǡͶͳȐè‹
†‹ƒ„‡–—Ž†‡–‹’ʹȏͶʹǡͶ͵Ȑǡ•‡”‡ƒ”…£†‹•„‹‘œ£‹–‡•–‹ƒŽ£Ǥ
•–‡‹–‡”‡•ƒ–…£‘†‹ϐ‹…£”‹Ž‡‹…”‘„‹‘–‡‹‹–‡•–‹ƒŽ‡•—–
MJHS 17(3)/2018 71
mammalian microorganisms, causing innate immune system
response [22]. Immune innate response activates genes for
•‡˜‡”ƒŽ‹ϐŽƒƒ–‘”›…›–‘‹‡•ƒ†‹•‡••‡–‹ƒŽˆ‘”–Š‡†‡˜‡Ž-
‘’‡– ‘ˆ ƒ–‹‰‡Ǧ•’‡…‹ϐ‹… ƒ†ƒ’–‹˜‡ ‹—‹–›ǡ Š—‘”ƒŽǡ ƒ•
well as cellular [23]. TLRs are present in monocytes, macro-
phages, immune cells. TLR3, mediating the antiviral response
ȏʹͶȐǡ ƒ”‡ ’”‡•‡– ’”‡†‘‹ƒ–Ž› ‹ †‡†”‹–‹… …‡ŽŽ• Ȃ ƒ–‹‰‡
presenting cells that process, then present antigenic peptides
to lymphoid cells from lymphoid organs [25]. Recently, TL3
have been described on non-immune cells in association with
autoimmune diseases. TLR3 in pancreatic beta cells are in-
volved in the pathogenesis of insulitis and type 1 diabetes [26]
and, more recently, in autoimmune thyroiditis [27].
A growing body of evidence suggests the involvement of
non-pathogenic commensal microorganisms in the develop-
‡–‘ˆƒ•Š‹‘–‘–Š›”‘‹†‹–‹•„›‹†—…‹‰’”‘Ǧ‹ϐŽƒƒ–‘”›
immune responses in the host. Studies show the critical role
of commensal intestinal microbiota in the development of au-
toimmune diseases. The intestinal microbiota is composed of
over 1200 species of anaerobic and aerobic bacteriophages,
viruses and fungi [28]. This bacterial population is predomi-
nantly represented by the species Bƒc–‡”‹o‹†‡–‡•, ‹”‹c—–‡•,
c–‹no„ƒc–‡”‹ƒ, P”o–‡o„ƒc–‡”‹ƒ and ‡””—co‹c”o„‹ƒ. A recent
study in Š›”o‹† shows that HT patients have a more diverse
ƒ†”‹…Š‡”‹–‡•–‹ƒŽ‹…”‘„‹‘–ƒȋȽǦ†‹˜‡”•‹–›Ȍ–ŠƒŠ‡ƒŽ–Š›‹-
dividuals [29]. ‹”‹c—–‡• was more abundant and Bƒc–‡”o‹†‡Ǧ
–‡• less abundant, which is characteristic for healthy host’s
microbiota, but also occurs in obesity and in subjects with ir-
ritable bowel syndrome [30]. According to the results of the
same study, Pƒ”ƒ„ƒc–‡”o‹†‡• and Pƒ”ƒ’”‡˜o–‡ŽŽƒ were low in
patients with AT. In previous studies, it has been found out that
these species play an important role in maintaining human
health. Therefore, in patients with AT, their low levels can lead
to the destruction of the intestinal mucosa barrier, leading to
the translocation of bacteria and their products via the muco-
sal barrier and, consequently, to the activation of the immune
response [31]. Other species were also higher in patients with
ǣ BŽƒ—–‹ƒ, o”‡ƒ, Žo•–”‹†‹— •‡n•— •–”‹c–o 1, ƒ‡o’Š‹Ž—•,
E—„ƒc–‡”‹— ŠƒŽŽ‹‹ ‰”o—’, E—„ƒc–‡”‹— ”—‹nƒn–‹— ‰”o—’,
o•‡„—”‹ƒ, B—–›”‹c‹cocc—•, S–”‡’–ococc—•, —•‹cƒ–‡n‹„ƒc–‡”, nǦ
ƒ‡”o•–‹’‡•, o„o—–•‹ƒ, o’”ococc—• ͸ and S—„†oŽ‹‰”ƒn—Ž—
[29]. In previous studies, the high abundance of these species
Šƒ•„‡‡•Š‘™–‘„‡Ž‹‡†–‘ƒ—–‘‹—‡‘”‹ϐŽƒƒ–‘”›
diseases. Intestinal dysbiosis is noted in multiple sclerosis [32,
33], type 1 diabetes [34, 35, 36], rheumatic diseases [37, 38]
and obesity [39, 40, 41].
Interestingly, changes in intestinal microbiota are similar
in patients with IBS and AT. Several recent microbiota stud-
ies in IBS patients reported increases in the abundance of ‹”Ǧ
ƒ•‡££–‘ƒ”‡Žƒ’ƒ…‹‡ì‹‹…—è‹ǤŸ–‡˜ƒ•–—†‹‹”‡…‡–‡ ‹c—–‡•, —‹nococc—• –o”“—‡•, S–”‡’–ococc—• and ƒcŠno•’‹Ǧ
’”‹˜‹†‹…”‘„‹‘–ƒŽƒ’ƒ…‹‡ì‹‹…—ƒ—”ƒ’‘”–ƒ–…”‡è–‡”‹ƒŽ‡
ƒ„—†‡ì‡‹ ‹”‹c—–‡•, —‹nococc—• –o”“—‡•, S–”‡’–ococc—•è‹
ƒcŠno•’‹”ƒc‡ƒ‡ǡ‹ƒ”‹˜‡Ž—Ž†‡ƒ„—†‡ì£ƒ…‘”‡Žƒ–’‘œ‹–‹˜…—
simptomele intestinale [44, 45].
‘‡‘•–ƒœ‹ƒ ‹–”ƒ–‹”‘‹†‹ƒ£ è‹ ƒ ‹‘†–‹”‘‹‡Ž‘” ’‡”‹ˆ‡”‹…‡
†‡’‹†‡ǡÁƒ”‡£•—”£ǡ†‡ˆ—…싃‡œ‹‡Ž‘”ǡ’‘’‡Ž‘”‹‘‹-
…‡ǡ–”ƒ•’‘”–ƒ–‘”‹Ž‘”ǡƒŽ‡…£”‘”ƒ…–‹˜‹–ƒ–‡‡•–‡‘†—Žƒ–£†‡‹‘†-
”ƒc‡ƒ‡, and abundance was positively correlated with intesti-
nal symptoms [44, 45].
Intra-thyroid homeostasis and peripheral iodothyronines
depend to a large extent on the function of enzymes, ion
pumps, transporters whose activity is modulated by iodothy-
”‘‹‡–Š‡•‡Ž˜‡•ǡƒ†–Š‡ƒ˜ƒ‹Žƒ„‹Ž‹–›‘ˆ–™‘‹…”‘—–”‹‡–•ǣ
iodine and selenium.
72
–‹”‘‹‡Á•‡Ž‡ǡ†ƒ”苆‡†‹•’‘‹„‹Ž‹–ƒ–‡ƒƒ†‘‹‹…”‘—–”‹‡ì‹ǣ
‹‘†è‹•‡Ž‡‹—Ǥ
Seleniul este un constituent obligatoriu al selenoproteine-
Ž‘”ȏͶ͸Ȑǡ’”‹–”‡…ƒ”‡ǡ•—–†‡‹‘†‹ƒœ‡Ž‡ǡ…ƒ”‡”‡‰Ž‡ƒœ£Š‘‡-
‘•–ƒœ‹ƒ–‹”‘‹†‹ƒ£’‡”‹ˆ‡”‹…£ȏͶ͹ȐǤ„•‘”„싃†‡•‡Ž‡‹—ƒ”‡Ž‘…
Á†—‘†‡è‹Žƒ‹˜‡Ž—Ž…‡…—Ž—‹è‹’‘ƒ–‡˜ƒ”‹ƒÁˆ—…싇†‡ˆ‘”ƒ
•ƒ…Š‹‹…£ȏͶͺȐǤ‹”‘‹†ƒƒ”‡…‡Žƒ‹ƒ”‡…‘ì‹—–†‡•‡Ž‡‹—
’‡‰”ƒ†‡쇕—–†‹Á–”‡‰—Ž…‘”’ȏͶͻȐǤǦƒ†‡–‡”‹ƒ–…£—‡-
Ž‡ „ƒ…–‡”‹‹ ‹–‡•–‹ƒŽ‡ǡ …— ƒ” ϐ‹ E•cŠ‡”‹cŠ‹ƒ coŽ‹, Žo•–”‹†‹ƒ è‹
En–‡”o„ƒc–‡”‹ƒ•—–’—”–£–‘ƒ”‡†‡‰‡‡…ƒ”‡…‘†‹ϐ‹…£•‡Ž‡‘-
proteine [50].
B–”Ǧ— •–—†‹— ”‡…‡– ȏͷͳȐǡ •Ǧƒ †‘˜‡†‹– …£ •‡Ž‡‹—Žǡ …ƒ”‡
—‡•–‡ƒ„•‘”„‹–Á‹–‡•–‹—Ž•—„ì‹”‡ǡ’‘ƒ–‡ϐ‹’”‡Ž—ƒ–Á‘†
ƒ…–‹˜ Á …‘Ž‘ è‹ ‡–ƒ„‘Ž‹œƒ– †‡ ‹…”‘„‹‘–£ǡ ”‡’”‡œ‡–Ÿ† ‘
…‘…—”‡ì£ ’‡–”— •—„•–”ƒ–ǡ …‡‡ƒ …‡ †‡–‡”‹£ ‘ ”‡†—…‡”‡ ƒ
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–—Ž‹˜‡”•ǡ‡š‡”…‹–ƒ–†‡’”‡œ‡ìƒ—‡‹‹…”‘„‹‘–‡‹ƒ…–‹˜‡ȏͷͳȐǤ
•–ˆ‡Žǡ„ƒ…–‡”‹‹Ž‡’‘–…‘…—”ƒ…—‰ƒœ†ƒǡÁ•’‡…‹ƒŽǡÁ’”‡œ‡ìƒ
—‡‹ …ƒ–‹–£ì‹ Ž‹‹–ƒ–‡ †‡ •‡Ž‡‹—ǡ ‹ƒ” …”‡è–‡”‡ƒ ƒ„•‘”„싇‹ †‡
•‡Ž‡‹—†‡…£–”‡„ƒ…–‡”‹‹Ž‡‹–‡•–‹ƒŽ‡’‘ƒ–‡‹ϐŽ—‡ìƒ‡‰ƒ–‹˜
‡š’”‡•‹ƒ•‡Ž‡‘’”‘–‡‹‡Ž‘”Žƒ‰ƒœ†£ȏͷʹȐǤ
‹•…—ì‹‹
‹”‘‹†‹–ƒƒ—–‘‹—£‡•–‡…‡ƒƒ‹”£•’Ÿ†‹–£ƒŽƒ†‹‡ƒ—–‘-
‹—£ȏͷ͵Ȑè‹…‡ƒƒ‹ˆ”‡…˜‡–£…ƒ—œ£†‡Š‹’‘–‹”‘‹†‹‡ȏͷͶȐǤƒ
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’”‡œ‡ìƒƒ–‹…‘”’‹Ž‘”Á’‘–”‹˜ƒƒ–‹‰‡‹Ž‘”–‹”‘‹†‹‡‹ǤƒŒ‘”‹-
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reoperoxidazei. Tratamentul actual al hipotiroidiei de origine
ƒ—–‘‹—£•‡„ƒœ‡ƒœ£’‡ƒ†‹‹•–”ƒ”‡ƒŠ‘”‘‹Ž‘”–‹”‘‹†‹‡‹
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varea martorului, apoptoza celulelor tiroidiene sunt mecanis-
‡…—”‘ŽÁƒ’ƒ”‹ì‹ƒè‹†‡œ˜‘Ž–ƒ”‡ƒ–‹”‘‹†‹–‡‹ƒ•Š‹‘–‘Ǥ–—†‹-
‹Ž‡”‡…‡–‡ƒ—†‡‘•–”ƒ–”‘Ž—Žƒ…–‹˜£”‹‹ƒ„‡”ƒ–‡ƒ•‹•–‡—Ž—‹
‹— Á£•…—– Á ’ƒ–‘‰‡‡œƒ  ȏ͵ͳȐǤ ‹…”‘„‹‘–ƒ ‹–‡•–‹ƒŽ£
苏‹…”‘‘”‰ƒ‹•‡Ž‡…‘‡•ƒŽ‡‡’ƒ–‘‰‡‡•—–‹’Ž‹…ƒ–‡Á
†‡œ˜‘Ž–ƒ”‡ƒ ǡ ’”‹ ’”‘˜‘…ƒ”‡ƒ ”£•’—•—”‹Ž‘” ‹—‡ ’”‘‹-
ϐŽƒƒ–‘”‹‹ Žƒ ‰ƒœ†£ ȏ͵ͳȐǤ ‘‹Ž‡ ‡…ƒ‹•‡ ‡–‹‘’ƒ–‘‰‡‡–‹…‡
cercetate în ultimii ani, cu implicarea microbiotei intestinale
苃ǡ˜‘”’‡”‹–‡‡Žƒ„‘”ƒ”‡ƒ—‘”‘‹–”ƒ–ƒ‡–‡ǡ„ƒœƒ–‡ǡ
ƒ‹…—”Ÿ†ǡ’‡‡…ƒ‹•‡ǡ†‡…Ÿ–’‡ƒ‹ˆ‡•–£”‹…Ž‹‹…‡Ǥ
‘…Ž—œ‹‹
–—†‹‹Ž‡”‡…‡–‡•—‰‡”‡ƒœ£…£‹…”‘„‹‘–ƒè‹ƒ…–‹˜ƒ”‡ƒƒ„‡-
”ƒ–£ƒ•‹•–‡—Ž—‹‹—Á£•…—–Œ‘ƒ…£—”‘Žƒ’ƒ”–‡Á’ƒ–‘-
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–‹…£Ǥ—£”Ž‹‹–ƒ–†‡•–—†‹‹ƒƒ„‘”†ƒ–ƒ…‡•–‡‹–‡””‡Žƒì‹‹è‹
‡•–‡‡˜‘‹‡†‡ƒ‹—Ž–‡…‡”…‡–£”‹’‡–”—ƒ…‘ϐ‹”ƒ•ƒ—‹ϐ‹”-
ma ipotezele respective, pentru ca noi strategii de diagnostic
è‹–”ƒ–ƒ‡–•£ϐ‹‡‹’Ž‡‡–ƒ–‡Ǥ
‡…Žƒ”ƒì‹ƒ†‡…‘ϐŽ‹…–†‡‹–‡”‡•‡
—–‘”‹‹†‡…Žƒ”£Ž‹’•ƒ…‘ϐŽ‹…–—Ž—‹†‡‹–‡”‡•‡ϐ‹ƒ…‹ƒ”‡•ƒ—
‘ϐ‹ƒ…‹ƒ”‡Ǥ
‡cƒn‹•‡Ž‡ ‡–‹o’ƒ–o‰‡n‡–‹c‡ ‹’Ž‹cƒ–‡ Án †‡œ˜oŽ–ƒ”‡ƒ –‹”o‹†‹–‡‹ ƒ—–o‹—n‡
Selenium is a mandatory constituent of selenoproteins
[46], among which deiodinases, which regulate peripheral
thyroid homeostasis [47]. Absorption of selenium occurs in
the duodenum and at the level of the cecum and may vary de-
pending on its chemical form [48]. The thyroid has the highest
selenium content per gram of whole body tissue [49]. It has
been determined that some intestinal bacteria, such as E•cŠǦ
‡”‹cŠ‹ƒ coŽ‹, Žo•–”‹†‹ƒ and En–‡”o„ƒc–‡”‹ƒ, are carriers of genes
encoding selenoproteins [50].
In a recent study [51], it has been shown that selenium,
which is not absorbed in the small intestine, can be actively
taken up in the colon and metabolized by the microbiota,
representing a competition for the substrate, which results in
a reduction in bioavailability of selenium, as evidenced by the
inverse effect of an inactive microbiota [51]. Thus, bacteria can
compete with the host, especially in the presence of a limited
amount of selenium, and the increase in selenium uptake by
‹–‡•–‹ƒŽ „ƒ…–‡”‹ƒ …ƒ ‡‰ƒ–‹˜‡Ž› ‹ϐŽ—‡…‡ –Š‡ ‡š’”‡••‹‘ ‘ˆ
selenoproteins in the host [52].
Discussion
Autoimmune thyroiditis is the most prevalent autoimmune
disease [53] and the most common cause of hypothyroidism
[54]. It is diagnosed based on clinical, ultrasonographic data
and the presence of antibodies against thyroid antigens. Most
patients have increased antibody titers against thyroid peroxi-
dase. Current treatment of hypothyroidism due to Hashimoto
thyroiditis is based on the administration of synthetic thyroid
hormones, which does not always alleviate the symptoms of
the patient. In the etiopathogenesis of autoimmune thyroid-
itis, both genetic and non-genetic factors are involved. Molec-
ular mimicry, bystander activation, thyroid cell apoptosis are
mechanisms that play a role in the development of Hashimo-
to’s thyroiditis. Recent studies have demonstrated the role of
aberrant activation of the innate immune system in AT patho-
genesis [31]. The intestinal microbiota and non-pathogenic
commensal microorganisms are involved in the development
‘ˆ„›…ƒ—•‹‰’”‘Ǧ‹ϐŽƒƒ–‘”›‹—‡”‡•’‘•‡•‹–Š‡
host [31]. The new etiopathogenetic mechanisms researched
in recent years, involving intestinal microbiota and TLRs, will
allow the development of new treatments based on mecha-
nisms rather than clinical manifestations.
Conclusions
Recent studies suggest that microbiota and aberrant ac-
tivation of the innate immune system play a special role in
the pathogenesis of autoimmune thyroiditis in subjects with
genetic predisposition. A limited number of studies have ap-
proached these interrelations, and more research is needed to
…‘ϐ‹”‘””‡ˆ—–‡–Š‡•‡Š›’‘–Š‡•‡•‹‘”†‡”ˆ‘”‡™†‹ƒ‰‘•-
tic and treatment strategies to be implemented.
‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‹‰‹–‡”‡•–•
Š‡ƒ—–Š‘”•Šƒ˜‡‘…‘ϐŽ‹…–•‘ˆ‹–‡”‡•––‘†‡…Žƒ”‡Ǥ
E–‹o’ƒ–Šo‰‡n‡–‹c ‡cŠƒn‹•• ‹n˜oŽ˜‡† ‹n –Š‡ †‡˜‡Žo’‡n– oˆ ƒ—–o‹—n‡ –Š›”o‹†‹–‹• MJHS 17(3)/2018 73

‘–”‹„—싃ƒ—–‘”‹Ž‘” Authors’ contribution

—–‘”‹‹ƒ—…‘–”‹„—‹–Á‘†‡‰ƒŽŽƒ‡Žƒ„‘”ƒ”‡ƒè‹•…”‹‡”‡ƒ The authors contributed equally to writing the article. The
ƒ”–‹…‘Ž—Ž—‹Ǥ ‡”•‹—‡ƒ ϐ‹ƒŽ£ ƒ ˆ‘•– …‹–‹–£ è‹ ƒ’”‘„ƒ–£ Á …£–”‡ ϐ‹ƒŽƒ—•…”‹’–™ƒ•”‡ƒ†ƒ†ƒ’’”‘˜‡†„›ƒŽŽƒ—–Š‘”•Ǥ
–‘싃—–‘”‹‹Ǥ

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disease. —””Ǥ
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…‹‡•Ǧ•’‡…‹ϐ‹…ƒŽ–‡”ƒ–‹‘•‹ˆƒ‡…ƒŽ‹…”‘„‹‘–ƒǤ
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ͳͷǤ‘•‡Ǥǡ‘‹–ƒǤǡ—”‡Ǥ‘†‹‡ǣƒ‡˜‹”‘‡–ƒŽ–”‹‰‰‡”‘ˆ ʹͲͳͷǢͳͲȋͻȌǣ‡Ͳͳ͵͹ͶʹͻǤ
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‹”±Ǥ‹””‹–ƒ„Ž‡„‘™‡Ž•›†”‘‡•—„–›’‡†‡ϐ‹‡†„›•’‡…‹-
‡•Ǧ•’‡…‹ϐ‹…ƒŽ–‡”ƒ–‹‘•‹ˆƒ‡…ƒŽ‹…”‘„‹‘–ƒǤ
Ͷ͸Ǥڊ”Ž‡
–‡• „‡•ǤǡʹͲͳͷǢʹʹȋͷȌǣ͵ͻʹǦͶͲͳǤ
Ͷ͹Ǥڊ”Ž‡
acting as gate keepers to thyroid hormone action. c–ƒǤ ‡†Ǥ —•Ǧ
–”‹ƒcƒǡͳͻͻ͸Ǣʹ͵ǣͳ͹Ǧ͵ͲǤ
P”ƒc–Ǥ ‡•Ǥ Ž‹nǤ Š‡—ƒ–oŽǤǡʹͲͳͶǢʹͺȋͷȌǣ͸ͺ͹Ǧ͹ͲʹǤ
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ʹͲͳ͸ǢʹͺȋͷȌǣͷ͵͹ǦͶ͵Ǥ
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ͶͲǤ‡›Ǥǡ—”„ƒ—‰ŠǤǡƒƒ†›Ǥǡƒ–•—‡‘Ǥ‡– ƒŽǤ A core gut
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Ǥ —–”Ǥ B‹ocŠ‡ǤǡʹͲͲͻǢʹͲǣ͸͵ͺǦ͸ͶͺǤ
41. Turnbaugh P., Klein S. ‡– ƒŽǤ‹…”‘„‹ƒŽ‡…‘Ž‘‰›ǣŠ—ƒ‰—–‹…”‘-
bes associated with obesity. ƒ–—”‡ǡʹͲͲ͸ǢͶͶͶǣͳͲʹʹǦ͵Ǥ
42. Tilg H., Moschen AǤ‹…”‘„‹‘–ƒƒ††‹ƒ„‡–‡•ǣƒ‡˜‘Ž˜‹‰”‡Žƒ–‹‘-
ship.
—–,ʹͲͳͶǢ͸͵ȋͻȌǣͳͷͳ͵ǦʹͳǤ supplements. oo† Š‡ǤǡʹͲͳ͸Ǣͳͻ͹ǣ͵ͺʹǦ͵ͺ͹Ǥ
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Ž‹”‡•‹•–ƒ…‡ǡ‘„‡•‹–›ǡƒ†…Š”‘‹…‹ϐŽƒƒ–‹‘Ǥ‹ƒ„‡–‡• ƒ”‡,
ǤǡʹͲͳͳǢʹͷǣʹͶͻʹǦʹͶͻͻǤ
ʹͲͳͳǢ͵ͶǣͳͺͲͻǦͳͷǤ
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Tims S., de Vos W. Global and deep molecular analysis of microbi-
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ƒ•–”o‡n–‡”oŽo‰›ǡʹͲͳͳǢͳͶͳǣͳ͹ͻʹǦͳͺͲͳǤ
ͶͺǤ‡Š†‹Ǥǡ‘”‹…Ǥǡ•–ƒ••‡Ǥǡ—ˆ”ƒ•‡Ǥ‡Ž‡‹—‹–Š‡‡˜‹-
ronment, metabolism and involvement in body functions. oŽ‡Ǧ
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—ŽŽǤǡʹͲͳͳǢͻͻǣ͵ͻǦͷͳǤ
 MJHS 17(3)/2018 75

$ REVIEW ARTICLE

”‘–‡œ‡Ž‡’ƒ”싃Ž‡ϐ‹š‡ç‹ ƒ”–‹ƒŽϐ‹š‡††‡–ƒŽ’”‘•–Š‡•‡•
•‹•–‡—Ž‹’Žƒ–‘Ǧ’”‘–‡–‹… ƒ†‹’Žƒ–Ǧ’”‘•–Š‡–‹…
Á–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹ system in the prosthetic
—‹†‡–ƒ”‡ǣ•‹–‡œ£ƒ”ƒ–‹˜£ treatment of single
†‡Ž‹–‡”ƒ–—”£ edentulism
Olga Cheptanaru1* Olga Cheptanaru1*
1
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o†o”oŒƒDzǡ n‹˜‡”•‹–ƒ–‡ƒ †‡ S–ƒ– 1
Šƒ‹” oˆ †‡n–ƒŽ ’”o’‡†‡—–‹c• DzPƒ˜‡Ž
o†o”oŒƒdzǡ ‹coŽƒ‡ ‡•–‡‹–ƒn— S–ƒ–‡
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Data primirii manuscrisului: 21.05.2018 Manuscript received on: 21.05.2018

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Autor corespondent: Correspondent author:

Ž‰ƒ Š‡’–ƒnƒ”—ǡ ƒ•‹•–‡n– —n‹˜‡”•‹–ƒ” Ž‰ƒ Š‡’–ƒnƒ”—ǡ ƒ••‹•–Ǥ ’”oˆǤ
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o†o”oŒƒDz Šƒ‹” oˆ †‡n–ƒŽ ’”o’‡†‡—–‹c• DzPƒ˜‡Ž
o†o”oŒƒdz
n‹˜‡”•‹–ƒ–‡ƒ †‡ S–ƒ– †‡ ‡†‹c‹n£ è‹ ƒ”ƒc‹‡ Ƿ‹coŽƒ‡ ‡•–‡‹ìƒn—dz ‹coŽƒ‡ ‡•–‡‹–ƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
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‡Ǧƒ‹Ž: oŽ‰ƒǤcŠ‡’–ƒnƒ”—̻—•ˆǤ† ‡Ǧƒ‹Ž: oŽ‰ƒǤcŠ‡’–ƒnƒ”—̻—•ˆǤ†

‡—‡•–‡…—‘•…—–ǡ†‡‘…ƒ†ƒ–£ǡŽƒ•—„‹‡…–—Žƒ„‘”†ƒ– What is not known yet, about the topic

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ϐ‹š‡è‹…‘’‘‡–‡Ž‘”•‹•–‡‡Ž‘”‹’Žƒ–‘Ǧ’”‘–‡–‹…‡ǡ—‡•–‡
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ƒŽ’ƒ…‹‡ì‹Ž‘”…—‡†‡–ƒì‹‡—‹†‡–ƒ”£Ǥ
In the context of fast development and improvement of the
ϐ‹š‡†’ƒ”–‹ƒŽ’”‘•–Š‡•‡•–‡…Š‘Ž‘‰‹‡•ǡƒ–‡”‹ƒŽ•ƒ†–Š‡…‘-
ponents of implant-prosthetic systems, the comparative effec-
tiveness of the contemporary treatment of patients with single
edentulism is not assessed.
’‘–‡œƒ†‡…‡”…‡–ƒ”‡
Expunerea unei sinteze narative a literaturii contempora-
‡”‡ˆ‡”‹–‘ƒ”‡Žƒ‡ϐ‹…‹‡ìƒ…‘’ƒ”ƒ–‹˜£ƒ—–‹Ž‹œ£”‹‹’”‘–‡œ‡Ž‘”
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Introducere. ”‡˜ƒŽ‡ìƒ ÁƒŽ–£ ƒ ‡†‡–ƒì‹‡‹ —‹†‡–ƒ”‡
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‹…Ž—•‹˜ Áˆ£ì‹èƒ”‡ƒǡ ˆ—…싃ǡ ”‡Žƒì‹‹Ž‡ ‹–‡”’‡”•‘ƒŽ‡ è‹ …ƒŽ‹–ƒ-
–‡ƒ˜‹‡ì‹‹ǡƒ†”‡•ƒ„‹Ž‹–ƒ–‡ƒ•’‘”‹–£ƒ’ƒ…‹‡ì‹Ž‘”苇š‹•–‡ìƒƒ‹
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Research hypothese
Exposing a narrative synthesis of contemporary literature
”‡‰ƒ”†‹‰ –Š‡ …‘’ƒ”ƒ–‹˜‡ ‡ˆˆ‡…–‹˜‡‡•• ‘ˆ –Š‡ —•‡ ‘ˆ ϐ‹š‡†
partial prostheses and implant prosthetic systems in the treat-
ment of patients with single edentulism.
”–‹…Ž‡ǯ•ƒ††‡†‘˜‡Ž–›–‘–Š‹••…‹‡–‹ϐ‹…–‘’‹…
The article presents a synthesis of contemporary studies
at an international level about results of patients with single
‡†‡–—Ž‹•ǡ–”‡ƒ–‡†™‹–Šϐ‹š‡†’ƒ”–‹ƒŽ’”‘•–Š‡•‡•ƒ†‹’Žƒ–Ǧ
•—’’‘”–‡†…”‘™•ǣ–Š‡•—”˜‹˜ƒŽƒ†•—……‡••‘ˆ†‡–ƒŽ‹’Žƒ–•
and prosthetic restorations, complications, quality of life re-
lated to oral health and patient satisfaction.
Abstract
Introduction. The high prevalence of single edentulism in
people, affecting various aspects of patients’ lives, including
appearance, function, interpersonal relationships and quality
of life, increased patient addressability, and the existence of
—Ž–‹’Ž‡™ƒ›•‘ˆ–”‡ƒ–‡–Œ—•–‹ϐ‹‡•–Š‡ƒ…–—ƒŽ‹–›‘ˆƒ…‘’ƒ”ƒ-
tive study of the treatment of single edentulism using the clas-
76
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ƒ–‡”‹ƒŽè‹‡–‘†‡Ǥ‹„ƒœ‡Ž‡†‡†ƒ–‡—„‡†è‹…‘’—•
(Elsevier) au fost selectate articolele publicate în perioada
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è‹…—•‹•–‡‡‹’Žƒ–‘Ǧ’”‘–‡–‹…‡Ǥ
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—„‡† è‹ …‘’—• ȋŽ•‡˜‹‡”Ȍǡ …‘ˆ‘” …”‹–‡”‹‹Ž‘” †‡ …£—–ƒ”‡
ƒ— ˆ‘•– ‰£•‹–‡ ͸ʹͷ †‡ ƒ”–‹…‘Ž‡ ’”‹˜‹† –”ƒ–ƒ‡–—Ž ‡†‡–ƒì‹‡‹
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inclusiv articole publicate în Republica Moldova, care au fost
considerate reprezentative pentru materialele publicate la
–‡ƒƒ…‡•–—‹ƒ”–‹…‘Ž†‡•‹–‡œ£Ǥ
‘…Ž—œ‹‹Ǥƒ”‹‹Ž‡†‡–ƒ”‡è‹ƒŽƒ†‹ƒ’ƒ”‘†‘–ƒŽ£•—–…ƒ-
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•‡š‡’‡–”—‡†‡–ƒì‹ƒ’ƒ”싃Ž£ǡ‹ƒ”˜Ÿ”•–ƒƒ”‡—‡ˆ‡…–•‡‹ϐ‹-
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ͺǡͲΨ苇•–‡ƒ‹ˆ”‡…˜‡–£Áœ‘‡Ž‡’‘•–‡”‹‘ƒ”‡ƒŽ‡ƒš‹Žƒ”‡-
Ž‘”Ǥ ”ƒ–ƒ‡–—Ž ‡†‡–ƒì‹‡‹ —‹†‡–ƒ”‡ …— …‘”‘ƒ‡ ’‡ •—’‘”–
†‡ ‹’Žƒ–ǡ …‘’ƒ”ƒ–‹˜ …— ‹•–ƒŽƒ”‡ƒ ’”‘–‡œ‡Ž‘” ’ƒ”싃Ž‡ ϐ‹š‡
…‘˜‡ì‹‘ƒŽ‡ǡ’”‡œ‹–£‘”ƒ–£•—’‡”‹‘ƒ”£†‡•—’”ƒ˜‹‡ì—‹”‡’‡
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…‹‹ǡ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹è‹•ƒ–‹•ˆƒ…싇‹’ƒ…‹‡ì‹Ž‘”Ǥ…‡ƒ•–£‘†ƒŽ‹–ƒ–‡
†‡–”ƒ–ƒ‡–‡•–‡—Ž–ƒ‹”‡–ƒ„‹Ž£Á•‹–—ƒì‹‹Ž‡…Ž‹‹…‡…ƒ”‡
‹’Ž‹…£ †‹ì‹ …— ”‡•–ƒ—”£”‹ ‹‘”‡ •ƒ— ˆ£”£ ”‡•–ƒ—”£”‹ è‹Ȁ•ƒ—
…‘†‹ì‹‹‘•‘ƒ•‡ˆƒ˜‘”ƒ„‹Ž‡Ǥ
Cuvinte cheie:‡†‡–ƒì‹‡—‹†‡–ƒ”£ǡ’”‘–‡œ£’ƒ”싃Ž£ϐ‹š£ǡ
‹’Žƒ–†‡–ƒ”ǡ”‡•–ƒ—”ƒ”‡‹’Žƒ–‘Ǧ’”‘–‡–‹…£ǡ”ƒ–£†‡•—’”ƒ-
˜‹‡ì—‹”‡ǡ”ƒ–£†‡•—……‡•ǡ”‡œ—Ž–ƒ–‡•–‡–‹…ǡ…‘’Ž‹…ƒì‹‹Ǥ
Introducere
†‡–ƒì‹ƒ—‹†‡–ƒ”£ǡ‘…‘•‡…‹ì£–‹’‹…£ƒ…ƒ”‹‹Ž‘”†‡–ƒ”‡
苃ƒŽƒ†‹‡‹’ƒ”‘†‘–ƒŽ‡ǡ…‘–‹—£•£”£Ÿ£è‹Á’”‡œ‡–‘
†‹Ž‡£ƒŒ‘”£ƒ•–‘ƒ–‘Ž‘‰‹‡‹…‘–‡’‘”ƒ‡è‹‘’”‘„Ž‡£†‡
•££–ƒ–‡‘”ƒŽ£ǡˆƒ’–‡š’Ž‹…ƒ–’”‹ˆ”‡…˜‡ìƒÁƒŽ–£Á”Ÿ†—Ž’‘-
’—Žƒì‹‡‹‹†‹ˆ‡”‡–†‡˜Ÿ”•–£ǡÁ†‡‘•‡„‹Žƒ’ƒ…‹‡ì‹‹–‹‡”‹ȏͳȐǤ
‹‡”†‡”‡ƒ†‹ì‹Ž‘”‡•–‡‘–”ƒ—£’•‹Š‘Ž‘‰‹…£’‡–”—’ƒ…‹-
‡–ǡ †‡‘ƒ”‡…‡ …‘’”‘‹–‡ Á…”‡†‡”‡ƒ Á •‹‡ è‹ ‹ƒ‰‹‡ƒ †‡
•‹‡ǡ’‘•‡†£…‘•‡…‹ì‡†‹ˆ‡”‹–‡Á…‡‡ƒ…‡’”‹˜‡è–‡”‡Žƒì‹‹Ž‡•‘-
…‹ƒŽ‡ǡƒ‰”ƒ˜‡ƒœ£•££–ƒ–‡ƒ‰‡‡”ƒŽ£è‹…ƒŽ‹–ƒ–‡ƒ˜‹‡ì‹‹ǡ‹…Ž—•‹˜
…ƒ’ƒ…‹–ƒ–‡ƒƒ•–‹…ƒ–‘”‹‡è‹†‡…‘—‹…ƒ”‡˜‡”„ƒŽ£ǡ†—”‡”‡ƒè‹
‡•ƒ–‹•ˆƒ…싃‡•–‡–‹…£ǡ…—‹’ƒ…–•‡‹ϐ‹…ƒ–‹˜ƒ•—’”ƒ˜‹‡ì‹‹…‘-
tidiene [1, 2].
…–—ƒŽ‡–‡ǡ’ƒ…‹‡ì‹‹…—‡†‡–ƒì‹‡’ƒ”싃Ž£•—–—Ž–ƒ‹
”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
•‹…ƒŽ‡–Š‘†™‹–Šϐ‹š‡†’ƒ”–‹ƒŽ’”‘•–Š‡•‡•ƒ†‘†‡”–”‡ƒ–-
ment with implant-supported prostheses. The existing actu-
ality is explained by the attitude of the population towards
its aesthetic appearance and the desire to keep the remaining
natural teeth next to the edentulous gap without using them
as elements of aggregation in prosthetic constructions.
Material and methods. The articles published between
2000 and 2017 were selected from the PubMed and Scopus
ȋŽ•‡˜‹‡”Ȍ †ƒ–ƒ„ƒ•‡•ǡ „› –Š‡ ‡›™‘”†•ǣ •‹n‰Ž‡ ‡†‡n–—Ž‹•ǡ
ϔ‹š‡† ’ƒ”–‹ƒŽ ’”o•–Š‡•‹•ǡ †‡n–ƒŽ ‹’Žƒn–ǡ ‹’Žƒn–Ǧ’”o•–Š‡–‹c
”‡•–o”ƒ–‹onǤ ƒ–ƒ ‘ …Žƒ••‹ϐ‹…ƒ–‹‘ǡ ‡–‹‘Ž‘‰›ǡ ’”‡˜ƒŽ‡…‡ ƒ†
‡–Š‘†•‘ˆ–”‡ƒ–‡–‘ˆ•‹‰Ž‡‡†‡–—Ž‹•ǡ–›’‡•‘ˆϐ‹š‡†’ƒ”-
tial prostheses, dental implants and prosthetic restorations
on implants, survival, success, complications and the quality
of life related to oral health in single edentulous patients with
ϐ‹š‡†’ƒ”–‹ƒŽ’”‘•–Š‡•‡•ƒ†‹’Žƒ–Ǧ’”‘•–Š‡–‹…•›•–‡•Ǥ
Results. After processing the information from the
PubMed and Scopus (Elsevier) databases, according to the
search criteria, 625 articles on the treatment of single eden-
–—Ž‹• ™‡”‡ ˆ‘—†Ǥ Š‡ ϐ‹ƒŽ „‹„Ž‹‘‰”ƒ’Š› …‘–ƒ‹• ͷʹ ”‡Ž‡-
vant sources, including articles published in the Republic of
Moldova, which were considered representative for the mate-
rials published on the subject of this article.
Conclusions. Dental caries and periodontal disease are
the major causes of the partial edentulism. There is no gen-
†‡”…‘””‡Žƒ–‹‘ˆ‘”’ƒ”–‹ƒŽ–‡‡–ŠŽ‘••ǡ„—–ƒ‰‡Šƒ•ƒ•‹‰‹ϐ‹…ƒ–
effect. The prevalence of the permanent tooth edentulism is
2.8-8.0% and is more common in the posterior areas of the
jaws. The treatment of single edentulism using crowns on im-
plant support, compared with the installation of conventional
’ƒ”–‹ƒŽϐ‹š‡†’”‘•–Š‡•‹•ǡŠƒ•ƒŠ‹‰Š‡”Ž‘‰Ǧ–‡”•—”˜‹˜ƒŽ”ƒ–‡ǡ
ƒ‘”‡•‹‰‹ϐ‹…ƒ–‹’”‘˜‡‡–‹ˆ—…–‹‘ǡƒ‡•–Š‡–‹…•ǡ“—ƒŽ-
ity of life and patient satisfaction. This treatment is gainful in
clinical situations involving teeth with minor restorations or
without restorative and/or favorable bone conditions.
Key words: •‹‰Ž‡ ‡†‡–—Ž‹•ǡ ’ƒ”–‹ƒŽ ϐ‹š‡† ’”‘•–Š‡•‹•ǡ
dental implant, implant supported restoration, survival rate,
success rate, aesthetic result, complications.
Introduction
Single edentulism, a typical consequence of dental caries
and periodontal disease, continues to be a major dilemma of
contemporary dentistry and an oral health problem, which is
explained by the high rate among the population, regardless of
age, especially in young patients [1].
Teeth loss is a psychological trauma to the patient because
‹– …‘’”‘‹•‡• •‡ŽˆǦ…‘ϐ‹†‡…‡ ƒ† •‡ŽˆǦ‹ƒ‰‡ǡ Šƒ• †‹ˆˆ‡”‡–
consequences in terms of social relationships, worsens gen-
eral health and quality of life, including masticatory capability
and verbal communication, pain and aesthetic dissatisfaction,
™‹–Šƒ•‹‰‹ϐ‹…ƒ–‹’ƒ…–‘‡˜‡”›†ƒ›Ž‹ˆ‡ȏͳǡʹȐǤ
Currently, patients with partial teeth loss are more aware
of functional, aesthetic and social disorders. The social impact
…‘è–‹‡ì‹†‡†‡”‡‰Ž£”‹Ž‡ˆ—…ì‹‘ƒŽ‡ǡ‡•–‡–‹…‡è‹•‘…‹ƒŽ‡Ǥ’ƒ…- of facial aesthetics, the desire to look younger and more pleas-
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
–—Ž•‘…‹ƒŽƒŽ‡•–‡–‹…‹‹ˆƒ…‹ƒŽ‡ǡ†‘”‹ìƒ†‡ƒ’£”‡ƒ…Ÿ–ƒ‹–Ÿ£”è‹
’Ž£…—–‡š’Ž‹…£‘•…Š‹„ƒ”‡†‡ƒ–‹–—†‹‡ƒ’ƒ…‹‡–—Ž—‹…ƒ”‡•‡
ƒ†”‡•‡ƒœ£’‡–”—ƒ•‹•–‡ì£•–‘ƒ–‘Ž‘‰‹…£ǤB…‘–‡š–—ŽŠ‘‡-
‘•–ƒœ‹‡‹Ž‘…ƒŽ‡ǡ…”‡ƒ”‡ƒ—‡‹ƒ”‘‹‹ˆƒ…‹ƒŽ‡è‹ˆ—…ì‹‘ƒŽ‡…—
ƒŒ—–‘”—Ž †‹ì‹Ž‘” ƒ”–‹ϐ‹…‹ƒŽ‹ †‡˜‹‡ ‘ …‡”‹ì£ „‹‘Ž‘‰‹…£ è‹ …‘-
’‘”–ƒ‡–ƒŽ£†‡‘‹’‘”–ƒì£†‡‘•‡„‹–£Ǥ”‡è–‡”‡ƒ’‘’—Žƒ”‹-
–£ì‹‹‹’Žƒ–—”‹Ž‘”†‡–ƒ”‡ǡ‡š–‹†‡”‡ƒ†‘Ž‡ƒì‡Ž‘”è‹…‡”‹ì‡-
Ž‘”’ƒ…‹‡–—Ž—‹’‡–”—”‡•–ƒ—”£”‹ƒ’ƒ”‡–ƒ–—”ƒŽ‡ƒ—…‘†—•
Žƒ‘•…Š‹„ƒ”‡ƒ’ƒ”ƒ†‹‰‡‹†‡Žƒ•‹’Žƒ”‡•–ƒ„‹Ž‹”‡ƒˆ—…싇‹
Žƒ”‡•–ƒ„‹Ž‹”‡ƒˆ‘”‡‹è‹ˆ—…싇‹ǡÁ†‡‘•‡„‹Á”‡‰‹—‡ƒ‡•–‡–‹-
…£ǡ…—…‘•‡”˜ƒ”‡ƒ‘’–‹ƒŽ£ƒ쇕—–—”‹Ž‘”‘‹è‹†—”‡è‹…”‹–‡”‹‹
‡•–‡–‹…‡†‡–ƒ”‡–‘–ƒ‹•–”‹…–‡Ǥ‡…‘•–”—…싃…‘’Ž‡–£ƒ‡•–‡-
–‹…‹‹†‡–ƒ”‡è‹‰‹‰‹˜ƒŽ‡”£Ÿ‡‘„‹‡…–‹˜—Ž’”‹…‹’ƒŽǤ”‡ƒ”‡ƒ
——‹’”‘ϐ‹Ž†‡쇕—–‘ƒŽ‡•‹‹Žƒ”苃”‘‹œƒ–…—’”‘ϐ‹Ž—Ž†‡
쇕—–‘ƒŽ‡ƒŽ†‡–‹ì‹‡‹ƒ†‹ƒ…‡–‡‡•–‡…‡Žƒ‹†‹ϐ‹…‹Ž‡Ž‡‡–Á
realizarea unui rezultat estetic optimal [3, 4, 5].
‡œ‹•–‡ìƒ ‹’Žƒ–—Ž—‹ǡ †—”ƒ„‹Ž‹–ƒ–‡ƒ ’”‘–‡œ‡Ž‘” è‹ ”‡…—-
”‡ìƒ …‘’Ž‹…ƒì‹‹Ž‘” •—– …‡Ž‡ ƒ‹ ‘–ƒ„‹Ž‡ ”‡œ—Ž–ƒ–‡ ’‡–”—
—‡†‹…’”‘–‡–‹…‹ƒǡ‹ƒ”‹’ƒ…–—Ž•‘…‹ƒŽè‹’•‹Š‘Ž‘‰‹…ƒŽ–”ƒ–ƒ-
mentului cu proteze dentare, caracterul adecvat al costurilor,
ƒ˜ƒ–ƒŒ—Žè‹—–‹Ž‹–ƒ–‡ƒ•—–ƒ‹‡•‡ì‹ƒŽ‡†‹’—…–—Ž†‡˜‡†‡”‡
al pacientului [2, 6].
”ƒ–ƒ‡–—Ž’‘ƒ–‡ϐ‹•‘Ž—ì‹‘ƒ–ǡ…Žƒ•‹…ǡ…—’”‘–‡œ‡’ƒ”싃Ž‡
ϐ‹š‡ȋ Ȍ…‘˜‡ì‹‘ƒŽ‡ȋ’‡•—’‘”–†‡†‹ì‹Ȍ•ƒ—‘†‡”ǡ…—
•—’”ƒ•–”—…–—”‹ ’‡ ‹’Žƒ–—”‹ǡ ‘„싐Ÿ† — ‡ˆ‡…– ‡•–‡–‹… †‡-
–ƒ”ƒš‹Ǥ•–‡–‹…ƒ’‡”‹Ǧ‹’Žƒ–ƒ”£‡•–‡†‡–‡”‹ƒ–£ǡÁ’”‹-
—Ž”Ÿ†ǡ†‡‘•—ŽƒŽ˜‡‘Žƒ”ƒ”‰‹ƒŽǡ’ƒ’‹Žƒ†‡–ƒ”£è‹‰‹‰‹ƒ
ƒ”‰‹ƒŽ£Ǥ‡–”—”‡ƒŽ‹œƒ”‡ƒ——‹‡ˆ‡…–‡•–‡–‹…ƒš‹•‡싐‡
…‘– †‡ ‘ •‡”‹‡ †‡ ˆƒ…–‘”‹ …ƒ”‡ •—– ‹–‡”…‘†‹ì‹‘ƒì‹ǣ ’”‘…‡-
•—ŽƒŽ˜‡‘Žƒ”ǡ’”‘ϐ‹Ž—Ž‰‹‰‹˜ƒŽǡˆ‘”ƒ’ƒ’‹Ž‡‹‹–‡”†‡–ƒ”‡ǡ†‹ì‹‹
”‡•–ƒì‹ǡ „—œƒ •—’‡”‹‘ƒ”£ è‹ ‹ˆ‡”‹‘ƒ”£ǡ Ž‹‹ƒ •—”Ÿ•—Ž—‹ǡ •–ƒ”‡ƒ
’ƒ”‘†‘ì‹—Ž—‹ ƒ”‰‹ƒŽ è‹ ’”‘ˆ—†ǡ £”‹‡ƒ ˆ‘”쇎‘” ‘…Ž—œƒ-
Ž‡ǡ•–ƒ”‡ƒ‰‡‡”ƒŽ£†‡•££–ƒ–‡ƒ’ƒ…‹‡–—Ž—‹Ǥ‡œ—Ž–ƒ–—Žˆƒ˜‘-
”ƒ„‹Ž…Š‹”—”‰‹…ƒŽǡ”ƒ–ƒÁƒŽ–£†‡•—’”ƒ˜‹‡ì—‹”‡ƒ‹’Žƒ–—Ž—‹è‹
coroanei pe implant nu prezic succesul estetic, iar pierderea
†‡ƒ•£‘•‘ƒ•£ƒ”‰‹ƒŽ£’‘ƒ–‡ƒ’£”‡ƒ…Š‹ƒ”†ƒ…£”‡œ—Ž–ƒ–—Ž
‡•–‡–‹…‡•–‡•ƒ–‹•ˆ£…£–‘”ȏ͹ǡͺȐǤ
B’‘ϐ‹†ƒ•—……‡•—Ž—‹’‡–‡”‡Ž—‰ƒ”‡•–ƒ—”£”‹Ž‘”’‡‹-
’Žƒ–ǡ ”ƒ–‡Ž‡ ‘†‹ƒŽ‡ †‡ …”‡è–‡”‡ ƒ ’‘’—Žƒì‹‡‹ Á’”‡—£ …—
†—”ƒ–ƒ’”‡Ž—‰‹–£†‡˜‹ƒì£’‘ƒ–‡†—…‡Žƒ‘•‘Ž‹…‹–ƒ”‡Á…”‡è–‡”‡
ƒ …‘˜‡ì‹‘ƒŽ‡Ǥ‡è‹•‹•–‡—Ž‹’Žƒ–‘Ǧ’”‘–‡–‹……‡Žƒ‹
‡ϐ‹…‹‡– ’”‡œ‡”˜‡ƒœ£ †‹ì‹‹ è‹ •–”—…–—”‹Ž‡ ‘”ƒŽ‡ ƒ†‹ƒ…‡–‡ǡ ’ƒ-
…‹‡ì‹‹ ’‘– ”‡•’‹‰‡ –”ƒ–ƒ‡–—Ž …— ‹’Žƒ–—”‹ǡ …ƒ”‡ ‡…‡•‹–£
–‹’ǡ‡•–‡…‘•–‹•‹–‘”è‹’‘ƒ–‡‡…‡•‹–ƒ–”ƒ–ƒ‡–…Š‹”—”‰‹…ƒŽƒŽ
쇕—–—”‹Ž‘” †—”‡ è‹ ‘‹Ǥ B ’Ž—•ǡ –”ƒ–ƒ‡–—Ž …—   …‘˜‡-
싑ƒŽ‡ ’‡”‹–‡ ‡˜‹–ƒ”‡ƒ ”‹•…—”‹Ž‘”ǡ †‹ϐ‹…—Ž–£ì‹Ž‘” è‹ …‘•–—”‹Ž‘”
chirurgicale asociate cu protezele pe suport de implant. Ca-
’ƒ…‹–ƒ–‡ƒ‡…‘‘‹…£ƒ——‹’ƒ…‹‡–†‡ƒ•—•ì‹‡–”ƒ–ƒ‡–—Žǡ
ˆ”‡…˜‡– Œ‘ƒ…£ — ”‘Ž †‡…‹•‹˜ Á •‡Ž‡…–ƒ”‡ƒ ‡–‘†‡‹ †‡ –”ƒ–ƒ-
ment recomandat. În plus, este necesar de luat în considera-
”‡…‘•–—”‹Ž‡„‹‘Ž‘‰‹…‡è‹ϐ‹ƒ…‹ƒ”‡è‹†‡ƒƒŽ‹œƒ–ƒ–‡–„ƒŽƒìƒ
…‘•–Ǧ„‡‡ϐ‹…‹—ȏ͵ǡ͸ǡͻǡͳͲǡͳͳȐǤ
胆ƒ”ǡ ’”‡˜ƒŽ‡ìƒ ÁƒŽ–£ ƒ ‡†‡–ƒì‹‡‹ —‹†‡–ƒ”‡ Á ’‘-
’—Žƒì‹‡ǡƒˆ‡…–ƒ”‡ƒ†‹ˆ‡”‹–‘”ƒ•’‡…–‡ƒŽ‡˜‹‡ì‹‹ƒ…‡•–‘”’ƒ…‹‡ì‹ǡ
‹…Ž—•‹˜ Áˆ£ì‹èƒ”‡ƒǡ ˆ—…싃ǡ ”‡Žƒì‹‹Ž‡ ‹–‡”’‡”•‘ƒŽ‡ è‹ …ƒŽ‹–ƒ-
–‡ƒ˜‹‡ì‹‹ǡƒ†”‡•ƒ„‹Ž‹–ƒ–‡ƒ•’‘”‹–£ƒ’ƒ…‹‡ì‹Ž‘”苇š‹•–‡ìƒƒ‹
—Ž–‘”–‹’—”‹†‡–”ƒ–ƒ‡–ƒ”‰—‡–‡ƒœ£ƒ…–—ƒŽ‹–ƒ–‡ƒ•–—†‹‡-
MJHS 17(3)/2018 77
ant, explains a change in attitude of the patient seeking dental
care. In the context of local homeostasis, creating a facial and
ˆ—…–‹‘ƒŽŠƒ”‘›™‹–Šƒ”–‹ϐ‹…‹ƒŽ–‡‡–Š„‡…‘‡•ƒ„‹‘Ž‘‰‹…ƒŽ
and behavioral requirement of particular importance. The in-
creasing popularity of dental implants, the expanding wishes
and requirements for seemingly natural restorations have led
to a paradigm shift from a simple rehabilitation of function to
restoring both form and function, especially in the aesthetic
region, with optimal preservation of soft and hard tissues and
more strict aesthetic dental criteria. The complete reconstruc-
tion of dental aesthetics and gingiva remains the main aim.
”‡ƒ–‹‰ƒ•‹‹Žƒ”•‘ˆ––‹••—‡’”‘ϐ‹Ž‡Šƒ”‘‹œ‡†™‹–Š–Š‡•‘ˆ–
–‹••—‡’”‘ϐ‹Ž‡‘ˆƒ†Œƒ…‡––‡‡–Š‹•–Š‡‘•–†‹ˆϐ‹…—Ž–‡Ž‡‡–‹
achieving an optimal aesthetic result [3, 4, 5].
Implant resistance, denture durability, and recurrence of
complications are the most notable results for a prosthodon-
tist and the social and psychological impact of dental prosthe-
•‹•ǡ …‘•–Ǧˆ”‹‡†Ž‹‡••ǡ „‡‡ϐ‹–ǡ ƒ† —–‹Ž‹–› ƒ”‡ ‘”‡ ‡••‡–‹ƒŽ
from a patient’s point of view [2, 6].
The treatment can be resolved in a classic way, with con-
˜‡–‹‘ƒŽ ’ƒ”–‹ƒŽ ϐ‹š‡† †‡–—”‡• ȋ Ȍ ȋ‘ –‡‡–ŠȌ ‘” ‘†‡”
ones, with implant supported prostheses, achieving a maxi-
mum aesthetic effect. Peri-implant aesthetics is primarily de-
termined by marginal alveolar bone, dental papilla and mar-
ginal gingiva. In order to achieve a maximum aesthetic effect,
ƒ—„‡”‘ˆˆƒ…–‘”•ƒ”‡‹–‡””‡Žƒ–‡†ǣ–Š‡ƒŽ˜‡‘Žƒ”’”‘…‡••ǡ–Š‡
‰‹‰‹˜ƒŽ ’”‘ϐ‹Ž‡ǡ –Š‡ ‹–‡”†‡–ƒŽ ’ƒ’‹ŽŽƒ ˆ‘”ǡ –Š‡ ”‡ƒ‹‹‰
teeth, the upper and lower lip, the smile line, the state of the
marginal and deep periodontium, the occlusal force, general
health of the patient. The favorable surgical result, the high
survival rate of implant and crown on the implant does not
predict aesthetic success, and loss of marginal bone mass can
occur even if the esthetic result is satisfying [7, 8].
Despite the long-term success of implant restorations,
the increasing rate of world population along with prolonged
lifespan may lead to a growing demand for conventional PFDs.
Although the implant-prosthetic system maintains teeth and
adjacent oral structures most effectively, patients may reject
implant treatment that requires time, is costly and may require
surgical treatment of hard and soft tissues. Moreover, conven-
–‹‘ƒŽ –”‡ƒ–‡–ƒŽŽ‘™•ƒ˜‘‹†‹‰–Š‡”‹••ǡ†‹ˆϐ‹…—Ž–‹‡•ƒ†
surgical costs, which are associated with implant-supported
restorations. The economic capacity of a patient to support
treatment often plays a decisive role in selecting the recom-
mended treatment method. In addition, it is necessary to take
‹–‘ …‘•‹†‡”ƒ–‹‘ –Š‡ „‹‘Ž‘‰‹…ƒŽ ƒ† ϐ‹ƒ…‹ƒŽ …‘•–• ƒ† –‘
…ƒ”‡ˆ—ŽŽ›ƒƒŽ›œ‡–Š‡…‘•–Ǧ„‡‡ϐ‹–„ƒŽƒ…‡ȏ͵ǡ͸ǡͻǡͳͲǡͳͳȐǤ
Therefore, the high prevalence of single edentulism in the
population, affecting the different aspects of the life of the pa-
tients, including the appearance, function, interpersonal rela-
tionships and quality of life, the increased addressability of the
patients and the existence of several types of treatment proves
the actuality of the research. Therefore, a comparative study
of the treatment of single edentulism using the classic method
with conventional PFD and the modern one with prosthetic
superstructures on implants was done. The existing reality is
explained by the attitude of the population towards its aes-
78
rii problemei abordate prin efectuarea unui studiu comparativ
ƒ–”ƒ–ƒ‡–—Ž—‹‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡’”‹‡–‘†ƒ…Žƒ•‹…£…—
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…ƒ‡Ž‡‡–‡†‡ƒ‰”‡‰ƒ”‡Á…‘•–”—…ì‹‹’”‘–‡–‹…‡ȏͻǡͳͲǡͳͳȐǤ
B …‘–‡š–—Ž †‡œ˜‘Ž–£”‹‹ è‹ ’‡”ˆ‡…ì‹‘£”‹‹ ”ƒ’‹†‡ ƒ –‡Š‘-
Ž‘‰‹‹Ž‘” è‹ ƒ–‡”‹ƒŽ‡Ž‘” †‡ …‘ˆ‡…ì‹‘ƒ”‡ ƒ ’”‘–‡œ‡Ž‘” è‹ ‹-
planturilor dentare, scopul acestui articol este prezentarea
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ƒ–‡”‹ƒŽç‹‡–‘†‡
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†‡•’”‡–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡Ǥ†‹ì‹‘ƒŽǡƒˆ‘•–•–—-
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ƒ”–‹…‘Ž‡”‡Ž‡˜ƒ–‡’‡ƒ…‡ƒ•–£–‡£Ǥˆ‘•–•‡Ž‡…–ƒ–£è‹’”‘…‡•ƒ–£
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Ž‡†‡–”ƒ–ƒ‡–ƒŽ‡‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡ǡ–‹’—”‹Ž‡†‡’”‘–‡œ‡
’ƒ”싃Ž‡ϐ‹š‡ǡ‹’Žƒ–£”‹†‡–ƒ”‡è‹”‡•–ƒ—”£”‹’”‘–‡–‹…‡’‡‹-
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‡œ—Ž–ƒ–‡
—’£’”‘…‡•ƒ”‡ƒ‹ˆ‘”ƒì‹‡‹†‹„ƒœ‡Ž‡†‡†ƒ–‡—„‡†è‹
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”‡Ǥ ‹„Ž‹‘‰”ƒϐ‹ƒ ϐ‹ƒŽ£ …‘ì‹‡ ͷʹ †‡ •—”•‡ ”‡Ž‡˜ƒ–‡ǡ …ƒ”‡ ƒ—
fost considerate reprezentative pentru materialele publicate
Žƒ–‡ƒƒ…‡•–—‹ƒ”–‹…‘Ž†‡•‹–‡œ£Ǥ
—„Ž‹…ƒì‹‹Ž‡ǡ …‘ì‹—–—Ž …£”‘”ƒ — ”‡ϐŽ‡…–ƒ ”‡œ—Ž–ƒ–‡Ž‡ –”ƒ-
–ƒ‡–—Ž—‹ ’ƒ…‹‡ì‹Ž‘” …— ‡†‡–ƒì‹‡ —‹†‡–ƒ”£ ’”‹ ‡–‘†ƒ
…Žƒ•‹…£ …—   …‘˜‡ì‹‘ƒŽ‡ è‹ ’”‹ –”ƒ–ƒ‡– ‘†‡” …—
•—’”ƒ•–”—…–—”‹ ’”‘–‡–‹…‡ ’‡ ‹’Žƒ–‡ǡ †‡è‹ ƒ— ˆ‘•– •‡Ž‡…–ƒ–‡
†‡’”‘‰”ƒ—Ž†‡…£—–ƒ”‡ǡ’”‡…—è‹ƒ”–‹…‘Ž‡Ž‡…ƒ”‡—ƒ—ˆ‘•–
”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
thetic appearance and the desire to keep the remaining teeth
next to the edentulous gap without their use as abutments in
prosthetic constructions [9, 10, 11].
In the context of the fast development and improvement
of dental implants technologies and materials, the aim of this
article is to present the synthesis of the latest data on the
comparative effectiveness of conventional PFD and implant-
prosthetic systems in the treatment of patients with single
edentulism.
Material and methods
The publications were selected from the PubMed and
…‘’—•ȋŽ•‡˜‹‡”Ȍ†ƒ–ƒ„ƒ•‡•„›‡›™‘”†•ǣ•‹‰Ž‡‡†‡–—Ž‹•ǡ
ϐ‹š‡† ’ƒ”–‹ƒŽ ’”‘•–Š‡•‹•ǡ †‡–ƒŽ ‹’Žƒ–ǡ ‹’Žƒ–Ǧ’”‘•–Š‡–‹…
restoration. All English publications since January 2000 have
been selected. The sources also include articles published in
the Republic of Moldova. After a preliminary analysis of the
–‹–Ž‡•ǡ–Š‡ϐ‹ƒŽ„‹„Ž‹‘‰”ƒ’Š›‹…Ž—†‡•‘”‹‰‹ƒŽƒ”–‹…Ž‡•ǡ‡†‹–‘-
rials, narrative synthesis, systematic and meta-analysis, con-
taining new information and contemporary concepts about
the treatment of the single edentulism. Additionally, the bib-
liography of selected articles has been studied in order to
ϐ‹† ‘–Š‡” ”‡Ž‡˜ƒ– ƒ”–‹…Ž‡• ‘ –Š‡ •—„Œ‡…–Ǥ Š‡ ‹ˆ‘”ƒ–‹‘
”‡‰ƒ”†‹‰…Žƒ••‹ϐ‹…ƒ–‹‘ǡ‡–‹‘Ž‘‰›ǡ’”‡˜ƒŽ‡…‡ƒ†‡–Š‘†•‘ˆ
–”‡ƒ–‡–‘ˆ•‹‰Ž‡‡†‡–—Ž‹•ǡ–›’‡•‘ˆϐ‹š‡†’ƒ”–‹ƒŽ’”‘•–Š‡-
ses, dental implants and prosthetic restorations on implants,
survival, success, complications and quality of life related to
oral health in patients with single edentulism treated with
conventional PFD and implant-prosthetic systems was se-
lected and analyzed.
Results
After processing the information from the PubMed and
Scopus (Elsevier) databases, according to the search criteria,
625 articles on the treatment of single edentulism were found.
Š‡ ϐ‹ƒŽ „‹„Ž‹‘‰”ƒ’Š› …‘–ƒ‹• ͷʹ ”‡Ž‡˜ƒ– •‘—”…‡•ǡ ™Š‹…Š
were considered representative for the materials published
on the subject of this synthesis article.
Also, there were subsequently excluded from the list the
’—„Ž‹…ƒ–‹‘•ǡ–Š‡…‘–‡–•‘ˆ™Š‹…Š†‘‘–”‡ϐŽ‡…––Š‡”‡•—Ž–•
of the treatment of patients with single edentulism by clas-
sical method with conventional PFD and modern treatment
with prosthetic superstructures on implants, although they
were selected by the search program as well as articles that
were not accessible for free viewing and the HINARI (Health
ƒ……‡•‹„‹Ž‡’‡–”—˜‹œ‹‘ƒ”‡Ž‹„‡”£è‹’”‹„ƒœƒ†‡†ƒ–‡
(‡ƒŽ–Š In–‡”n‡– o” cc‡•• –o ‡•‡ƒ”cŠ In‹–‹ƒ–‹˜‡) sau dispo-
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†‡‡†‹…‹£è‹ ƒ”ƒ…‹‡Ƿ‹…‘Žƒ‡‡•–‡‹ìƒ—dzǡƒ—ˆ‘•–ǡ—Ž–‡”‹-
‘”ǡ‡š…Ž—•‡†‹Ž‹•–£Ǥ
Žƒ•‹ϔ‹cƒ”‡ƒ è‹ ‡’‹†‡‹oŽo‰‹ƒ ‡†‡n–ƒì‹‡‹
†‡–ƒì‹ƒ‡•–‡‘•–ƒ”‡’ƒ–‘Ž‘‰‹…£è‹†‡ϐ‹…‹‡ì£ϐ‹œ‹…£…ƒ”ƒ…-
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‡•–‡‘’”‘„Ž‡£ƒŒ‘”£†‡•££–ƒ–‡‹†‹ˆ‡”‡–†‡•‘…‹‡–£ì‹ǡ”‡-
‰‹—‹ǡ‡–‹‹è‹’£–—”‹•‘…‹ƒŽ‡ǡƒ”‡‘—Ž–‹–—†‹‡†‡”‡’‡”…—•‹—‹
•‘…‹‘Ǧ‡…‘‘‹…‡è‹†‡•££–ƒ–‡Ǥ‡•–ƒ„‹Ž‹”‡ƒ‹–‡‰”‹–£ì‹‹ƒ”…ƒ-
Internet Access Work to Research Initiative) database or avail-
ƒ„Ž‡‹–Š‡‡†‹…ƒŽ•…‹‡–‹ϐ‹…Ž‹„”ƒ”›‘ˆ–Š‡‹coŽƒ‡ ‡•–‡‹–ƒn—
State University of Medicine and Pharmacy.
Žƒ••‹ϔ‹cƒ–‹on ƒn† ‡’‹†‡‹oŽo‰› oˆ ‡†‡n–—Ž‹•
†‡–—Ž‹• ‹• ƒ ’ƒ–Š‘Ž‘‰‹…ƒŽ …‘†‹–‹‘ ƒ† ’Š›•‹…ƒŽ †‡ϐ‹-
ciency characterized by the absence of one or more teeth in
the arch, is a major health problem regardless of societies, re-
gions, ethnicities and social strata, has a multitude of socio-
economic and health effects. Restoring the integrity of dental
arches in the case of single edentulism remains a fairly current
problem until now [4, 12, 13].
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
†‡Ž‘”†‡–ƒ”‡Á…ƒœ—Ž‡†‡–ƒì‹‹Ž‘”—‹†‡–ƒ”‡’Ÿ£Á’”‡œ‡–
”£Ÿ‡‘’”‘„Ž‡£†‡•–—Ž†‡ƒ…–—ƒŽ£ȏͶǡͳʹǡͳ͵ȐǤ
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†‹–‡Ȍǡ’ƒ”싃Ž£ȋŽ‹’•‡è–‡—‰”—’†‡†‹ì‹Ȍè‹–‘–ƒŽ£ȋŽ‹’•‡•…–‘ì‹
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ˆ”‡…˜‡–£ȏͳͷǡͳ͸ǡͳ͹ǡͳͺȐǤ
”‹–”‡ †‹ˆ‡”‹–‡Ž‡ ‡–‘†‡ †‡ …Žƒ•‹ϐ‹…ƒ”‡ ƒ ‡†‡–ƒì‹‹Ž‘” ’ƒ”-
싃Ž‡ ȋ‡‡†›ǡ ’’Ž‡‰ƒ–‡•ǡ ˜ƒ–ǡ ‡—”‘Šƒ”ǡ ‹…Š‡”ǡ ‡”‹-
…ƒ‘ŽŽ‡‰‡‘ˆ”‘•–Š‘†‘–‹…•Ȍǡ…Žƒ•‹ϐ‹…ƒ”‡ƒ†‘…–‘”—Ž—‹†™ƒ”†
‡‡†›‡•–‡•‹’Ž£ǡŽƒ”‰•–—†‹ƒ–£ǡ…‡Žƒ‹ˆ”‡…˜‡–—–‹Ž‹œƒ–£è‹
ƒ……‡’–ƒ–£…Ž‹‹…†‡…‘—‹–ƒ–‡ƒ•–‘ƒ–‘Ž‘‰‹Ž‘”ǡ†ƒ–‘”‹–£ƒ˜ƒ-
–ƒŒ‡Ž‘”•ƒŽ‡†‡˜‹œ—ƒŽ‹œƒ”‡è‹”‡…—‘ƒè–‡”‡‹‡†‹ƒ–£ƒ•—’‘”–—-
Ž—‹’‡–”—’”‘–‡œ‡è‹”‘Ž—Ž—‹‹’‘”–ƒ–Á’Žƒ‹ϐ‹…ƒ”‡ƒŽ—…”£”‹Ž‘”
†‡–ƒ”‡Ǥ‡‡†›ƒÁ’£”ì‹–‡†‡–ƒì‹‹Ž‡’ƒ”싃Ž‡ÁͶ…Žƒ•‡ǡÁ
ˆ—…싇†‡’‘œ‹ì‹ƒè‹Á–‹†‡”‡ƒ„”‡è‡Ž‘”‡†‡–ƒ–‡ǣ…Žƒ•ƒͳ‡-
‡†›ȋ‡†‡–ƒì‹‡„‹Žƒ–‡”ƒŽ£–‡”‹ƒŽ£Ȍǡ…Žƒ•ƒʹ‡‡†›ȋ‡†‡-
–ƒì‹‡—‹Žƒ–‡”ƒŽ£–‡”‹ƒŽ£Ȍǡ…Žƒ•ƒ͵‡‡†›ȋ‡†‡–ƒì‹‡‹–‡”-
…ƒŽƒ–£ ’‘•–‡”‹‘ƒ”£Ȍ è‹  …Žƒ•ƒ Ͷ ‡‡†› ȋ‡†‡–ƒì‹‡ ‹–‡”…ƒŽƒ–£
ƒ–‡”‹‘ƒ”£ǡ…‡‹–‡”•‡…–‡œ£Ž‹‹ƒ‹–‡”‹…‹•‹˜ƒŽ£ȌȏͳͶǡͳͻǡʹͲȐǤ
†‡–ƒì‹‹Ž‡—‹†‡–ƒ”‡è‹—Ž–‹’Ž‡•—–…ƒ—œƒ–‡ǡÁ’”‹…‹-
’ƒŽǡ†‡ƒ’Žƒœ‹‡ȋ–—Ž„—”£”‹‰‡‡–‹…‡è‹Ȁ•ƒ—†‡‡†‹—ǡ‡š’—‡”‹
Žƒ ”ƒ†‹ƒì‹‹ è‹ …Š‹‹‘–‡”ƒ’‹‡ Á –‹’—Ž †‡œ˜‘Ž–£”‹‹ †‹ì‹Ž‘”Ȍǡ Ž‡-
ziuni traumatice parodontale sau ocluzale, boli sistemice con-
…‘‹–‡–‡ǡ‘•–‡‘‹‡Ž‹–£ǡ–—‘”‹†‡–‘Ǧƒš‹Žƒ”‡ǡ–‡”ƒ’‹‡‡†‘-
†‘–‹…£‡è—ƒ–£ǡ‡š–”ƒ…ì‹‹†‡–ƒ”‡”‡ƒŽ‹œƒ–‡Á•…‘’‘”–‘†‘–‹…ǡ
’”‘–‡–‹…•ƒ—’”‘ϐ‹Žƒ…–‹…ǡ‡š–”ƒ…ì‹‹†‡–ƒ”‡…ƒ—œƒ–‡†‡…ƒ”‹‹•ƒ—
ƒŽƒ†‹ƒ’ƒ”‘†‘–ƒŽ£Ǥ‡ƒƒ‹ƒ”‡’ƒ”–‡ƒ‡†‡–ƒì‹‹Ž‘”•—–
produse de cariile dentare (83%), de parodontopatiile dege-
‡”ƒ–‹˜‡‹ϐŽƒƒ–‘”‹‹•ƒ—‹š–‡ȋͳ͹ΨȌè‹…‘’Ž‹…ƒì‹‹Ž‡ƒ…‡•–‘”ƒ
[13, 14, 16, 19, 21, 22, 23].
—–…‘•–ƒ–ƒì‹è‹ƒŽì‹ˆƒ…–‘”‹‰‡‡”ƒŽ‹…ƒ”‡‹ϐŽ—‡ì‡ƒœ£•£-
£–ƒ–‡ƒ ’ƒ”‘†‘–ƒŽ£ǣ •–ƒ–—–—Ž •‘…‹‘Ǧ‡…‘‘‹… ȋ‹˜‡Ž—Ž ”‡†—•
†‡ ‡†—…ƒì‹‡ǡ ˜‡‹–—”‹Ž‡ ‹…‹ǡ ˆ—ƒ–—ŽȌǡ ˆƒ…–‘”‹ …‘’‘”–ƒ‡-
–ƒŽ‹ǡˆƒ…–‘”‹‘†‘–‘‰‡‹ȋ’‹‡”†‡”‡ƒ†‡ƒ•£‘•‘ƒ•£ƒŽ˜‡‘Žƒ”£ǡ
‘„‹Ž‹–ƒ–‡ƒ†‹–‡Ž—‹ǡ‰”ƒ†—Ž†‡‹’Ž‹…ƒ”‡Á”ƒ‹ϐ‹…ƒ”‡ƒ”ƒ†‹…—-
Žƒ”£ǡ–‹’—Ž†‡†‹–‡è‹˜‹–ƒŽ‹–ƒ–‡ƒ†‹–‡Ž—‹Ȍǡ’”‹‘”‹–£ì‹Ž‡…—Ž–—”ƒŽ‡ǡ
•‹•–‡‡Ž‡†‡ƒ•‹‰—”£”‹‡†‹…ƒŽ‡è‹–‡†‹ì‡Ž‡•‡…—Žƒ”‡ȏͳ͵ǡͳͶǡ
22, 24, 25].
ƒŒ‘”‹–ƒ–‡ƒ ƒ—–‘”‹Ž‘” ƒ— ƒŒ—• Žƒ …‘…Ž—œ‹ƒ …£ — ‡š‹•–£ ‘
…‘”‡Žƒì‹‡•‡‹ϐ‹…ƒ–‹˜£ƒ•‡š—Ž—‹…—ƒ’ƒ”‹ì‹ƒ‡†‡–ƒì‹‡‹’ƒ”싃Ž‡
MJHS 17(3)/2018 79
The variation of the number and location of the edentulous
space and its relation to the natural teeth requires the classi-
ϐ‹…ƒ–‹‘‘ˆ–Š‡’ƒ”–‹ƒŽŽ›‡†‡–—Ž‘—•ƒ”…Š‡•Ǥ†‡–—Ž‹•…ƒ„‡
single (missing one tooth), partial (missing a group of teeth)
and total (all teeth missing). Depending on the anatomical lo-
cation, edentulism may be maxillary or mandibular, in the an-
terior region (central incisors, lateral incisors and canines) or
in the posterior area (premolars and molars) of the oral cavity
[4, 12, 14]. From a clinical and etiopathogenic point of view,
–Š‡”‡ƒ”‡–Š‡ˆ‘ŽŽ‘™‹‰–›’‡•‘ˆ‡†‡–—Ž‹•ǣ
ƒcongenital (primary) edentulism or dental agenesis,
also known as hypodontia (absence of 1 to 5 teeth), oli-
godontia (absence of 6 or more teeth), anodontia (total
absence of teeth), occurs due to lack of teeth buds and
usually affects permanent dentition;
ƒapparent or transitory edentulism occurs temporarily,
more frequently during mixed dentition, and more rarely
in the case of permanent dentition;
ƒthe acquired or secondary edentulism is the most com-
mon form [15-18].
Among the various methods of classifying partial edentu-
lism (Kennedy, Applegates, Avant, Neurohar, Eichner, Ameri-
…ƒ‘ŽŽ‡‰‡‘ˆ”‘•–Š‘†‘–‹…•Ȍǡ–Š‡…Žƒ••‹ϐ‹…ƒ–‹‘‘ˆ”Ǥ†™ƒ”†
Kennedy is simple, widely studied, most commonly used and
clinically accepted by the dentist community due to its advan-
tages of visualization and immediate recognition of prosthe-
sis support and the important role in dental work planning.
Kennedy divided the partial editions into 4 classes, depending
‘–Š‡’‘•‹–‹‘ƒ†‡š–‡–‘ˆ–Š‡‡†‡–—Ž‘—•‰ƒ’•ǣ‡‡†›ͳ
(bilateral posterior edentulous areas), Class 2 Kennedy (uni-
lateral posterior edentulous), Kennedy Class 3 (unilateral pos-
terior intercalated edentulous area) and Kennedy Class 4 (a
single but bilateral anterior (crossing the midline) edentulous
area) [14, 19, 20].
Single and multiple edentulism are mainly caused by apla-
sia (genetic and/or environmental disorders, radiation expo-
sure and chemotherapy during teeth development), periodon-
tal or occlusal traumatic lesions, concomitant systemic dis-
eases, osteomyelitis, dento-maxillary tumors, failure of end-
odontic treatment, dental extractions made for orthodontic,
prosthetic or prophylactic purposes, dental extractions caused
by caries or periodontal disease. The biggest part of the eden-
–—Ž‹••‹–—ƒ–‹‘•ƒ”‡’”‘†—…‡†„›†‡–ƒŽ…ƒ”‹‡•ȋͺ͵ΨȌǡ‹ϐŽƒ-
matory or mixed degenerative parodontopathies (17%) and
their complications [13, 14, 16, 19, 21, 22, 23].
Š‡”‡ƒ”‡‘–Š‡”‰‡‡”ƒŽˆƒ…–‘”•–Šƒ–‹ϐŽ—‡…‡’‡”‹‘†‘–ƒŽ
Š‡ƒŽ–Šǣ •‘…‹‘Ǧ‡…‘‘‹… •–ƒ–—• ȋŽ‘™ ‡†—…ƒ–‹‘ Ž‡˜‡Žǡ Ž‘™ ‹-
comes, smoking), behavioral factors, odontogenic factors (al-
veolar bone mass loss, tooth mobility, the involvement degree
in tooth root dividing, tooth type and vitality of the tooth), cul-
tural priorities, health insurance systems and secular trends
[13, 14, 22, 24, 25].
The majority of authors concluded that there was no sig-
‹ϐ‹…ƒ– ‰‡†‡” …‘””‡Žƒ–‹‘ ™‹–Š –Š‡ ’ƒ”–‹ƒŽ ‡†‡–—Ž‹• ‘…-
currence (52.02% among men and 47.98% among women),
ƒŽ–Š‘—‰Š•‘‡•–—†‹‡•Šƒ˜‡‘–‹…‡†ƒ•‹‰‹ϐ‹…ƒ–‰‡†‡””‡Žƒ-
tionship with different classes of partial edentulism [14, 23].
80
ȋͷʹǡͲʹΨ’”‹–”‡„£”„ƒì‹è‹Ͷ͹ǡͻͺΨ’”‹–”‡ˆ‡‡‹Ȍǡ†‡è‹ǡ…Ÿ–‡˜ƒ
•–—†‹‹ƒ—‘„•‡”˜ƒ–‘”‡Žƒì‹‡•‡‹ϐ‹…ƒ–‹˜£Á–”‡‰‡è‹†‹ˆ‡”‹–‡
…Žƒ•‡†‡‡†‡–ƒì‹‡’ƒ”싃Ž£ȏͳͶǡʹ͵ȐǤ
”‡˜ƒŽ‡ìƒ ‡†‡–ƒì‹‡‹ ——‹ †‹–‡ ’‡”ƒ‡– ‡•–‡ †‡ ʹǡͺǦ
ͺǡͲΨȋƒŽ–”‡‹Ž‡ƒ‘Žƒ”‡•–‡‡š…Ž—•Ȍǡ˜ƒ”‹‹†Áˆ—…싇†‡‡–‹‡
è‹ ’‘’—Žƒì‹‡Ǥ †‡–ƒì‹ƒ —‹†‡–ƒ”£ ‡•–‡ …‡ƒ ƒ‹ ˆ”‡…˜‡–£ Á
œ‘‡Ž‡’‘•–‡”‹‘ƒ”‡ƒŽ‡ƒš‹Žƒ”‡Ž‘”ǡ†‹ì‹‹…‡‹ƒ‹ƒˆ‡…–ƒì‹•—–
al doilea premolar inferior, urmat de incisivii laterali superi-
‘”‹ǡƒŽ†‘‹Ž‡ƒ’”‡‘Žƒ”•—’‡”‹‘”è‹‹…‹•‹˜‹‹‹ˆ‡”‹‘”‹ȏʹͳȐǤ
‡˜‹œ—‹”‹Ž‡•‹•–‡ƒ–‹…‡ƒŽ‡Ž‹–‡”ƒ–—”‹‹ƒ—…‘•–ƒ–ƒ–…£’‹‡”-
†‡”‡ƒ†‹ì‹Ž‘”†‹ˆ‡”£Áˆ—…싇†‡ƒ”…ƒ†£ǣ’”‡˜ƒŽ‡ìƒ‡†‡–ƒ-
싇‹’ƒ”싃Ž‡‡•–‡ƒ‹ˆ”‡…˜‡–£Áƒ”…ƒ†‡Ž‡ƒ†‹„—Žƒ”‡†‡…Ÿ–
Áƒ”…ƒ†‡Ž‡ƒš‹Žƒ”‡è‹Áœ‘‡Ž‡’‘•–‡”‹‘ƒ”‡†‡…Ÿ–Áœ‘‡Ž‡
anterioare. Clasa 3 Kennedy este modelul cel mai frecvent al
‡†‡–ƒì‹‡‹ ’ƒ”싃Ž‡ ƒ–Ÿ– Á ƒš‹Žƒ” …Ÿ– è‹ Á ƒ†‹„—Ž£Ǥ ”‹-
–”‡’ƒ…‹‡ì‹‹…—˜Ÿ”•–ƒηͳ͹ƒ‹ƒˆ‘•–”ƒ’‘”–ƒ–£‘‹…‹†‡ì£†‡
ͶͻǡͺͶǦͷ͸ǡ͹Ψ’‡–”—…Žƒ•ƒ͵‡‡†›ǡ—”ƒ–£†‡…Žƒ•ƒʹ‡-
‡†› ȋͳͺǦʹʹǡͺͶΨȌǡ …Žƒ•ƒ ͳ ‡‡†› ȋͳ͸ǡ͹Ǧʹͷǡ͹ͷΨȌ è‹ …Žƒ•ƒ
Ͷ ‡‡†› ȋͳǡͷͷǦͺǡ͸ΨȌǤ Žƒ•ƒ ͵ ‡‡†› ‡•–‡ †‡’‹•–ƒ–£ Á
ͷʹǡͻʹǦͷ͸Ψ †‹ …ƒœ—”‹ Á ƒš‹Žƒ” è‹ Á ͶͷǦͷͺΨ †‹ …ƒœ—”‹ Á
ƒ†‹„—Ž£ǤŽƒ•ƒͶ‡‡†›‡•–‡‘†‡Ž—Ž…‡Žƒ‹”ƒ”ƒŽ‡†‡-
–ƒì‹‡‹ ’ƒ”싃Ž‡ ȏͳͶǡ ͳͻǡ ʹͲǡ ʹ͵ȐǤ ‘…‘‹–‡– …— ˜Ÿ”•–ƒ …”‡è–‡
ˆ”‡…˜‡ìƒ…Žƒ•‡‹ͳè‹…Žƒ•‡‹ʹ‡‡†›ǡ•…ƒ†‡ˆ”‡…˜‡ìƒ…Žƒ•‡‹͵
è‹…Žƒ•‡‹Ͷ‡‡†›Áƒ„‡Ž‡ƒ”…ƒ†‡†‡–ƒ”‡Ǥ
‡—Ž—ƒƒ˜—– A large-scale study made in the USA between 1988 and
‘”‡Žƒì‹‡•‡‹ϐ‹…ƒ–‹˜£…—†‹•–”‹„—싃…‘ˆ‘”…Žƒ•‹ϐ‹…£”‹‹‡†‡-
–ƒì‹‡‹’ƒ”싃Ž‡‡‡†›ȏʹ͵ȐǤ
Un studiu de amploare, realizat în SUA în perioada anilor
ͳͻͺͺǦͳͻͻͳ’”‹–”‡’‡”•‘ƒ‡Ž‡Á˜Ÿ”•–£†‡ͳͺƒ‹è‹ƒ‹—Ž–ǡ
ƒ ”‡Ž‡˜ƒ– ‡†‡–ƒì‹‡ —‹†‡–ƒ”£ Žƒ ͳͲǡͷΨ ’‡”•‘ƒ‡ǡ ‡†‡–ƒì‹‡
–‘–ƒŽ£Ȃ†‡ŽƒͶ͵ǡͻΨÁ”Ÿ†—Ž’‡”•‘ƒ‡Ž‘”…—˜Ÿ”•–ƒ†‡͹ͷ†‡
ƒ‹è‹’‡•–‡’Ÿ£ŽƒͲΨŽƒ’‡”•‘ƒ‡Ž‡…—˜Ÿ”•–‡…—’”‹•‡Á–”‡
ͳͺè‹ʹͶ†‡ƒ‹Ǥ†‡–ƒì‹ƒƒˆ‘•–†‡’‡†‡–£†‡˜Ÿ”•–£è‹‡–‹‡
苇”ƒ•‹‹Žƒ”£Žƒ’‡”•‘ƒ‡Ž‡†‡ƒ„‡Ž‡•‡š‡ȏʹ͸ȐǤ
Conform rezultatelor unei revizuiri sistematice a literaturii,
‹…‹†‡ìƒ’‹‡”†‡”‹‹†‹ì‹Ž‘”Žƒ’‡”•‘ƒ‡Ž‡…—˜Ÿ”•–ƒ†‡ʹͲǦ͸ͷ†‡
ƒ‹ƒ˜ƒ”‹ƒ–ÁŽ‹‹–‡Ž‡ͳǡ͵ǦͷΨǤB†‘—£•–—†‹‹‡’‹†‡‹‘Ž‘‰‹…‡ǡ
”‡ƒŽ‹œƒ–‡ ’”‹–”‡ ’‘’—Žƒì‹‹ ”—”ƒŽ‡ …Š‹‡œ‡ǡ ‹…‹†‡ìƒ ’‹‡”†‡”‹‹
†‹–‡Ž—‹ƒ…‘•–‹–—‹–ͳͶǦʹͲΨǡ‹ƒ”’”‘’‘”싃’‡”•‘ƒ‡Ž‘”…ƒ”‡ƒ—
•—’‘”–ƒ–‘‡†‡–ƒì‹‡ƒ˜ƒ”‹ƒ–†‡ŽƒʹͷΨ’Ÿ£Žƒ͹ͷΨȏʹ͹ȐǤ
胆ƒ”ǡ…ƒ”‹‹Ž‡†‡–ƒ”‡è‹ƒŽƒ†‹ƒ’ƒ”‘†‘–ƒŽ£•—–…ƒ—œ‡Ž‡
ƒŒ‘”‡ƒŽ‡‡†‡–ƒì‹‡‹’ƒ”싃Ž‡Ǥ—‡š‹•–£‘…‘”‡Žƒì‹‡Á–”‡•‡š‡
’‡–”—‡†‡–ƒì‹ƒ’ƒ”싃Ž£ǡ‹ƒ”˜Ÿ”•–ƒƒ”‡—‡ˆ‡…–•‡‹ϐ‹…ƒ–‹˜Ǥ
”‡˜ƒŽ‡ìƒ‡†‡–ƒì‹‡‹——‹†‹–‡’‡”ƒ‡–‡•–‡†‡ʹǡͺǦͺǡͲΨ
苇•–‡ƒ‹ˆ”‡…˜‡–£Áœ‘‡Ž‡’‘•–‡”‹‘ƒ”‡ƒŽ‡ƒš‹Žƒ”‡Ž‘”Ǥ
‡–o†‡Ž‡ †‡ –”ƒ–ƒ‡n– ƒŽ‡ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
‹ŒŽ‘ƒ…‡Ž‡ †‡ –”ƒ–ƒ‡– ’”‘–‡–‹… •—– …Žƒ•‹ϐ‹…ƒ–‡ †—’£ †‹-
˜‡”•‡…”‹–‡”‹‹ǣ‘†ƒŽ‹–ƒ–‡ƒ†‡–”ƒ•‹–‡”‡ƒ’”‡•‹—‹Ž‘”ƒ•—’”ƒ
oaselor maxilare; raportul cu grupul dentar restant; modalita-
tea de integrare a piesei protetice la sistemul stomatognat. În
ˆ—…싇†‡•—’‘”–—Ž’‡…ƒ”‡•—–”‡ƒŽ‹œƒ–‡ǡ‹ŒŽ‘ƒ…‡Ž‡†‡–”ƒ–ƒ-
‡–’”‘–‡–‹…•—–…Žƒ•‹ϐ‹…ƒ–‡Á–”‡‹‰”—’—”‹ǣ—…‘Ǧ‘•‘•ȋ‘-
„‹ŽȌǡ†‡–‘Ǧ’ƒ”‘†‘–ƒŽè‹‹’Žƒ–ƒ”ȏͳ͸ȐǤ
‡–‘†‡Ž‡–”ƒ†‹ì‹‘ƒŽ‡†‡•‘Ž—ì‹‘ƒ”‡ƒ‡†‡–ƒì‹‹Ž‘”—‹†‡-
–ƒ”‡•—–ǣÁ…Š‹†‡”‡ƒ„”‡è‡‹†‡–ƒ”‡’”‹‡–‘†‡‘”–‘†‘–‹-
ce, protezele mobile temporare sau pe termen lung, PPF (cu 3
—‹–£ì‹ǡ…—‡š–‡•‹‡ǡ…—‡Ž‡‡–‡†‡ƒ‰”‡‰ƒ”‡’ƒ”싃Ž£‹–”ƒ–‹•—-
”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
The prevalence of one permanent tooth edentulism is 2.8-
8.0% (the third molar is excluded), varying by ethnic groups
and population. The single edentulism is the most common in
the posterior areas of the jaw the most affected teeth are the
second lower premolar, followed by the upper lateral incisors,
the second upper premolar and inferior incisors [21].
Systematic reviews of the literature concluded that teeth
Ž‘•• †‹ˆˆ‡”• †‡’‡†‹‰ ‘ –Š‡ ƒ”…Šǣ –Š‡ ’”‡˜ƒŽ‡…‡ ‘ˆ ’ƒ”–‹ƒŽ
edentulism is more common in the mandibular arches than in
the maxillary arches and the posterior areas than in the ante-
rior areas. Class 3 Kennedy is the most common pattern of the
partial edentulism in both the upper and lower jaw. Among
ηͳ͹›‡ƒ”•‘Ž†’ƒ–‹‡–•ǡƒ‹…‹†‡…‡‘ˆͶͻǤͺͶǦͷ͸Ǥ͹Ψˆ‘”‡‡-
dy class 3 was reported, followed by Kennedy 2 (18-22.84%),
Kennedy 1 (16.7-25, 75%) and Kennedy 4 (1.55-8.6%). Class
3 Kennedy is detected in 52.92-56% of cases in the upper jaw
and in 45-58% of cases in the mandible. Class 4 Kennedy is the
rarest part of the partial editorial [14, 19, 20, 23].
As people get older, the frequency of Class 1 and Class 2
Kennedy rises and the frequency of Class 3 and Class 4 Ken-
nedy decreases in both dental arches. The gender did not have
ƒ •‹‰‹ϐ‹…ƒ– ”‡Žƒ–‹‘•Š‹’ ™‹–Š †‹•–”‹„—–‹‘ ƒ……‘”†‹‰ –‘ –Š‡
‡‡†›’ƒ”–‹ƒŽ‡†‡–—Ž‹•…Žƒ••‹ϐ‹…ƒ–‹‘ȏʹ͵ȐǤ
1991 among 18-year-olds and older people revealed a single
‡†‡–—Ž‹• –‘ ͳͲǤͷΨ ‘ˆ ƒŽŽǡ –‘–ƒŽ ‡†‡–—Ž‹• Ȃ ˆ”‘ Ͷ͵ǤͻΨ
among the 75 years old and elder people, up to 0% in people
aged 18-24. The edentulism depended on age and ethnic, and
was similar in both genders [26].
According to the results of a systematic review of litera-
ture, the incidence of tooth loss in people of 20-65 years old
ranged from 1.3-5%. In two epidemiological studies conduct-
ed among Chinese rural populations, the incidence of tooth
loss accounted for 14-20%, and the proportion of people who
suffered from an edentulism ranged from 25% to 75% [27].
Thus, dental caries and periodontal disease are the major
causes of the partial edentulism. There is no gender correla-
–‹‘ˆ‘”’ƒ”–‹ƒŽ‡†‡–—Ž‹•ƒ†ƒ‰‡Šƒ•ƒ•‹‰‹ϐ‹…ƒ–‡ˆˆ‡…–ǤŠ‡
prevalence of the permanent tooth edentulism is 2.8-8.0% and
is more common in the posterior areas of the jaws.
‡–Šo†• oˆ –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
”‘•–Š‡–‹… –”‡ƒ–‡–• ƒ”‡ …Žƒ••‹ϐ‹‡† ƒ……‘”†‹‰ –‘ ˜ƒ”‹‘—•
…”‹–‡”‹ƒǣ–Š‡™ƒ›‘ˆ–”ƒ•‹••‹‘‘ˆ–Š‡’”‡••—”‡‘–Š‡Œƒ™Ǣ
the relation with the remaining dental group; the way of in-
tegrating the prosthetic part into the Stomatognathic System.
Depending on the support on which they are made, the pros-
–Š‡–‹… ”‡‡†‹‡• ƒ”‡ …Žƒ••‹ϐ‹‡† ‹–‘ –Š”‡‡ ‰”‘—’•ǣ —…‘Ǧ„‘›
support (mobile), dental and periodontal support and implant
support [16].
”ƒ†‹–‹‘ƒŽ‡–Š‘†•‘ˆ–”‡ƒ–‹‰•‹‰Ž‡‡†‡–—Ž‹•ƒ”‡ǣ…Ž‘•-
ing of the edentulous gap with orthodontic methods, temporal
or long-term prostheses, PFD (with 3 units, with extension,
™‹–Š‹Žƒ›Ȁ‘Žƒ›ǡƒ†Š‡•‹˜‡Ȍƒ†‹’Žƒ–Ȃ•—’’‘”–‡†”‡•–‘”ƒ-
tions [28, 29].
Movable partial prosthesis and orthodontic closure are
rarely accepted by patients [12, 30, 31]. Classic mobile pros-
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
Žƒ”£•ƒ—‹Žƒ›è‹‡š–”ƒ–‹•—Žƒ”£•ƒ—‘Žƒ›ǡƒ†‡œ‹˜£Ȍè‹”‡•–ƒ—”£”‹Ž‡
protetice pe suport de implant dentar [28, 29].
”‘–‡œƒ ’ƒ”싃Ž£ ‘„‹Ž‹œƒ„‹Ž£ è‹ Á…Š‹†‡”‡ƒ „”‡è‡‹ ’”‹
‡–‘†‡‘”–‘†‘–‹…‡•—–”ƒ”ƒ……‡’–ƒ–‡†‡…£–”‡’ƒ…‹‡ì‹ȏͳʹǡ
͵Ͳǡ͵ͳȐǤƒ…‹‡ì‹‹’”‘–‡œƒì‹‘„‹Ž…Žƒ•‹…ǡ’”‡œ‹–£Ž‹‹–ƒ”‡ƒ‹-
–”‹•‡…£‹”‡˜‡”•‹„‹Ž£ƒˆ—…ì‹‹Ž‘”ƒ’ƒ”ƒ–—Ž—‹†‡–‘Ǧƒš‹Žƒ”ǡ‹ƒ”
ƒ†ƒ’–ƒ”‡ƒ …— ‘ ’”‘–‡œ£ ‘„‹Ž‹œƒ„‹Ž£ …ƒ”‡ ‡•–‡ ƒ–Ÿ– †‡ †‹ˆ‡”‹-
–£†‡†‡–‹ì‹ƒƒ–—”ƒŽ£‡•–‡†‡•‡‘”‹ˆ‘ƒ”–‡‰”‡ƒ…Š‹ƒ”†ƒ…£†‹
punct de vedere estetic corespunde foarte bine. Dezavantajele
’”‹…‹’ƒŽ‡ƒŽ‡’”‘–‡œ‡Ž‘”†‡–ƒèƒ„‹Ž‡ǡ…‘•‹†‡”ƒ–‡ƒ‹†‡‰”ƒ„£
’”‘˜‹œ‘”‹‹†‡…Ÿ–†‡ϐ‹‹–‹˜‡ǡ•—–†‡œŽ‹’‹”‡ƒˆ”‡…˜‡–£è‹ƒ–”‘ϐ‹ƒ
’ƒ’‹Ž‡Ž‘”‹–‡”†‡–ƒ”‡Ǥ
”ƒ†—Ž†‡‡ì‹‡”‡è‹‡…Š‹Ž‹„”—Ž’”‘- ƒ† ˆ—…–‹‘ƒŽ ”‡•—Ž–•ǣ ƒ•–‹…ƒ–‘”›ǡ ƒ‡•–Š‡–‹…ǡ “—ƒŽ‹–› ‘ˆ Ž‹ˆ‡
–‡œ‡Ž‘”‡•–‡†‹”‡…–’”‘’‘”ì‹‘ƒŽ…—‰”ƒ†—Ž†‡ƒ–”‘ϐ‹‡ƒŽ•—„•–”ƒ-
tului osos al maxilarelor [3, 28].
 …‘˜‡ì‹‘ƒŽ‡è‹”‡•–ƒ—”£”‹Ž‡’‡•—’‘”–†‡‹’Žƒ–˜‹-
œ‡ƒœ£’‡–”—•—……‡•’‡–‡”‡Ž—‰ȋ…‹”…ƒͳͷǦʹͲ†‡ƒ‹Ȍǡ’‡-
–”—…‡Ž‡ƒ‹„—‡”‡œ—Ž–ƒ–‡‡•–‡–‹…‡è‹ˆ—…ì‹‘ƒŽ‡ǣ…ƒ’ƒ…‹–ƒ–‡ƒ
ƒ•–‹…ƒ–‘”‹‡ǡ ‡•–‡–‹…ƒǡ …ƒŽ‹–ƒ–‡ƒ ˜‹‡ì‹‹ è‹ •ƒ–‹•ˆƒ…싃 ’ƒ…‹‡ì‹Ž‘”
ȏͳʹǡʹͺǡ͵Ͳǡ͵ͳȐǤ ’‡•—’‘”–†‡†‹ì‹”‡’”‡œ‹–£‘•‘Ž—싇†‡
’”‘–‡œƒ”‡ϐ‹š£ǡÁ•£ƒ——†‡œƒ˜ƒ–ƒŒƒŒ‘”Ȃ•‡ƒ…‘”‡ƒœ£’‡
†‹ì‹‹ƒ†‹ƒ…‡ì‹„”‡è‡‹ȋ†‹ì‹‹•–ŸŽ’‹Ȍǡƒ…‘’‡”‹†—Ǧ‹Á–‘–ƒŽ‹–ƒ–‡Ǥ
˜ƒ–ƒŒ‡Ž‡ˆ—…ì‹‘ƒŽ‡ƒŽ‡”‡ƒ„‹Ž‹–£”‹Ž‘”’”‘–‡–‹…‡ϐ‹š‡è‹‘„‹-
lizabile pe implanturi, comparativ cu cele clasice, sunt atât de
‡˜‹†‡–‡Á…Ÿ–ƒ…‡•–‡•‘Ž—ì‹‹ȋ‹†‹ˆ‡”‡–†‡—£”—Ž†‡‹’Žƒ-
–—”‹Ȍ•—–’‡”…‡’—–‡–‡”ƒ’‹‹…—”ƒ–£ƒ”‡†‡•—……‡•ȋ…‹”…ƒͻͲΨ
’‡•–‡ͳͲǦͳͷƒ‹ȌÁ…‡‡ƒ…‡’”‹˜‡è–‡‡ϐ‹…‹‡ìƒƒ•–‹…ƒ–‘”‹‡ǡÁ-
„—£–£ì‹”‡ƒ•‡‹ϐ‹…ƒ–‹˜£ƒ‡•–‡–‹…‹‹è‹…ƒŽ‹–£ì‹‹˜‹‡ì‹‹’ƒ…‹‡ì‹Ž‘”
ƒ†—Žì‹ȏ͵ǡͳͺǡʹͺȐǤ—–‘ƒ–‡ƒ…‡•–‡ƒǡ‡–‘†ƒƒ”‡è‹†‡œƒ˜ƒ–ƒŒ‡ǣ
–‹’Ž—‰†‡–”ƒ–ƒ‡–ǡ…ƒ”‡‡…‡•‹–£‘”‡•–ƒ—”ƒ”‡’”‘˜‹œ‘”‹‡
’‡’‡”‹‘ƒ†ƒ†‡‹–‡‰”ƒ”‡ƒ‹’Žƒ–—Ž—‹ǡ‡…‡•‹–£’Žƒ•ƒ”‡…Š‹”—”-
‰‹…ƒŽ£ƒ‹’Žƒ–—Ž—‹è‹ƒ”‡—…‘•–ƒ‹ƒ”‡ȏͳ͸ǡ͵ʹȐǤ
Actualmente, coroanele pe suport de implanturi sunt con-
•‹†‡”ƒ–‡ ‘ ‘’ì‹—‡ ˆƒ˜‘”ƒ„‹Ž£ †‡ –”ƒ–ƒ‡– ’‡–”— ‡†‡–ƒì‹ƒ
—‹†‡–ƒ”£Ǥ‹’—…–†‡˜‡†‡”‡‡…‘‘‹…ƒ•££–£ì‹‹ǡ…‘”‘ƒ-
nele unitare pe suport de implant au fost sugerate ca o alter-
ƒ–‹˜£†‡–”ƒ–ƒ‡–˜ƒŽ‹†’‡–”— …‘˜‡ì‹‘ƒŽ‡…—͵—‹-
–£ì‹Ǥ ‘”‘ƒ‡Ž‡ ’‡ •—’‘”– †‡ ‹’Žƒ–—”‹ ’”‡œ‡”˜‡ƒœ£ 쇕—–—Ž
†‡–ƒ”ǡ•—’”ƒ˜‹‡ì—‹”‡ƒƒ…‡•–‘”ƒ’‡–”—ͳͲƒ‹‡•–‡…—ͳͲ؏ƒ‹
mare, iar cu dezvoltarea unor proceduri de tratament, cum ar
ϐ‹ ƒ—‰‡–ƒ”‡ƒ ‘•‘ƒ•£ è‹ ƒ 쇕—–—”‹Ž‘” ‘‹ǡ †‡œ˜‘Ž–ƒ”‡ƒ –‡Š-
‘Ž‘‰‹‹Ž‘” è‹ ƒ–‡”‹ƒŽ‡Ž‘” †‡ …‘ˆ‡…ì‹‘ƒ”‡ ƒ …‘’‘‡–‡Ž‘”
•‹•–‡—Ž—‹‹’Žƒ–‘Ǧ’”‘–‡–‹…’‘ƒ–‡ϐ‹‘„싐—–—‹˜‡Ž…”‡•…—–
de rezultate estetice [33, 34].
š‹•–£ ‘ —Ž–‹–—†‹‡ †‡ ˆƒ…–‘”‹ …ƒ”‡ †‡–‡”‹£ •‡Ž‡…–ƒ”‡ƒ
ϐ‹ƒŽ£ ƒ ‡–‘†‡‹ †‡ –”ƒ–ƒ‡– Á ‡†‡–ƒì‹‹Ž‡ —‹†‡–ƒ”‡Ǥ B
—Ž–‹’Ž‡Ž‡…ƒœ—”‹…Ž‹‹…‡ǡ…Ÿ†•—–’‘•‹„‹Ž‡ƒ‹—Ž–‡‘’ì‹—‹
†‡–”ƒ–ƒ‡–ǡ•‡Ž‡…–ƒ”‡ƒϐ‹ƒŽ£ƒ‡–‘†‡‹†‡–”ƒ–ƒ‡–†‡’‹-
†‡†‡—”£–‘”‹‹ˆƒ…–‘”‹ǣ•‹–—ƒì‹ƒ…Ž‹‹…£ƒ‡†‡–ƒì‹‡‹ǡ•–ƒ”‡ƒ‰‡-
‡”ƒŽ£è‹†‘Ž‡ƒì‡Ž‡’ƒ…‹‡–—Ž—‹ǡ•–ƒ–—–—ŽŽ‘…ƒŽǡ‡•–‡–‹…ƒˆƒ…‹ƒŽ£ǡ
•–ƒ”‡ƒ•‘…‹ƒŽ£è‹—Á—Ž–‹—Ž”Ÿ†•–ƒ”‡ƒϐ‹ƒ…‹ƒ”£ƒ’ƒ…‹‡-
–—Ž—‹Ǥ—Ž†‹–”‡ˆƒ…–‘”‹‹’”‹ƒ”‹…ƒ”‡†‡–‡”‹£–‹’—Ž†‡–”ƒ-
–ƒ‡–•‡Ž‡…–ƒ–ƒŽ‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡Áœ‘ƒ‡•–‡–‹…£‡•–‡
’”‡œ‡ìƒ è‹ ‰”ƒ†—Ž †‡ ”‡…‡•‹—‡ ƒ 쇕—–—”‹Ž‘” ‘‹ Žƒ ‹˜‡Ž—Ž
†‹–‡Ž—‹‡š–”ƒ•ǡ’”‡œ‡ìƒ•—ϐ‹…‹‡–£•ƒ—ƒ„•‡ìƒ‘•—Ž—‹ƒŽ˜‡‘-
Žƒ”Ǥ ƒ…–‘”‹‹•—’Ž‹‡–ƒ”‹…ƒ”‡‹ϐŽ—‡ì‡ƒœ£ƒŽ‡‰‡”‡ƒ–”ƒ–ƒ‡-
–—Ž—‹•—–•–ƒ”‡ƒ†‹ì‹Ž‘”ƒ†‹ƒ…‡ì‹ǡ†‡•—•ì‹‡”‡è‹ƒ–ƒ‰‘‹è–‹
[11, 13, 21].
MJHS 17(3)/2018 81
theses have the irreversible intrinsic limitation of dento-max-
illary functions and adapting to a mobile prosthesis that is so
†‹ˆˆ‡”‡–ˆ”‘ƒ–—”ƒŽ–‡‡–Šǡ‹•‘ˆ–‡˜‡”›†‹ˆϐ‹…—Ž–ǡ‡˜‡–Š‘—‰Š
it is aesthetically good. The main disadvantages of movable
’”‘•–Š‡•‹• …‘•‹†‡”‡† ”ƒ–Š‡” –‡’‘”ƒ”› ”ƒ–Š‡” –Šƒ †‡ϐ‹‹-
tive, are frequent detachment and interdental papillary atro-
phy. The degree of maintenance and the balance of prostheses
is directly proportional to the degree of atrophy of the bone
jaw substrate [3, 28].
Conventional PFD and implant-based restorations aim for
long-term success (about 15-20 years) for the best aesthetic
and patient satisfaction [12, 28, 30, 31]. PFD on the tooth sup-
’‘”–‹•ƒϐ‹š‡†’”‘•–Š‡–‹…•‘Ž—–‹‘ǡ„—––Š‡›Šƒ˜‡ƒƒŒ‘”†‹•ƒ†-
˜ƒ–ƒ‰‡Ȃ–Š‡›ƒ”‡ƒ…Š‘”‡†–‘–Š‡–‡‡–Šƒ†Œƒ…‡––‘–Š‡‡†‡-
tulous gap (abutment teeth), covering them totally. The func-
–‹‘ƒŽƒ†˜ƒ–ƒ‰‡•‘ˆϐ‹š‡†ƒ†‘„‹Ž‡’”‘•–Š‡–‹…”‡Šƒ„‹Ž‹–ƒ–‹‘
on implants, compared to classical ones, are so obvious that
these solutions (regardless of the number of implants) are
perceived as successful high-rate therapies (about 90% over
ͳͲǦͳͷ›‡ƒ”•Ȍ‹–‡”•‘ˆƒ•–‹…ƒ–‘”›‡ˆϐ‹…ƒ…›ǡ•‹‰‹ϐ‹…ƒ–‹-
provement in the aesthetics and quality of life of adult patients
ȏ͵ǡͳͺǡʹͺȐǤ‘™‡˜‡”ǡ–Š‡‡–Š‘†ƒŽ•‘Šƒ•†‹•ƒ†˜ƒ–ƒ‰‡•ǣŽ‘‰
treatment time, which requires a temporary restoration dur-
ing the implant integration period, requires surgical implant
placement and has a higher cost [16, 32].
Currently, implant- supported crowns are considered a fa-
vorable treatment option for the single edentulism. From the
economic and health point of view, the unitary crowns on im-
plant support have been suggested as a valid treatment alter-
native for conventional PFDs with 3 units. The crowns on the
implant support preserve the dental tissue, 10-year survival
is 10% higher, and along with the development of treatment
procedures, such as bone and soft tissue augmentation, and
also with the development of technologies and materials for
the implant-prosthetic system components, a higher aesthetic
result can be obtained [33, 34].
Š‡”‡ƒ”‡ƒ›ˆƒ…–‘”•–Šƒ–†‡–‡”‹‡–Š‡ϐ‹ƒŽ•‡Ž‡…–‹‘
of the treatment method in single edentulism. In multiple
clinical cases, when more treatment options are available, the
ϐ‹ƒŽ•‡Ž‡…–‹‘‘ˆ–Š‡–”‡ƒ–‡–‡–Š‘††‡’‡†•‘–Š‡ˆ‘ŽŽ‘™-
‹‰ˆƒ…–‘”•ǣ–Š‡…Ž‹‹…ƒŽ…‘†‹–‹‘‘ˆ–Š‡‡†‡–—Ž‘—•ƒ”‡ƒǡ–Š‡
general condition and the patient’s wishes, the local status, the
facial aesthetics, the social condition and, last but not least, the
ϐ‹ƒ…‹ƒŽ•‹–—ƒ–‹‘‘ˆ–Š‡’ƒ–‹‡–Ǥ‡‘ˆ–Š‡’”‹ƒ”›ˆƒ…–‘”•ǡ
which determine the selected treatment type of single edentu-
lism in the aesthetic area, is the presence and degree of reces-
•‹‘‘ˆ•‘ˆ––‹••—‡•‹–Š‡‡š–”ƒ…–‡†–‘‘–Šǡ•—ˆϐ‹…‹‡–’”‡•‡…‡
‘”ƒ„•‡…‡‘ˆƒŽ˜‡‘Žƒ”„‘‡Ǥ††‹–‹‘ƒŽˆƒ…–‘”•–Šƒ–‹ϐŽ—‡…‡
the choice of treatment are adjacent teeth, supportive teeth
and antagonists [11, 13, 21].
The Expert Group of the Oral Rehabilitation Foundation
proposed the following recommendations on the treatment of
•‹‰Ž‡‡†‡–—Ž‹•ȏ͵ͷȐǣ
ƒthe selected treatment must be based on evidence, in the
best interests of the patient, rather than on the clinician's
82
”—’—Ž†‡‡š’‡”싃‹ —†ƒì‹‡‹’‡–”—‡ƒ„‹Ž‹–ƒ”‡ƒ”ƒŽ£ƒ—
’”‘’—•—”£–‘ƒ”‡Ž‡”‡…‘ƒ†£”‹’”‹˜‹†–”ƒ–ƒ‡–—Ž‡†‡–ƒ-
싇‹—‹†‡–ƒ”‡ȏ͵ͷȐǣ
ƒ–”ƒ–ƒ‡–—Ž•‡Ž‡…–ƒ––”‡„—‹‡•£ϐ‹‡„ƒœƒ–’‡†‘˜‡œ‹ǡÁ‹-
–‡”‡•—Ž•—’‡”‹‘”ƒŽ’ƒ…‹‡–—Ž—‹ǡ†‡…Ÿ–†‡’”‡ˆ‡”‹ì‡Ž‡•ƒ—
ƒ„‹Ž‹–£ì‹Ž‡…Ž‹‹…‹ƒ—Ž—‹ǡè‹’‡‡•–‹ƒ”‡ƒ…‘•–Ǧ‡ϐ‹…‹‡ì‡‹Ǣ
ƒ—–‹Ž‹œƒ”‡ƒ…‘”‘ƒ‡Ž‘”’‡•—’‘”–†‡‹’Žƒ–—‹–ƒ”‘ˆ‡”£
”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
preferences or abilities, and on cost-effectiveness esti-
mation;
ƒthe use of crowns on a single implant support provides
greater survival than PFD on teeth;
ƒin the absence of universal guides, after the main radio-
‰”ƒ’Š›‘ˆ–Š‡†‡–—”‡ϐ‹šƒ–‹‘ǡ–Š‡”ƒ†‹‘‰”ƒ’Š‹……‘–”‘Ž
is performed after 1 year, in order to monitor the results
‘•—’”ƒ˜‹‡ì—‹”‡ƒ‹ƒ”‡†‡…Ÿ– ’‡•—’‘”–†‡†‹ì‹Ǣ
ƒÁŽ‹’•ƒ—‘”‰Š‹†—”‹—‹˜‡”•ƒŽ‡ǡ†—’£”ƒ†‹‘‰”ƒϐ‹ƒ†‡„ƒœ£
Žƒϐ‹šƒ”‡ƒ’”‘–‡œ‡‹ǡ”ƒ†‹‘‰”ƒϐ‹ƒ†‡…‘–”‘Ž•‡‡ˆ‡…Ǧ–—‡ƒœ£
†—’£ͳƒ’‡–”—‘‹–‘”‹œƒ”‡ƒ”‡œ—Ž–ƒ–‡Ž‘”è‹”‡‘†‡-
Ž£”‹‹ ‘•‘ƒ•‡Ǥ ƒ…£ ’‹‡”†‡”‡ƒ ‘•‘ƒ•£ ƒ”‰‹ƒŽ£ ‡•–‡ ζͳ
ǡ —”£–‘ƒ”‡ƒ ”ƒ†‹‘‰”ƒϐ‹‡ ‡•–‡ ‡ˆ‡…–—ƒ–£ ’‡•–‡ ͷ ƒ‹Ǥ
ƒ†‹‘‰”ƒϐ‹ƒ’‘ƒ–‡ϐ‹”‡ƒŽ‹œƒ–£Á‘”‹…‡‘‡–ǡ†ƒ…£‡š‹•-
–£’”‘„Ž‡‡‡˜‹†‡–‡†‹’—…–†‡˜‡†‡”‡…Ž‹‹…ȏ͵ͷȐǤ
胆ƒ”ǡ‡–‘†‡Ž‡–”ƒ†‹ì‹‘ƒŽ‡†‡•‘Ž—ì‹‘ƒ”‡ƒ‡†‡–ƒì‹‹Ž‘”
—‹†‡–ƒ”‡•—–ǣÁ…Š‹†‡”‡ƒ„”‡è‡‹†‡–ƒ”‡’”‹‡–‘†‡‘”–‘-
dontice, protezele mobile temporare sau pe termen lung, PPF
ȋ…—͵—‹–£ì‹ǡ…—‡š–‡•‹‡ǡƒ†‡œ‹˜£Ȍè‹”‡•–ƒ—”£”‹Ž‡’”‘–‡–‹…‡’‡
•—’‘”– †‡ ‹’Žƒ– †‡–ƒ”Ǥ   …‘˜‡ì‹‘ƒŽ‡ è‹ ”‡•–ƒ—”£”‹Ž‡
’‡ •—’‘”– †‡ ‹’Žƒ– ˜‹œ‡ƒœ£ ’‡–”— •—……‡• ’‡ –‡”‡ Ž—‰
ȋ…‹”…ƒͳͷǦʹͲ†‡ƒ‹Ȍǡ’‡–”—…‡Ž‡ƒ‹„—‡”‡œ—Ž–ƒ–‡‡•–‡–‹…‡è‹
ˆ—…ì‹‘ƒŽ‡ǣ…ƒ’ƒ…‹–ƒ–‡ƒƒ•–‹…ƒ–‘”‹‡ǡ‡•–‡–‹…ƒǡ…ƒŽ‹–ƒ–‡ƒ˜‹‡ì‹‹
è‹•ƒ–‹•ˆƒ…싃’ƒ…‹‡ì‹Ž‘”Ǥ
Eϔ‹c‹‡nìƒ co’ƒ”ƒ–‹˜£ ƒ –”ƒ–ƒ‡n–—Ž—‹ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
c— ’”o–‡œ‡ ’ƒ”싃Ž‡ ϔ‹š‡ è‹ ’”o–‡œ‡ ’‡ •—’o”– †‡ ‹’Žƒn–
B•…‘’—Ž‡˜ƒŽ—£”‹‹è‹…‘’ƒ”£”‹‹†‹ˆ‡”‹–‡Ž‘”‘’ì‹—‹†‡–”ƒ-
–ƒ‡–’”‘–‡–‹…ǡ‡•–‡‡…‡•ƒ”†‡Ž—ƒ–Á…‘•‹†‡”ƒ”‡ƒ‹—Žì‹
ˆƒ…–‘”‹ǣ…‘•–—Ž–”ƒ–ƒ‡–—Ž—‹ǡ ”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡è‹”ƒ–ƒ†‡
•—……‡•ƒ’”‘–‡œ‡Ž‘”ǡ’ƒ”ƒ‡–”‹‹‡•–‡–‹…‹ǡˆ”‡…˜‡ìƒ…‘’Ž‹…ƒì‹‹-
Ž‘”ǡ…ƒŽ‹–ƒ–‡ƒ˜‹‡ì‹‹Ž‡‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£è‹•ƒ–‹•ˆƒ…싃’ƒ…‹-
entului [1, 9].
ƒ‹ —Ž–‡ •–—†‹‹ è‹ ”‡˜‹œ—‹”‹ •‹•–‡ƒ–‹…‡ ƒŽ‡ Ž‹–‡”ƒ–—”‹‹ ƒ—
”‡Ž‡˜ƒ–”ƒ–‡•‹‹Žƒ”‡†‡‡è‡…ǡ•—’”ƒ˜‹‡–—‹”‡ǡ…ƒ”ƒ…–‡”‹•–‹…‹…Ž‹-
‹…‡ȋ‡•–‡–‹…‡ǡˆ—…ì‹‘ƒŽ‡ǡ„‹‘Ž‘‰‹…‡Ȍè‹•…‘”—”‹ƒŽ‡•ƒ–‹•ˆƒ…싇‹
’ƒ…‹‡ì‹Ž‘”’‡–‡”‡•…—”–è‹’‡–‡”‡Ž—‰ƒ–”ƒ–ƒ‡–—Ž—‹
‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡…—…‘”‘ƒ‡—‹–ƒ”‡’‡•—’‘”–†‡‹’Žƒ–
è‹…— …‘˜‡ì‹‘ƒŽ‡…—͵—‹–£ì‹ȏͳʹȐǤ
‡–ƒǦƒƒŽ‹œ£ ƒ—‘””‡˜‹œ—‹”‹•‹•–‡ƒ–‹…‡ƒŽ‹–‡”ƒ–—”‹‹ƒ
”‡œ—ƒ–”‡œ—Ž–ƒ–‡Ž‡’”‹˜‹†”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡è‹‹…‹†‡ìƒ
…‘’Ž‹…ƒì‹‹Ž‘” †‹ˆ‡”‹–‘” ‘†‡Ž‡ †‡   …— ‘ ’‡”‹‘ƒ†£ †‡ —”-
£”‹”‡ †‡ …‡Ž ’—싐 ͷ ƒ‹Ǥ ƒ–ƒ †‡ •—’”ƒ˜‹‡ì—‹”‡ ‡•–‹ƒ–£ Žƒ
ͷƒ‹ƒ …‘˜‡ì‹‘ƒŽ‡ƒˆ‘•–†‡ͻ͵ǡͺΨǡ …—‡š–‡•‹‡Ȃ
†‡ͻͳǡͶΨǡ —‹–ƒ”£’‡•—’‘”–†‡‹’Žƒ–Ȃ†‡ͻͷǡʹΨǡ 
…— •—’‘”– …‘„‹ƒ– ’‡ †‹ì‹ è‹ ‹’Žƒ– Ȃ †‡ ͻͶǡͷΨǡ …‘”‘ƒ£
—‹–ƒ”£’‡•—’‘”–†‡‹’Žƒ–Ȃ†‡ͻͷǡͷΨè‹ ƒ†‡œ‹˜£Ž‹’‹–£
…— ”£è‹£ †‡ …‹‡–ƒ”‡ Ȃ †‡ ͺ͹ǡ͹ΨǤ —’£ ͳͲ ƒ‹ †‡ ˆ—…싇ǡ
”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡‡•–‹ƒ–£ƒ•…£œ—–ŽƒͺͻǡʹΨ’‡–”— 
…‘˜‡ì‹‘ƒŽ‡ǡ ͺͲǡ͵Ψ ’‡–”—   …— ‡š–‡•‹‡ǡ ͺ͸ǡ͹Ψ ’‡–”—
 —‹–ƒ”£’‡•—’‘”–†‡‹’Žƒ–ǡ͹͹ǡͺΨ’‡–”— …—•—’‘”–
…‘„‹ƒ–’‡†‹ì‹è‹‹’Žƒ–ǡͺͻǡͶΨ’‡–”—…‘”‘ƒ£—‹–ƒ”£’‡
•—’‘”–†‡‹’Žƒ–è‹͸ͷΨ’‡–”— ƒ†‡œ‹˜£Ž‹’‹–£…—”£è‹£
†‡…‹‡–ƒ”‡Ǥ ’‡•—’‘”–†‡†‹ì‹ƒ—ƒ˜—–‘”ƒ–£†‡•—……‡•
Žƒͷƒ‹†‡—”£”‹”‡•–ƒ–‹•–‹…•‡‹ϐ‹…ƒ–‹˜ȋ’αͲǡͲͲͺȌƒ‹ƒ”‡
(84,3%), comparativ cu PPF pe suport de implant (61,3%) [36,
37, 38].
ƒ†„‘‡”‡‘†‡Ž‹‰Ǥˆ–Š‡ƒ”‰‹ƒŽ„‘‡Ž‘••‹•ζͳǡ
the next radiography is performed over 5 years. Radio-
graphy can be done at any time if there are clinically ob-
vious problems [35].
Therefore, traditional methods of treating single eden-
–—Ž‹• ƒ”‡ǣ …Ž‘•‹‰ ‘ˆ –Š‡ ‡†‡–—Ž‘—• ‰ƒ’ ™‹–Š ‘”–Š‘†‘–‹…
methods, temporal or long-term prostheses, PFD (with 3
units, with extension, adhesive) and prosthetic restorations
on dental implant support. Conventional tooth-based PFD
and implant-based restorations aim for long-term success
(about 15-20 years) for the best aesthetic and functional re-
•—Ž–•ǣƒ•–‹…ƒ–‘”›…ƒ’ƒ…‹–›ǡƒ‡•–Š‡–‹…•ǡ“—ƒŽ‹–›‘ˆŽ‹ˆ‡ƒ†’ƒ-
tient satisfaction.
o’ƒ”ƒ–‹˜‡ ‡ˆˆ‡c–‹˜‡n‡•• oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹• –”‡ƒ–‡n–
™‹–Š ’ƒ”–‹ƒŽ ϔ‹š‡† †‡n–—”‡• ƒn† ‹’Žƒn– •—’’o”–‡† ’”o•–Š‡•‡•
In order to evaluate and compare different prosthetic
–”‡ƒ–‡–‘’–‹‘•ǡ‹–‹•‡…‡••ƒ”›–‘…‘•‹†‡”•‡˜‡”ƒŽˆƒ…–‘”•ǣ
treatment cost, survival rate and prosthesis success rate, aes-
thetic parameters, frequency of complications, quality of life
related to oral health and patient satisfaction [1, 9].
Several studies and systematic revisions of literature have
shown similar rates of failure, survival, clinical characteris-
tics (aesthetic, functional, biological) and patient satisfaction
scores in the short and long-term treatment of single edentu-
lism with unitary crowns on implant support and with 3-unit
conventional PFD [12].
A meta-analysis of systematic literature reviews summa-
rized the survival rate and incidence of complications of differ-
ent PFD models with a follow-up period of at least 5 years. The
5-year survival rate of conventional PFD was 93.8%, PFD with
‡š–‡•‹‘ Ȃ ͻͳǤͶΨǡ ‹‰Ž‡   ‘ ‹’Žƒ– •—’’‘”– Ȃ ͻͷǤʹΨǡ
 ™‹–Š…‘„‹‡†–‡‡–Šƒ†‹’Žƒ–•—’’‘”–ȂͻͶǤͷΨǡ—‹-
–ƒ”› ‹’Žƒ–Ǧ •—’’‘”–‡† …”‘™ Ȃ ͻͷǤͷΨ ƒ† ƒ†Š‡•‹˜‡  
„‘†‡†™‹–Š…‡‡–”‡•‹Ȃͺ͹Ǥ͹ΨǤˆ–‡”ͳͲ›‡ƒ”•‘ˆˆ—…–‹‘ǡ
the expected survival rate decreased to 89.2% for convention-
al PFD, 80.3% for PFD with extension, 86.7% for unitary PFD
on implant support, 77.8% for PFD with combined support on
teeth and implant, 89.4% for unitary crown on implant sup-
port and 65% for adhesive PPF bonded with cement resin.
PFD on tooth support had a successful 5-year statistically sig-
‹ϐ‹…ƒ–ˆ‘ŽŽ‘™Ǧ—’ȋ’αͲǤͲͲͺȌŠ‹‰Š‡”ȋͺͶǤ͵ΨȌ…‘’ƒ”‡†–‘ 
on implant support (61.3%) [36, 37, 38].
Despite the high survival rates in unitary edentulous pa-
tients, 38.7% of implant-supported PFD had some complica-
tions during the 5-year follow-up period, compared to con-
ventional PFD (15.7%) and PFD with extension (20.6%). The
most common complications in patients with conventional
  ™‡”‡ –Š‡ „‹‘Ž‘‰‹…ƒŽ …‘’Ž‹…ƒ–‹‘• Ȃ †‡–ƒŽ …ƒ”‹‡•ǡ Ž‘••
of pulp vitality and periodontitis. In comparison with PFD on
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
B ’‘ϐ‹†ƒ ”ƒ–‡Ž‘” ”‹†‹…ƒ–‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ Žƒ ’ƒ…‹‡ì‹‹ …—
‡†‡–ƒì‹‡—‹†‡–ƒ”£ǡ͵ͺǡ͹Ψ†‹–”‡ ’‡•—’‘”–†‡‹’Žƒ–
ƒ—’”‡œ‡–ƒ–—‡Ž‡…‘’Ž‹…ƒì‹‹Á–‹’—Ž’‡”‹‘ƒ†‡‹†‡‘„•‡”˜ƒ-
싇†‡ͷƒ‹ǡ…‘’ƒ”ƒ–‹˜…— …‘˜‡ì‹‘ƒŽ‡ȋͳͷǡ͹ΨȌè‹ 
…—‡š–‡•‹‡ȋʹͲǡ͸ΨȌǤ‡Ž‡ƒ‹ˆ”‡…˜‡–‡…‘’Ž‹…ƒì‹‹Žƒ’ƒ…‹‡ì‹‹
…— …‘˜‡ì‹‘ƒŽ‡ƒ—ˆ‘•–…‘’Ž‹…ƒì‹‹Ž‡„‹‘Ž‘‰‹…‡Ȃ…ƒ”‹‹Ž‡
†‡–ƒ”‡ǡ’‹‡”†‡”‡ƒ˜‹–ƒŽ‹–£ì‹‹’—Ž’‡‹è‹’ƒ”‘†‘–‹–ƒǤ‘’ƒ”ƒ-
–‹˜…— ’‡•—’‘”–†‡†‹ì‹ǡ‹…‹†‡ìƒ…‘’Ž‹…ƒì‹‹Ž‘”–‡Š‹…‡
ƒ ˆ‘•– •‡‹ϐ‹…ƒ–‹˜ ƒ‹ ƒ”‡ Žƒ ’ƒ…‹‡ì‹‹ …— ”‡…‘•–”—…ì‹‹ ’‡
•—’‘”–†‡‹’Žƒ–Ǥ‡Ž‡ƒ‹ˆ”‡…˜‡–‡…‘’Ž‹…ƒì‹‹–‡Š‹…‡ƒ—
ˆ‘•– ˆ”ƒ…–—”ƒ”‡ƒ ƒ–‡”‹ƒŽ—Ž—‹ †‡ ˆƒì‡–ƒ”‡ ȋˆ”ƒ…–—”‹ •ƒ— …‹‘„‹”‹
…‡”ƒ‹…‡Ȍǡ•Ž£„‹”‡ƒ„‘–—Ž—‹•ƒ—藔—„—Ž—‹è‹’‹‡”†‡”‡ƒ”‡–‡-
싇‹Ǥƒ’ƒ…‹‡ì‹‹…— Ž‹’‹–‡…—”£è‹£†‡…‹‡–ƒ”‡…‡ƒƒ‹
ˆ”‡…˜‡–£…‘’Ž‹…ƒì‹‡ƒˆ‘•–†‡‰”ƒ†ƒ”‡ƒȏ͵͸ǡ͵ͺǡ͵ͻǡͶͲǡͶͳȐǤ
‡–”—‘’‡”‹‘ƒ†£†‡ͷƒ‹ǡ”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡ƒ…‘”‘ƒ-
nei unitare pe suport de implant a fost de 94,5%, comparativ
cu 95-95,4% pentru PPF pe suport de implant. Rata de supra-
˜‹‡ì—‹”‡ ƒ    …‘˜‡ì‹‘ƒŽ‡ ƒ ƒŽ…£–—‹– ͻ͵ǡͺΨ †—’£ ͷ ƒ‹ è‹
ͺͻǡͳΨ†—’£ͳͲƒ‹†‡ˆ—…싇ǡ‹ƒ””ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡ƒ 
…—‡š–‡•‹‡ȂͻʹǡͷΨè‹ͺͳǡͺΨǡ”‡•’‡…–‹˜Ǥ•–ˆ‡Žǡ…‘’ƒ”Ÿ†”ƒ-
–‡Ž‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ †—’£ ͷ ƒ‹ǡ ˜ƒŽ‘ƒ”‡ƒ ’‡–”— …‘”‘ƒ‡Ž‡
—‹–ƒ”‡’‡•—’‘”–†‡‹’Žƒ–‡•–‡•‹‹Žƒ”£…—˜ƒŽ‘ƒ”‡ƒ’‡–”—
 ’‡•—’‘”–†‡†‹ì‹è‹’—싐ƒ‹„—£…‘’ƒ”ƒ–‹˜…—˜ƒŽ‘ƒ-
rea pentru PPF cu extensie [40, 41, 42, 43, 44].
‡Ž‡ƒ‹ˆ”‡…˜‡–‡…‘’Ž‹…ƒì‹‹„‹‘Ž‘‰‹…‡’‡–”—…‘”‘ƒ‡Ž‡
’‡•—’‘”–†‡‹’Žƒ–•—–Ž‡œ‹—‹Ž‡’‡”‹Ǧ‹’Žƒ–ƒ”‡ƒŽ‡쇕—-
–—”‹Ž‘”‘‹ȋͻǡ͹Ψ†—’£ͷƒ‹ȌǤ…‡•–‹†‹…ƒ–‘”‡•–‡•‹‹Žƒ”…—
”ƒ–ƒ…‘’Ž‹…ƒì‹‹Ž‘”„‹‘Ž‘‰‹…‡†—’£ͷƒ‹’‡–”—’ƒ…‹‡ì‹‹–”ƒ-
–ƒì‹…— ’‡•—’‘”–†‡‹’Žƒ–ȋͺǡͷǦͺǡ͸ΨȌǤƒ…‹‡ì‹‹…— 
…‘˜‡ì‹‘ƒŽ‡’”‡œ‹–£ƒ‹—Ž–‡…‘’Ž‹…ƒì‹‹„‹‘Ž‘‰‹…‡ǣ†—’£
ͳͲƒ‹ͻǡͳǦͻǡͷΨ†‹–”‡†‹ì‹‹•–ŸŽ’‹’”‡œ‡–ƒ—…ƒ”‹‹ǡ†ƒ”—ƒ‹
ʹǡ͸Ψ ƒ— …‘†—• Žƒ ’‹‡”†‡”‡ƒ   è‹ …‹”…ƒ ͳͲΨ †‹–”‡ †‹ì‹‹
•–ŸŽ’‹è‹Ǧƒ—’‹‡”†—–˜‹–ƒŽ‹–ƒ–‡ƒǤ‹•…—ŽŽƒͳͲƒ‹†‡’‹‡”†‡”‡ƒ
  …‘˜‡ì‹‘ƒŽ‡ †ƒ–‘”‹–£ ’ƒ”‘†‘–‹–‡‹ ”‡…—”‡–‡ ƒ ˆ‘•– †‡
0,5% [40, 41, 42, 44].
‡–”— ‘ ’‡”‹‘ƒ†£ †‡ ͷ ƒ‹ǡ ”ƒ–ƒ …——Žƒ–‹˜£ ƒ …‘”‘ƒ‡Ž‘”
cu aspect estetic inacceptabil sau semi-optimal a fost de 8,7%.
MJHS 17(3)/2018 83
–‡‡–Šǡ–Š‡‹…‹†‡…‡‘ˆ–‡…Š‹…ƒŽ…‘’Ž‹…ƒ–‹‘•™ƒ••‹‰‹ϐ‹…ƒ–-
ly higher in patients with implant-supported reconstructions.
The most common technical complications were the fracture
of the veneer material (fractures or ceramic cuts), the loosen-
ing of the bush or screw and loss of retention. In patients with
cement-bonded PFD, the most common complication was deg-
radation [36, 38, 39, 40, 41].
For a 5-year period, the survival rate of the single crown
on implant support was 94.5%, compared with 95-95.4% for
PFD on implant support. The survival rate of conventional PFD
accounted for 93.8% after 5 years and 89.1% after 10 years of
ˆ—…–‹‘ƒ†–Š‡•—”˜‹˜ƒŽ”ƒ–‡‘ˆ ™‹–Š‡š–‡•‹‘ȂͻʹǤͷΨ
and 81.8%, respectively. Thus, by comparing survival rates af-
ter 5 years, the value for implant- supported crowns is similar
to PFD on tooth support and slightly better compared to PFD
with extension [40, 41, 42, 43, 44].
The most common biological complications for implant-
supported crowns are soft tissue injuries around the implant
(9.7% after 5 years). This indicator is similar to the rate of
biological complications after 5 years for patients treated with
PFD on implant support (8.5-8.6%). Patients with convention-
ƒŽ  • Šƒ˜‡ ‘”‡ „‹‘Ž‘‰‹…ƒŽ …‘’Ž‹…ƒ–‹‘•ǣ ƒˆ–‡” ͳͲ ›‡ƒ”•ǡ
9.1-9.5% of the abutment teeth had cavities, but only 2.6% led
to the loss of PFD and about 10% of the abutment teeth lost
their vitality. The risk of 10 years of conventional PFD loss due
to recurrent periodontitis was 0.5% [40, 41, 42, 44].
For a 5-year period, the cumulative rate of crowns with
aesthetically unacceptable or semi-optimal crown was 8.7%.
The incidence of screw weakening was 12.7%, for implant-
supported crowns, which is approximately 2 times higher
…‘’ƒ”‡† –‘   ‘ ‹’Žƒ– •—’’‘”– Ȃ ͷǤͶǦͷǤͺΨǤ Š‡ ‹…‹-
dence of fracture of the façade material was 4.5% and 13.2-
13.5%, respectively [40, 41, 42]. PFD on teeth, compared to
PFD with extension and crowns on implant support, generally
Šƒ˜‡ Ž‘™‡” ‹…‹†‡…‡ ‘ˆ ˆƒ‹Ž—”‡ ƒ† –‡…Š‹…ƒŽ …‘’Ž‹…ƒ–‹‘•ǣ
the risk at 10 years for loss of retention was 6.4% for the frac-
–—”‡–Š‡•—’’‘”––‘‘–ŠȂʹǤͳΨƒ†–Š‡ˆ”ƒ…–—”‡‘ˆ–Š‡ƒ–‡”‹ƒŽ
…‹†‡ìƒ •Ž£„‹”‹‹ „‘–—Ž—‹ ƒ ˆ‘•– †‡ ͳʹǡ͹Ψ ’‡–”— …‘”‘ƒ‡Ž‡ ȋ‡–ƒŽˆ”ƒ‡™‘”ǡ˜‡‡‡”ƒ–‡”‹ƒŽȌȂ͵ǤʹΨǤ‘™‡˜‡”ǡ–‡…Š‹-
pe suport de implant, indicator care este de aproximativ 2 ori cal complications have to be compared with caution, because
ƒ‹ƒ”‡…‘’ƒ”ƒ–‹˜…— ’‡•—’‘”–†‡‹’Žƒ–ȂͷǡͶǦͷǡͺΨǤ conventional PFD treatment assessed in these systematic re-
…‹†‡ìƒˆ”ƒ…–—”‹Ž‘”ƒ–‡”‹ƒŽ—Ž—‹†‡ˆƒì‡–ƒ”‡ƒ…‘•–‹–—‹–ǡ”‡-
•’‡…–‹˜ǡ ͶǡͷΨ è‹ ͳ͵ǡʹǦͳ͵ǡͷΨ ȏͶͲǡ Ͷͳǡ ͶʹȐǤ   ’‡ •—’‘”– †‡
†‹ì‹ǡ…‘’ƒ”ƒ–‹˜…— …—‡š–‡•‹‡è‹…—…‘”‘ƒ‡Ž‡’‡•—’‘”–
†‡‹’Žƒ–ǡ’”‡œ‹–£ǡÁ‰‡‡”ƒŽǡ‹…‹†‡ì‡ƒ‹‹…‹†‡‡è‡…è‹
…‘’Ž‹…ƒì‹‹–‡Š‹…‡ǣ”‹•…—ŽŽƒͳͲƒ‹’‡–”—’‹‡”†‡”‡ƒ”‡–‡ì‹‡‹
ƒˆ‘•–†‡͸ǡͶΨǡ’‡–”—ˆ”ƒ…–—”ƒ†‹–‡Ž—‹†‡•—’‘”–Ȃ†‡ʹǡͳΨ
è‹ ’‡–”— ˆ”ƒ…–—”ƒ ƒ–‡”‹ƒŽ—Ž—‹ ȋ•…Š‡Ž‡–—Ž ‡–ƒŽ‹…ǡ ƒ–‡”‹ƒŽ—Ž
†‡ˆƒì‡–ƒ”‡ȌȂ†‡͵ǡʹΨǤ—–‘ƒ–‡ƒ…‡•–‡ƒǡ…‘’Ž‹…ƒì‹‹Ž‡–‡Š‹…‡
–”‡„—‹‡…‘’ƒ”ƒ–‡…—’”‡…ƒ—싇ǡ†‡‘ƒ”‡…‡–”ƒ–ƒ‡–—Ž…— 
…‘˜‡ì‹‘ƒŽ‡ǡ ‡˜ƒŽ—ƒ– Á ƒ…‡•–‡ ”‡˜‹œ—‹”‹ •‹•–‡ƒ–‹…‡ǡ ƒ ˆ‘•–
‡ˆ‡…–—ƒ–’‡•–‡ʹͲ†‡ƒ‹Á—”£ǡ‹ƒ”–”ƒ–ƒ‡–—Ž…—…‘”‘ƒ‡
’‡•—’‘”–†‡‹’Žƒ–ȂͷǦͳͲƒ‹Á—”£ȏͶʹǡͶ͵ǡͶͶȐǤ
‡œ˜‘Ž–ƒ”‡ƒè‹’‡”ˆ‡…ì‹‘ƒ”‡ƒ’‡”ƒ‡–£ƒ–‡Š‘Ž‘‰‹‹Ž‘”
苏ƒ–‡”‹ƒŽ‡Ž‘”†‡…‘ˆ‡…ì‹‘ƒ”‡…—Á„—£–£ì‹”‡ƒ’”‡…‹œ‹‡‹†‡
ˆƒ„”‹…ƒ”‡ǡ”‡œ‹•–‡ì‡‹‡…ƒ‹…‡ǡ‡•–‡–‹…‹‹è‹—è—”‹ì‡‹†‡’”‡Ž—-
…”ƒ”‡ƒ …‘˜‡ì‹‘ƒŽ‡ƒ—Á„—£–£ì‹–•‡‹ϐ‹…ƒ–‹˜’‡–‡”-
‡ Ž—‰ ”ƒ–‡Ž‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ è‹ •—……‡•ǡ ”‡œ—Ž–ƒ–‡Ž‡ ˆ—…-
views was performed more than 20 years ago and treatment
with implant crowns 5-10 years ago [42 , 43, 44].
Š‡…‘–‹—‘—•†‡˜‡Ž‘’‡–ƒ†”‡ϐ‹‡‡–‘ˆƒ—ˆƒ…-
turing technologies and materials with improved manufactur-
ing precision, mechanical strength, aesthetics, and ease of con-
˜‡–‹‘ƒŽ   ’”‘…‡••‹‰ •‹‰‹ϐ‹…ƒ–Ž› ‹’”‘˜‡† Ž‘‰Ǧ–‡”
survival and success rates, functional and aesthetic results by
developing, sustaining and maintaining the gingival architec-
ture [30].
A systematic review of literature, published in 2016, re-
vealed that in patients with single edentulism, their implants
and crowns have high survival rates that exceed survival rates
for conventional PFDs. Several publications, but not all, have
determined that single implants are more cost-effective than
…‘˜‡–‹‘ƒŽ ͵Ǧ—‹–  •ǡ ‡•’‡…‹ƒŽŽ› ™Š‡ –Š‡”‡ ‹• •—ˆϐ‹…‹‡–
bone mass and intact or minimally restored adjacent teeth.
Both initial treatment and root canal re-treatment are more
84
싑ƒŽ‡è‹‡•–‡–‹…‡’”‹†‡œ˜‘Ž–ƒ”‡ƒǡ•—•ì‹‡”‡ƒè‹‡ì‹‡”‡ƒ
arhitecturii gingivale [30].
 ”‡˜‹œ—‹”‡ •‹•–‡ƒ–‹…£ ƒ Ž‹–‡”ƒ–—”‹‹ǡ ’—„Ž‹…ƒ–£ Á ʹͲͳ͸ǡ ƒ
”‡Ž‡˜ƒ– …£ Žƒ ’ƒ…‹‡ì‹‹ …— ‡†‡–ƒì‹‹ —‹†‡–ƒ”‡ ‹’Žƒ–—”‹Ž‡
è‹ …‘”‘ƒ‡Ž‡ ƒ…‡•–‘”ƒ ƒ— ”ƒ–‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ ”‹†‹…ƒ–‡ǡ …ƒ”‡
†‡’£è‡•… ”ƒ–‡Ž‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ ’‡–”—   …‘˜‡ì‹‘ƒŽ‡Ǥ
ƒ‹—Ž–‡’—„Ž‹…ƒì‹‹ǡ†ƒ”—–‘ƒ–‡ǡƒ—•–ƒ„‹Ž‹–…£‹’Žƒ–—”‹Ž‡
—‹–ƒ”‡ •—– —Ž– ƒ‹ ”‡–ƒ„‹Ž‡ †‡…Ÿ–   …‘˜‡ì‹‘ƒŽ‡ …—
͵ —‹–£ì‹ǡ Á •’‡…‹ƒŽ Á •‹–—ƒì‹‹Ž‡ …Ÿ† ‡š‹•–£ ƒ•£ ‘•‘ƒ•£ •—-
ϐ‹…‹‡–£è‹†‹ì‹ƒ†‹ƒ…‡ì‹‹–ƒ…ì‹•ƒ—‹‹ƒŽ”‡•–ƒ—”ƒì‹Ǥ–Ÿ–
–”ƒ–ƒ‡–—Ž ‹‹ì‹ƒŽ …Ÿ– è‹ ”‡Ǧ–”ƒ–ƒ‡–—Ž …ƒƒŽ—Ž—‹ ”ƒ†‹…—Žƒ”
•—–ƒ‹”‡–ƒ„‹Ž‡†‡…Ÿ–‡š–”ƒ‰‡”‡ƒ†‹ì‹Ž‘”è‹”‡ƒ„‹Ž‹–ƒ”‡ƒ…—
‹’Žƒ–—‹–ƒ”è‹‘…‘”‘ƒ£ȏͶͷǡͶ͸ȐǤ
ƒ–‡Ž‡†‡•—’”ƒ˜‹‡ì—‹”‡’‡–”—‹’Žƒ–—”‹Ž‡—‹–ƒ”‡è‹…‘-
roanele acestora sunt foarte mari. Pentru implantul unitar
”ƒ–ƒ †‡ •—’”ƒ˜‹‡ì—‹”‡ ƒ ˆ‘•– †‡ ͻ͹ǡ͹Ψ Žƒ ͷ ƒ‹ è‹ ͻ͵ǡͺǦͻͶǡͻΨ
ŽƒͳͲƒ‹ȏ͵͵ǡͶͷȐǡ‹ƒ”’‡–”—…‘”‘ƒƒ—‹–ƒ”£’‡•—’‘”–†‡‹-
’Žƒ–Ȃ†‡ͻ͸ǡ͵ΨŽƒͷƒ‹è‹†‡ͺͻǡͻΨŽƒͳͲƒ‹Ǥ‹’‘–”‹˜£ǡ
”ƒ–‡Ž‡ †‡ •—’”ƒ˜‹‡ì—‹”‡ ’‡ –‡”‡ Ž—‰ ƒ   …‘˜‡ì‹‘ƒŽ‡
’‡–”— ‡†‡–ƒì‹‹Ž‡ —‹†‡–ƒ”‡ •—– •‡‹ϐ‹…ƒ–‹˜ ƒ‹ ‹…‹Ǥ 
‡–ƒǦƒƒŽ‹œ£ǡ’—„Ž‹…ƒ–£ÁͳͻͻͶǡƒ…ƒŽ…—Žƒ–—‹˜‡Ž”‹†‹…ƒ–†‡
•—’”ƒ˜‹‡ì—‹”‡Žƒͷƒ‹’‡–”— …‘˜‡ì‹‘ƒŽ‡ȂͻͷΨǤB’‘-
ϐ‹†ƒƒ…‡•–—‹ˆƒ’–ǡ”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡ƒ•…£œ—–ŽƒͻͲΨ’‡•–‡
ͳͲƒ‹è‹Žƒ͹ͶΨ’‡•–‡ͳͷƒ‹ǤŽ–£‡–ƒǦƒƒŽ‹œ£ǡ’—„Ž‹…ƒ–£Á
ͳͻͻͺǡƒ•–ƒ„‹Ž‹–…£ͳ͵Ψ†‹ …‘˜‡ì‹‘ƒŽ‡Ž‹’•‡ƒ—•ƒ—‡-
…‡•‹–ƒ—ÁŽ‘…—‹”‡†—’£ͳͲƒ‹è‹͵ͳΨƒ—ˆ‘•–•…‘ƒ•‡•ƒ—‡…‡•‹-
–ƒ—ÁŽ‘…—‹”‡†—’£ͳͷƒ‹Ǥ”‡˜‹œ—‹”‡•‹•–‡ƒ–‹…£ƒŽ‹–‡”ƒ–—”‹‹ǡ
’—„Ž‹…ƒ–£ÁʹͲͲ͹ǡƒ…‘•–ƒ–ƒ–…£Žƒͷƒ‹‹’Žƒ–—”‹Ž‡ƒ—ƒ˜—–‘
”ƒ–£†‡•—……‡•†‡ͻͷǡͳΨè‹ ’‡•—’‘”–†‡†‹ì‹Ȃ†‡ͻͶǡͲΨǤ
—–‘ƒ–‡ƒ…‡•–‡ƒǡ”ƒ–ƒ†‡•—’”ƒ˜‹‡ì—‹”‡ƒ ƒ•…£œ—–Žƒͺ͹ǡͲΨ
†—’£ͳͲƒ‹è‹Žƒ͸͹ǡ͵Ψ†—’£ͳͷƒ‹ȏͶͷȐǤ‡–ƒǦƒƒŽ‹œ£ǡ„ƒ-
œƒ–£’‡͸”‡˜‹œ—‹”‹•‹•–‡ƒ–‹…‡ƒ•–—†‹‹Ž‘”’”‘•’‡…–‹˜‡è‹”‡–”‘•-
’‡…–‹˜‡†‡…‘Š‘”–£è‹ƒ•‡”‹‹Ž‘”†‡…ƒœ—”‹è‹’—„Ž‹…ƒ–£ÁʹͲͳʹǡ
ƒ”‡Ž‡˜ƒ–…£‹’Žƒ–—”‹Ž‡ƒ—ƒ˜—–‘”ƒ–£†‡•—……‡•†‡ͻͶǡͷΨŽƒ
ͷƒ‹è‹†‡ͺͻǡͶΨŽƒͳͲƒ‹†‡—”£”‹”‡ǡ‹ƒ” ’‡•—’‘”–†‡
†‹ì‹Ȃ†‡ͻ͵ǡͺΨŽƒͷƒ‹è‹†‡ͺͻǡʹΨŽƒͳͲƒ‹†‡—”£”‹”‡ȏͶ͹ȐǤ
 ”‡˜‹œ—‹”‡ •‹•–‡ƒ–‹…£ ”‡…‡–£ ƒ Ž‹–‡”ƒ–—”‹‹ ƒ ‡˜ƒŽ—ƒ– ‡ϐ‹-
…‹‡ìƒ –”ƒ–ƒ‡–—Ž—‹ ‡†‡–ƒì‹‡‹ —‹†‡–ƒ”‡ ’‘•–‡”‹‘ƒ”‡ ƒ-
š‹Žƒ”‡è‹Ȁ•ƒ—ƒ†‹„—Žƒ”‡…—‘’”‘–‡œ£†‡–ƒ”£’‡•—’‘”–†‡
‹’Žƒ–Ǥƒ–ƒ†‡•—’”ƒ˜‹‡–—‹”‡è‹”ƒ–ƒ†‡•—……‡•ȋ’‹‡”†‡”‡†‡
ƒ•£‘•‘ƒ•£ƒ”‰‹ƒŽ£ǡ•Ÿ‰‡”ƒ”‡’‡”‹Ǧ‹’Žƒ–ƒ”£Žƒ’ƒŽ’ƒ”‡
•ƒ—•‘†ƒ”‡ƒ†Ÿ…£Ȍ’‡–”—‹’Žƒ–—”‹Ž‡…—Á…£”…ƒ”‡ˆ—…ì‹‘Ǧ
ƒŽ£‹‡†‹ƒ–£è‹…—Á…£”…ƒ”‡ˆ—…ì‹‘ƒŽ£Á–Ÿ”œ‹ƒ–£ƒ—ˆ‘•–ǡ”‡-
•’‡…–‹˜ǡͻ͸ǡͻΨè‹ͳͲͲΨǡͻ͸ǡͺΨè‹ͻͶǡͳΨǤƒ–‡Ž‡†‡•—’”ƒ˜‹‡ì—‹Ǧ
”‡è‹”ƒ–‡Ž‡†‡•—……‡•Á‹’Žƒ–ƒ”‡ƒ…—Á…£”…ƒ”‡ˆ—…ì‹‘ƒŽ£
‹‡†‹ƒ–£ è‹ ‹’Žƒ–ƒ”‡ƒ …— Á…£”…ƒ”‡ ˆ—…ì‹‘ƒŽ£ Á–Ÿ”œ‹ƒ–£ǡ
”‡’”‡œ‡–ƒ—ͻ͸ǡͺΨè‹ͻ͸ǡ͵ΨǡͺͷǡͺΨè‹ͻ͵ǡ͵Ψǡ”‡•’‡…–‹˜Ǥ‘-
parativ cu protezele dentare cu suport pe implanturi, ratele
†‡•—’”ƒ˜‹‡ì—‹”‡è‹†‡•—……‡•ƒŽ‡ Á–”ƒ–ƒ‡–—Ž‡†‡–ƒ-
싋Ž‘”—‹†‡–ƒ”‡’‘•–‡”‹‘ƒ”‡ƒ—…‘•–‹–—‹–ǡ”‡•’‡…–‹˜Ȃͺͷǡ͸Ψ
è‹ ͹ͷǡ͵ΨǤ —–‘”‹‹ ƒ— …‘…Ž—œ‹‘ƒ– …£ ”ƒ–‡Ž‡ †‡ •—’”ƒ˜‹‡ì—‹”‡
è‹ †‡ •—……‡• ƒŽ‡   ’Žƒ•ƒ–‡ Á ”‡‰‹—‡ƒ ’‘•–‡”‹‘ƒ”£ ƒ— ˆ‘•–
•‡‹ϐ‹…ƒ–‹˜ ƒ‹ ‹…‹ †‡…Ÿ– …‡Ž‡ ƒŽ‡ ‹’Žƒ–—”‹Ž‘” ’Žƒ•ƒ–‡ Á
”‡‰‹—‡ƒ’‘•–‡”‹‘ƒ”£ǡ‹†‹ˆ‡”‡–†‡’”‘–‘…‘Ž—Ž†‡Á…£”…ƒ”‡ǤB
–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‹Ž‘”—‹†‡–ƒ”‡’‘•–‡”‹‘ƒ”‡ƒš‹Žƒ”‡è‹Ȁ
•ƒ—ƒ†‹„—Žƒ”‡ǡ—–‹Ž‹œƒ”‡ƒ——‹‹’Žƒ–‡•–‡‘‘’ì‹—‡†‡–”ƒ-
–ƒ‡–•—’‡”‹‘ƒ”£…‘’ƒ”ƒ–‹˜…— ȏͶͺȐǤ
”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡
cost-effective than tooth extraction and rehabilitation with
single implant and a crown [45, 46].
Survival rates for single implants and their crowns are very
high. For the single implant, the survival rate was 97.7% at 5
years and 93.8-94.9% at 10 years [33, 45] and for the single
…”‘™ ‘ ‹’Žƒ– •—’’‘”– Ȃ ͻ͸Ǥ͵Ψ ƒ– ͷ ›‡ƒ”• ƒ† ͺͻǤͻΨ ƒ–
10 years. On the contrary, the long-term survival rates of con-
˜‡–‹‘ƒŽ  • ˆ‘” •‹‰Ž‡ ‡†‡–—Ž‹• ƒ”‡ •‹‰‹ϐ‹…ƒ–Ž› Ž‘™‡”Ǥ
A meta-analysis, published in 1994, calculated a high survival
”ƒ–‡ƒ–ͷ›‡ƒ”•ˆ‘”…‘˜‡–‹‘ƒŽ •ȂͻͷΨǤ‡•’‹–‡–Š‹•ǡ–Š‡
survival rate has fallen to 90% over 10 years and 74% over 15
years. Another meta-analysis, published in 1998, determined
that 13% of conventional PFD were missing or required re-
placement after 10 years, and 31% were removed or needed
to be replaced after 15 years. A systematic review of literature,
published in 2007, established that at 5 years implants had a
ͻͷǤͳΨ•—……‡••”ƒ–‡ƒ† ‘–‡‡–ŠȂͻͶǤͲΨǤ‘™‡˜‡”ǡ–Š‡
survival rate of PFD decreased to 87.0% after 10 years and to
67.3% after 15 years [45]. A meta-analysis, based on 6 system-
atic revisions of prospective and retrospective cohort studies
and case series, published in 2012, revealed that implants had
a success rate of 94.5% at 5 years and 89.4 % at 10 years of
ˆ‘ŽŽ‘™Ǧ—’ǡƒ† ‘–‡‡–ŠȂͻ͵ǤͺΨƒ–ͷ›‡ƒ”•ƒ†ͺͻǤʹΨƒ–
10 years of follow-up [47].
A recent systematic review of literature has evaluated the
‡ˆϐ‹…ƒ…›‘ˆ–Š‡–”‡ƒ–‡–‘ˆ–Š‡•‹‰Ž‡‡†‡–—Ž‹•‘ˆ’‘•–‡”‹‘”
upper and/or lower jaw with a dental prosthesis on implant
support. Survival and success rates (marginal bone mass loss,
bleeding on palpation or deep probing of tissues around the
implant) for implants with immediate functional load and
delayed functional load were respectively 96.9% and 100%,
96.8% and 94.1%. Survival rates and success rates in implan-
tation with immediate functional loading and implantation
with delayed functional load were 96.8% and 96.3%, 85.8%
and 93.3%, respectively. Compared to dental prostheses
with implant support, the survival and success rates of PFD
in the treatment of posterior single edentulism were 85.6%
and 75.3%, respectively. The authors concluded that the sur-
vival and success rates of PFD placed in the posterior region
™‡”‡•‹‰‹ϐ‹…ƒ–Ž›Ž‘™‡”–Šƒ–Š‡•—……‡••”ƒ–‡•‘ˆ–Š‡‹’Žƒ–•
placed in the posterior region, regardless of the loading proto-
col. In the treatment of single edentulism of the upper and/or
lower jaw, the use of an implant is a superior treatment option
compared to PFD [48].
Thus, the treatment of single edentulism using an implant
is a predictable treatment for a period of 10 years, without
indications of obvious changes in the failure rate of 5 to 10
years. The cumulative success rates of implant-supported
single crowns are at least equal to those reported for conven-
tional PFDs with 3 units. At the same time, the replacement
of crowns should be taken into account during the follow-up,
as part of the professional biological and mechanical mainte-
nance and at home [33].
The economic analysis of tooth replacement has revealed
that dental implants have demonstrated a more favorable
…‘•–Ȁ‡ˆϐ‹…‹‡…›”ƒ–‹‘™‹–ŠŽ‘™‡”‘˜‡”ƒŽŽ…‘•–•ƒ†ƒŠ‹‰Š‡”•—…-
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
•–ˆ‡Žǡ–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‹Ž‘”—‹†‡–ƒ”‡…—‹’Žƒ–‡•–‡
—–”ƒ–ƒ‡–’”‡˜‹œ‹„‹Ž’‡‘’‡”‹‘ƒ†£†‡ͳͲƒ‹ǡˆ£”£‹†‹…ƒì‹‹
’‡–”— ‘†‹ϐ‹…£”‹ ‡˜‹†‡–‡ Á ”ƒ–ƒ †‡ ‡è‡… Á–”‡ ͷ è‹ ͳͲ ƒ‹Ǥ
Ratele cumulative de succes ale implanturilor dentare care
•—•ì‹…‘”‘ƒ‡—‹–ƒ”‡•—–…‡Ž’—싐‡‰ƒŽ‡…—…‡Ž‡”ƒ’‘”–ƒ–‡
’‡–”—   …‘˜‡ì‹‘ƒŽ‡ …— ͵ —‹–£ì‹Ǥ ‘–‘†ƒ–£ǡ ÁŽ‘…—‹”‡ƒ
—‘”…‘”‘ƒ‡–”‡„—‹‡Ž—ƒ–£Á…‘•‹†‡”ƒ”‡Á–‹’—Ž—”£”‹”‹‹ǡ
…ƒ’ƒ”–‡ƒÁ–”‡ì‹‡”‹‹„‹‘Ž‘‰‹…‡è‹‡…ƒ‹…‡’”‘ˆ‡•‹‘ƒŽ‡è‹Žƒ
domiciliu [33].
ƒŽ‹œƒ‡…‘‘‹…£ƒÁŽ‘…—‹”‹‹——‹†‹–‡ƒ”‡Ž‡˜ƒ–…£‹-
’Žƒ–—”‹Ž‡†‡–ƒ”‡ƒ—†‡‘•–”ƒ–—”ƒ’‘”–…‘•–Ȁ‡ϐ‹…‹‡ì£ƒ‹
ˆƒ˜‘”ƒ„‹Ž …— …‘•–—”‹ ‰Ž‘„ƒŽ‡ ƒ‹ ‹…‹ è‹ ‘ ”ƒ–£ †‡ •—……‡• ƒ‹
ƒ”‡Á…‘’ƒ”ƒì‹‡…— …‘˜‡ì‹‘ƒŽ‡Ǥ‘•‡•—Ž…‘•–£Á
ˆƒ’–—Ž…£‹’Žƒ–—”‹Ž‡†‡–ƒ”‡ƒ—ˆ‘•–ƒ•‘…‹ƒ–‡…—…‘•–—”‹‹‹ì‹-
ƒŽ‡ƒ‹ƒ”‹ǡ…‘’ƒ”ƒ–‹˜…— …‘˜‡ì‹‘ƒŽ‡ǡ†ƒ”’‡–‡”‡
Ž—‰ǡ‹’Žƒ–—”‹Ž‡†‡–ƒ”‡ƒ—”‡’”‡œ‡–ƒ–‘‘’ì‹—‡•—’‡”‹‘ƒ-
”£è‹…‘•–Ǧ‡ϐ‹…‹‡ì£†‡–”ƒ–ƒ‡–ǤB’Ž—•ǡÁŽ‘…—‹”‡ƒ——‹†‹–‡
…—…‘”‘ƒ£’‡•—’‘”–†‡‹’Žƒ–ƒˆ‘•–ƒ‹”‡–ƒ„‹Ž£è‹…—”‡-
zultate mai bune privind rata de supravietuire, comparativ cu
 …‘˜‡ì‹‘ƒŽ‡ȏ͵Ͳǡ͵ͻǡͶ͸ȐǤ
—–‘ƒ–‡ƒ…‡•–‡ƒǡ‘”‡˜‹œ—‹”‡•‹•–‡ƒ–‹…£ƒŽ‹–‡”ƒ–—”‹‹’”‹˜‹†
ƒ•’‡…–‡Ž‡‡…‘‘‹…‡’‡–‡”‡Ž—‰—ƒ…‘•–ƒ–ƒ–†‹ˆ‡”‡ì‡
•‡‹ϐ‹…ƒ–‹˜‡Á–”‡…‘”‘ƒ‡Ž‡’‡•—’‘”–†‡‹’Žƒ–è‹ ’‡
•—’‘”–†‡†‹ì‹Á–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡Ǥ—–‘”‹‹
…‘•‹†‡”£…£ƒŽì‹ˆƒ…–‘”‹ǡ†‡…Ÿ–…‘•–—”‹Ž‡è‹”ƒ–‡Ž‡†‡•—’”ƒ˜‹‡-
엋”‡ǡ…—ƒ”ϐ‹†‡…‹œ‹ƒ’ƒ…‹‡–—Ž—‹•ƒ—ƒ‡†‹…—Ž—‹•–‘ƒ–‘Ž‘‰ǡ
’‘–ϐ‹ƒ‹†‡…‹•‹˜‹Á’”‘…‡•—Ž†‡•‡Ž‡…–ƒ”‡Á–”‡ƒ…‡•–‡†‘—£
–‹’—”‹†‡”‡•–ƒ—”£”‹ȏͶͻȐǤ
Motivele principale pentru utilizarea coroanei unitare pe
•—’‘”–†‡‹’Žƒ–†‡–ƒ”†‡…Ÿ–‘ …‘˜‡ì‹‘ƒŽ£•—–†‹•-
…—–ƒ–‡’‡Žƒ”‰ÁŽ‹–‡”ƒ–—”£薋‹ì‹ϐ‹…£†‡•’‡…‹ƒŽ‹–ƒ–‡è‹‹…Ž—†
ȏͶͷǡͷͲȐǣ
ͳȌ ‡˜‹–ƒ”‡ƒ †‡–‡”‹‘”£”‹‹ †‹ì‹Ž‘” ƒ–—”ƒŽ‹ ƒ†‹ƒ…‡ì‹ œ‘‡‹
edentate;
ʹȌ ‡˜‹–ƒ”‡ƒ Š‹’‡”•‡•‹„‹Ž‹–£ì‹‹ †‡–ƒ”‡ …ƒ”‡ ’‘ƒ–‡ Á•‘ì‹
’”‡’ƒ”ƒ”‡ƒ†‹ì‹Ž‘”Ǣ
͵Ȍ ‡˜‹–ƒ”‡ƒ‡…‡•‹–£ì‹‹’‘–‡ì‹ƒŽ‡†‡–”ƒ–ƒ‡–ƒ…ƒƒŽ—Ž—‹
”ƒ†‹…—Žƒ” ƒ–—…‹ …Ÿ† †‹ì‹‹ •—– ’”‡‰£–‹ì‹ ’‡–”—  
…‘˜‡ì‹‘ƒŽ£Ǣ
ͶȌ ”‡œ—Ž–ƒ–‡‡•–‡–‹…‡ÁƒŽ–‡ǡˆ—…ì‹‘ƒŽ‡è‹†‡…‘ˆ‘”–Ǣ
ͷȌ Á„—£–£ì‹”‡ƒƒ……‡•—Ž—‹Žƒ‹‰‹‡ƒ‘”ƒŽ£Ǣ
͸Ȍ ”£•’—•‰‹‰‹˜ƒŽÁ„—£–£ì‹–…—Ž‹‹‹†‡ϐ‹‹•ƒŒ•—„‰‹‰‹-
MJHS 17(3)/2018 85
cess rate compared to conventional PFDs. The consensus is
that dental implants were associated with higher initial costs
compared to conventional PFDs, but for a long term, dental
implants were a superior and cost-effective treatment op-
tion. In addition, replacing a tooth with an implant-supported
crown was more cost-effective and had better survival results
compared to conventional PFD [30, 39, 46].
However, a systematic review of the literature on long-
–‡” ‡…‘‘‹… ƒ•’‡…–• †‹† ‘– ”‡˜‡ƒŽ ƒ› •‹‰‹ϐ‹…ƒ– †‹ˆˆ‡”-
ences between implant-supported crowns and PFD on teeth
in the treatment of single edentulism. The authors consider
that factors other than survival rate and costs, such as patient
or dentist’s decision, may be more decisive in the selection
process between these two types of restoration [49].
The main reasons for using dental crown with implant sup-
port than a conventional PFD are widely discussed in the sci-
‡–‹ϐ‹…Ž‹–‡”ƒ–—”‡ƒ†‹…Ž—†‡ȏͶͷǡͷͲȐǣ
1) avoiding damage to the natural teeth adjacent to the
edentulous gap;
2) avoid dental hypersensitivity that can co-occur with
teeth preparation;
3) avoid the potential need for root canal treatment when
teeth are prepared for conventional PPF;
4) high aesthetic, functional and comfort results;
5) improve access to oral hygiene;
͸Ȍ ‹’”‘˜‡†‰‹‰‹˜ƒŽ”‡•’‘•‡™‹–Šϐ‹‹•Š‹‰Ž‹‡•—†‡”
the gingiva;
7) lower rate of complications [45, 50].
Multiple studies have investigated the impact of prosthetic
treatment on oral quality of life. However, most studies have
been performed in patients with total or partial edentulism.
Studies involving patients with single edentulism are limited.
A recent comparative transversal study performed on a group
of 35 patients with implant and a group of 36 patients with
conventional PFDs with 3 units for single edentulism found a
•‹‰‹ϐ‹…ƒ–‹’”‘˜‡‡–‹“—ƒŽ‹–›‘ˆŽ‹ˆ‡‹†›ƒ‹…•ǡ”‡Žƒ–‡†
to oral health in all participants (p<0.0001). There was no sta-
–‹•–‹…ƒŽŽ›•‹‰‹ϐ‹…ƒ–†‹ˆˆ‡”‡…‡„‡–™‡‡–Š‡–™‘–›’‡•‘ˆ–”‡ƒ–-
ment in the total and on each subscale (functional limitations,
pain, psychological discomfort, physical disability, psychologi-
cal disability, social disability and handicap) of the Oral Health
val;
͹Ȍ ”ƒ–£ƒ‹‹…£†‡…‘’Ž‹…ƒì‹‹ȏͶͷǡͷͲȐǤ
Multiple studii au investigat impactul tratamentului prote-
–‹… ƒ•—’”ƒ …ƒŽ‹–£ì‹‹ ˜‹‡ì‹‹ Ž‡‰ƒ–‡ †‡ •££–ƒ–‡ƒ ‘”ƒŽ£Ǥ B•£ǡ …‡Ž‡
ƒ‹—Ž–‡•–—†‹‹ƒ—ˆ‘•–‡ˆ‡…–—ƒ–‡Žƒ’ƒ…‹‡ì‹‹…—‡†‡–ƒì‹‹–‘–ƒ-
Ž‡•ƒ—’ƒ”싃Ž‡Ǥ–—†‹‹…ƒ”‡‹’Ž‹…£’ƒ…‹‡ì‹…—‡†‡–ƒì‹‡—‹†‡-
–ƒ”£•—–Ž‹‹–ƒ–‡Ǥ•–—†‹—”‡…‡––”ƒ•˜‡”•ƒŽ…‘’ƒ”ƒ–‹˜ǡ
”‡ƒŽ‹œƒ–’‡—Ž‘–†‹͵ͷ†‡’ƒ…‹‡ì‹…—‹’Žƒ–è‹—Ž‘–†‹͵͸
†‡’ƒ…‹‡ì‹…— …‘˜‡ì‹‘ƒŽ‡…—͵—‹–£ì‹’‡–”—‡†‡–ƒì‹‡
—‹†‡–ƒ”£ǡ ƒ …‘•–ƒ–ƒ– Á †‹ƒ‹…£ ‘ Á„—£–£ì‹”‡ •‡‹ϐ‹-
…ƒ–‹˜£ ƒ …ƒŽ‹–£ì‹‹ ˜‹‡ì‹‹ Ž‡‰ƒ–‡ †‡ •££–ƒ–‡ƒ ‘”ƒŽ£ Žƒ –‘ì‹ ’ƒ”–‹-
…‹’ƒì‹‹ȋ’δͲǡͲͲͲͳȌǤ—ƒ‡š‹•–ƒ–‘†‹ˆ‡”‡ì£•–ƒ–‹•–‹…•‡‹ϐ‹-
…ƒ–‹˜£Á–”‡…‡Ž‡†‘—£–‹’—”‹†‡–”ƒ–ƒ‡–Á–‘–ƒŽè‹’‡ϐ‹‡…ƒ”‡
’ƒ…–”‘ϐ‹Ž‡“—‡•–‹‘ƒ‹”‡ȋǦͳͶȌǡ‡˜‡ƒˆ–‡”ƒ†Œ—•–‹‰
–Š‡‹ϐŽ—‡…‡‘ˆ–Š‡…‘˜ƒ”‹ƒ–‡•ȋƒ‰‡ƒ†‰‡†‡”Ȍȋ’εͲǤͲͷȌǤŠ‡
implants and the 3 PFD units for the replacement of a tooth
Šƒ†ƒ•‹‰‹ϐ‹…ƒ–”‡•—Ž–ƒ†•‹‹Žƒ”‹’”‘˜‡‡–‹“—ƒŽ‹–›‘ˆ
life related to oral health [1].
‡–ƒŽ ‹’Žƒ–• ‘ˆˆ‡” •‹‰‹ϐ‹…ƒ– ƒ†˜ƒ–ƒ‰‡• ‹ –‡”• ‘ˆ
aesthetics, better functional results, long-term predictability,
and preserving the integrity of existing teeth [1, 51]. However,
dental implants also have disadvantages, including surgical
†‹ˆϐ‹…—Ž–‹‡•ǡŽ‘‰’‡”‹‘†‘ˆ–”‡ƒ–‡–ƒ†Š‹‰Š–”‡ƒ–‡–…‘•–•
[1, 9]. On the other hand, 3-unit conventional PFD is the treat-
ment of choice when patients have systemic health problems
that make them ineligible for surgery or the alveolar bone is
•—„•…ƒŽ£ ȋŽ‹‹–£”‹ ˆ—…ì‹‘ƒŽ‡ǡ †—”‡”‡ǡ †‹•…‘ˆ‘”– ’•‹Š‘Ž‘‰‹…ǡ ‹•—ˆϐ‹…‹‡––‘‹•–ƒŽŽ–Š‡‹’Žƒ–Ǥƒ††‹–‹‘ǡ–Š‡›ƒ”‡—…Š
†‹œƒ„‹Ž‹–ƒ–‡ϐ‹œ‹…£ǡ†‹œƒ„‹Ž‹–ƒ–‡’•‹Š‘Ž‘‰‹…£ǡ†‹œƒ„‹Ž‹–ƒ–‡•‘…‹ƒŽ£ cheaper than dental implant treatment. The major drawbacks
86 ”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡

è‹Šƒ†‹…ƒ’Ȍƒ…Š‡•–‹‘ƒ”—Ž—‹†‡‡˜ƒŽ—ƒ”‡ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹”ƒŽ of conventional PFDs with 3 units are the use of two adjacent
‡ƒŽ–Š I’ƒc– P”oϔ‹Ž‡ȋǦͳͶȌǡ‹…Ž—•‹˜è‹†—’£ƒŒ—•–ƒ”‡ƒ‹- teeth of edentulous gap as abutment teeth, causing their de-
ϐŽ—‡ì‡‹…‘˜ƒ”‹ƒ–‡Ž‘”ȋ˜Ÿ”•–ƒè‹•‡š—ŽȌȋ’εͲǡͲͷȌǤ’Žƒ–—”‹Ž‡è‹ terioration, and the estimated longevity of 8.3-10.3 years.
…‡Ž‡͵—‹–£ì‹ƒŽ‡ ’‡–”—ÁŽ‘…—‹”‡ƒ——‹†‹–‡ƒ—ƒ˜—–— However, some authors have found a greater number of vis-
”‡œ—Ž–ƒ–•‡‹ϐ‹…ƒ–‹˜è‹Á„—£–£ì‹”‡•‹‹Žƒ”£ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ ‹–•ˆ‘”–Š‡–”‡ƒ–‡– ƒ† ƒ ‘”‡ˆƒ˜‘”ƒ„Ž‡ …‘•–Ǧ„‡‡ϐ‹–”ƒ–‹‘
Ž‡‰ƒ–‡†‡•££–ƒ–‡ƒ‘”ƒŽ£ȏͳȐǤ in patients with implant-supported crowns compared to the
’Žƒ–—”‹Ž‡ †‡–ƒ”‡ ‘ˆ‡”£ ƒ˜ƒ–ƒŒ‡ •‡‹ϐ‹…ƒ–‹˜‡ Á –‡”-
‡‹†‡‡•–‡–‹…£ǡ”‡œ—Ž–ƒ–‡ˆ—…ì‹‘ƒŽ‡ƒ‹„—‡ǡ’”‡†‹…–‹„‹Ž‹-
–ƒ–‡’‡–‡”‡Ž—‰è‹’£•–”‡ƒœ£‹–‡‰”‹–ƒ–‡ƒ†‹ì‹Ž‘”‡š‹•–‡ì‹
ȏͳǡͷͳȐǤ‘–—è‹ǡ‹’Žƒ–—”‹Ž‡†‡–ƒ”‡ƒ—苆‡œƒ˜ƒ–ƒŒ‡ǡ‹…Ž—•‹˜
†‹ϐ‹…—Ž–£ì‹Ž‡ …Š‹”—”‰‹…ƒŽ‡ǡ ’‡”‹‘ƒ†ƒ Ž—‰£ è‹ …‘•–—”‹Ž‡ ”‹†‹…ƒ–‡
†‡–”ƒ–ƒ‡–ȏͳǡͻȐǤ‡†‡ƒŽ–£’ƒ”–‡ǡ …‘˜‡ì‹‘ƒŽ‡…—͵
—‹–£ì‹ ‡•–‡ –”ƒ–ƒ‡–—Ž †‡ ‡Ž‡…싇 Á …ƒœ—”‹Ž‡ …Ÿ† ’ƒ…‹‡ì‹‹
ƒ—’”‘„Ž‡‡†‡•££–ƒ–‡•‹•–‡‹…‡…ƒ”‡Á‹ˆƒ…‡‡Ž‹‰‹„‹Ž‹’‡-
–”— ‹–‡”˜‡ì‹‹ …Š‹”—”‰‹…ƒŽ‡ •ƒ— ‘•—Ž ƒŽ˜‡‘Žƒ” ‡•–‡ ‹•—ϐ‹…‹‡–
pentru instalarea implantului. În plus, acestea sunt mult mai
ieftine decât tratamentul cu implant dentar. Dezavantajele
ƒŒ‘”‡ ƒŽ‡   …‘˜‡ì‹‘ƒŽ‡ …— ͵ —‹–£ì‹ •—– —–‹Ž‹œƒ”‡ƒ …ƒ
•—’‘”–ƒ†‘‹†‹ì‹‹ƒ†‹ƒ…‡ì‹„”‡è‡‹‡†‡–ƒ–‡ǡ…ƒ—œŸ††‡–‡”‹‘-
”ƒ”‡ƒƒ…‡•–‘”ƒǡè‹Ž‘‰‡˜‹–ƒ–‡ƒ‡•–‹ƒ–£†‡ͺǡ͵ǦͳͲǡ͵ƒ‹Ǥ—–‘ƒ-
–‡ƒ…‡•–‡ƒǡ—‹‹ƒ—–‘”‹ƒ—…‘•–ƒ–ƒ–——£”–‘–ƒŽƒ‹ƒ”‡
†‡ ˜‹œ‹–‡ ’‡–”— –”ƒ–ƒ‡– è‹ — ”ƒ’‘”– …‘•–Ǧ„‡‡ϐ‹…‹— ƒ‹
ˆƒ˜‘”ƒ„‹Ž Žƒ ’ƒ…‹‡ì‹‹ …— …‘”‘ƒ‡ ’‡ •—’‘”– †‡ ‹’Žƒ–ǡ …‘-
’ƒ”ƒ–‹˜…—‹•–ƒŽƒ”‡ƒ—‡‹ …‘˜‡ì‹‘ƒŽ‡’‡–”—‡†‡–ƒì‹ƒ
—‹†‡–ƒ”£Ǥ”‹—”ƒ”‡ǡ‡•–‡‡…‡•ƒ”†‡Ž—ƒ–Á…‘•‹†‡”ƒ”‡
†‹ˆ‡”‹ì‹ ˆƒ…–‘”‹ǡ ‹…Ž—•‹˜ǡ ‹’ƒ…–—Ž ƒ•—’”ƒ …ƒŽ‹–£ì‹‹ ˜‹‡ì‹‹ Ž‡‰ƒ–‡
installation of a conventional PFD for the single edentulism.
It is therefore necessary to take into account various factors,
including the impact on the quality of life related to oral health
for the decision to treat the single edentulism [1, 50, 51].
Oral Health Quality Assessment in patients treated with
unitary implant-supported crowns, PFD on implant support or
conventional tooth-based PFD was performed using the OHIP-
49 questionnaire in healthy subjects with single edentulism.
The scores on each subset of the quality of life questionnaire
†”‘’’‡†•‹‰‹ϐ‹…ƒ–Ž›ˆ”‘‹‹–‹ƒŽ˜ƒŽ—‡–‘–Š‡‡†‘ˆ–Š‡͵”†
›‡ƒ” ‘ˆ ˆ‘ŽŽ‘™Ǧ—’ǡ ™Š‹…Š †‡‘•–”ƒ–‡• ƒ •‹‰‹ϐ‹…ƒ– ‹…”‡ƒ•‡
‹ “—ƒŽ‹–› ‘ˆ Ž‹ˆ‡ ”‡Žƒ–‡† –‘ ‘”ƒŽ Š‡ƒŽ–ŠǤ ‘ •‹‰‹ϐ‹…ƒ– †‹ˆˆ‡”-
ences in OHIP subscale scores were found, depending on the
gender [2, 52]. In patients with PFD on implant support, OHIP
•…‘”‡•™‡”‡•‹‰‹ϐ‹…ƒ–Ž›Š‹‰Š‡”–Šƒ‹ ‘–‡‡–Š•—’’‘”–
patients at both initial and assessment phases. Patients aged
ζ͸Ͳ ›‡ƒ”• ƒ† ε͸Ͳ ›‡ƒ”• ™‹–Š   ‘ ‹’Žƒ– •—’’‘”– ƒ†
PFD on teeth support have shown an equal improvement in
quality of life related to oral health [52]. Patients treated with
single crowns on implant support or PFD on implant support
†‡ •££–ƒ–‡ƒ ‘”ƒŽ£ ’‡–”— †‡…‹œ‹ƒ †‡ –”ƒ–ƒ‡– ƒ ‡†‡–ƒì‹‡‹
unidentare [1, 50, 51].
˜ƒŽ—ƒ”‡ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹Ž‡‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£Žƒ’ƒ…‹-
‡ì‹‹ –”ƒ–ƒì‹ …— …‘”‘ƒ‡ —‹–ƒ”‡ ’‡ •—’‘”– †‡ ‹’Žƒ– •ƒ— …—
 ’‡•—’‘”–†‡‹’Žƒ–•ƒ—…— …‘˜‡ì‹‘ƒŽ‡’‡•—’‘”–
•Š‘™‡† •‹‰‹ϐ‹…ƒ– †‹ˆˆ‡”‡…‡• ‹  •…‘”‡• ƒ– ͳǡ ʹ ƒ† ͵
years post-implant follow-up (p<0.05) [2]. Implant-supported
single crown treatment and implant-supported PFD treat-
ment improved the quality of life related to oral health in older
’ƒ–‹‡–•ȏʹǡͷʹȐǤŠ—•ǡƒ•‹‰‹ϐ‹…ƒ–‹…”‡ƒ•‡‹“—ƒŽ‹–›‘ˆŽ‹ˆ‡”‡-
†‡†‹ì‹ƒˆ‘•–‡ˆ‡…–—ƒ–£…—ƒŒ—–‘”—Ž…Š‡•–‹‘ƒ”—Ž—‹ǦͶͻŽƒ
•—„‹‡…ì‹•££–‘è‹…—‡†‡–ƒì‹‹—‹†‡–ƒ”‡Ǥ…‘”—”‹Ž‡’‡ϐ‹‡…ƒ”‡
•—„•…ƒŽ£ƒ…Š‡•–‹‘ƒ”—Ž—‹†‡‡˜ƒŽ—ƒ”‡ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ƒ—•…£-
œ—–•‡‹ϐ‹…ƒ–‹˜†‡Žƒ˜ƒŽ‘ƒ”‡ƒ‹‹ì‹ƒŽ£’Ÿ£Žƒϐ‹‡Ž‡ƒ—Ž—‹͵
†‡—”£”‹”‡ǡˆƒ’–…ƒ”‡†‡‘•–”‡ƒœ£‘…”‡è–‡”‡•‡‹ϐ‹…ƒ–‹˜£
ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹Ž‡‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£Ǥ—ƒ—ˆ‘•–…‘•–ƒ–ƒ-
lated to oral health has been demonstrated in patients treated
with single crowns on implant support or PFD on implant sup-
port or PFDs with teeth support, with an increase in patient
satisfaction [2]. Despite this, 98% of patients with implant
”‡…‘•–”—…–‹‘ ™‡”‡ •ƒ–‹•ϐ‹‡† ‘” ˜‡”› •ƒ–‹•ϐ‹‡†ǡ …‘’ƒ”‡† –‘
84% in the conventional PFD group [49].
–‡ †‹ˆ‡”‡ì‡ •‡‹ϐ‹…ƒ–‹˜‡ ƒŽ‡ •…‘”—”‹Ž‘” •—„•…ƒŽ‡Ž‘”  Á Patient satisfaction and various aspects of the quality of
†‡’‡†‡ì£ †‡ •‡š ȏʹǡ ͷʹȐǤ ƒ ’ƒ…‹‡ì‹‹ …—   ’‡ •—’‘”– †‡ life have been reduced from single crowns on implant support
‹’Žƒ–ǡ •…‘”—”‹Ž‡  ‡”ƒ— •‡‹ϐ‹…ƒ–‹˜ ƒ‹ ƒ”‹ †‡…Ÿ– Žƒ to conventional PFD and adhesive PFD bonded with synthetic
’ƒ…‹‡ì‹‹…— ’‡•—’‘”–†‡†‹ì‹ǡƒ–Ÿ–Žƒ‘‡–—Ž‹‹ì‹ƒŽǡ…Ÿ– resins. Lack of treatment and partially removable prosthe-
è‹Žƒ‡–ƒ’‡Ž‡†‡‡˜ƒŽ—ƒ”‡Ǥ
”—’—”‹Ž‡†‡’ƒ…‹‡ì‹…—˜Ÿ”•–ƒζ͸Ͳ ses show the lowest levels of satisfaction. PFD and implant-
†‡ƒ‹è‹ε͸Ͳ†‡ƒ‹…— ’‡•—’‘”–†‡‹’Žƒ–è‹…— ’‡ supported removable dentures enhance patient satisfaction.
•—’‘”–†‡†‹ì‹ƒ—’”‡œ‡–ƒ–‘ƒ‡Ž‹‘”ƒ”‡‡‰ƒŽ£ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹ However, the determination of the treatment protocol of the
Ž‡‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£ȏͷʹȐǡ‹ƒ”’ƒ…‹‡ì‹‹–”ƒ–ƒì‹…—…‘”‘ƒ‡ single edentulism that has a better impact on the quality of
unitare pe suport de implant sau cu PPF pe suport de implant life and patient satisfaction is still considered a controversial
ƒ—’”‡œ‡–ƒ–†‹ˆ‡”‡ì‡•‡‹ϐ‹…ƒ–‹˜‡ƒ•…‘”—”‹Ž‘”Žƒͳǡʹ
è‹͵ƒ‹†‡—”£”‹”‡†—’£‹•–ƒŽƒ”‡ƒ‹’Žƒ–—Ž—‹ȋ’δͲǡͲͷȌȏʹȐǤ
”ƒ–ƒ‡–—Ž…—…‘”‘ƒ‡—‹–ƒ”‡’‡•—’‘”–†‡‹’Žƒ–è‹…— 
’‡•—’‘”–†‡‹’Žƒ–ƒÁ„—£–£ì‹–ƒ‹„‹‡…ƒŽ‹–ƒ–‡ƒ˜‹‡ì‹‹Ž‡-
‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£Žƒ’ƒ…‹‡ì‹‹ƒ‹Á˜Ÿ”•–£ȏʹǡͷʹȐǤ•–ˆ‡Žǡ
ƒˆ‘•–†‡‘•–”ƒ–£‘…”‡è–‡”‡•‡‹ϐ‹…ƒ–‹˜£ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹Ž‡-
‰ƒ–£†‡•££–ƒ–‡ƒ‘”ƒŽ£Žƒ’ƒ…‹‡ì‹‹–”ƒ–ƒì‹…—…‘”‘ƒ‡—‹–ƒ”‡
pe suport de implant sau cu PPF pe suport de implant sau cu
P ’‡•—’‘”–†‡†‹ì‹…—‘…”‡è–‡”‡ƒ‹˜‡Ž—Ž—‹†‡•ƒ–‹•ˆƒ…싇
ƒ’ƒ…‹‡ì‹Ž‘”ȏʹȐǤB’‘ϐ‹†ƒƒ…‡•–—‹ˆƒ’–ǡͻͺΨ†‹–”‡’ƒ…‹‡ì‹‹
issue [30].
Based on the evidence of systematic revisions of the lit-
erature, the missing tooth is preferably replaced with a sin-
‰Ž‡ …”‘™ ‹’Žƒ– ȋƒ—ƒŽ ˆƒ‹Ž—”‡ ”ƒ–‡ Ȃ ͳǤͳʹΨȌ ‘Ž› ™Š‡
the adjacent teeth are intact and under perfect conditions.
Š‹• ‡–Š‘† ‹• –Š‡ ‘•– …‘•‡”˜ƒ–‹˜‡ ƒ† ‘•– Dz„‹‘Ž‘‰‹…ƒŽdz
treatment option. If the adjacent teeth are cut or need to be
crowned, conventional PFDs are preferred (annual failure
”ƒ–‡ȂͳǤͳͶΨȌǤ‘–Š‹–‡”•‘ˆŽ‘‰‡˜‹–›ƒ†‡…‘‘‹…•ǡ–Š‡•‡
two treatment options are similar to a 10-year survival rate of
P”o•–Š‡–‹c –”‡ƒ–‡n– oˆ •‹n‰Ž‡ ‡†‡n–—Ž‹•
…— ”‡…‘•–”—…ì‹‹ ’‡ •—’‘”– †‡ ‹’Žƒ– ƒ— ˆ‘•– •ƒ–‹•ˆ£…—ì‹ •ƒ—
ˆ‘ƒ”–‡—Žì—‹ì‹ǡ…‘’ƒ”ƒ–‹˜…—ͺͶΨÁ‰”—’—Ž…— …‘˜‡-
싑ƒŽ‡ȏͶͻȐǤ
ƒ–‹•ˆƒ…싃’ƒ…‹‡–—Ž—‹è‹†‹ˆ‡”‹–‡ƒ•’‡…–‡ƒŽ‡…ƒŽ‹–£ì‹‹˜‹‡ì‹‹
s-au redus de la coroane unitare pe suport de implant la PPF
…‘˜‡ì‹‘ƒŽ‡ è‹   ƒ†‡œ‹˜‡ Ž‹’‹–‡ …— ”£è‹‹ •‹–‡–‹…‡Ǥ ‹’•ƒ
–”ƒ–ƒ‡–—Ž—‹è‹’”‘–‡œ‡Ž‡’ƒ”싃Ž†‡–ƒèƒ„‹Ž‡’”‡œ‹–£…‡Ž‡ƒ‹
‹…‹ ‹˜‡Ž‡ †‡ •ƒ–‹•ˆƒ…싇Ǥ   è‹ ’”‘–‡œ‡Ž‡ †‡–ƒèƒ„‹Ž‡ ’‡ •—-
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ƒ…‡•–‡ƒǡ†‡–‡”‹ƒ”‡ƒ’”‘–‘…‘Ž—Ž—‹†‡–”ƒ–ƒ‡–ƒ‡†‡–ƒì‹‡‹
—‹†‡–ƒ”‡…ƒ”‡ƒ”‡—‹’ƒ…–ƒ‹„—ƒ•—’”ƒ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹è‹
•ƒ–‹•ˆƒ…싇‹’ƒ…‹‡–—Ž—‹‡•–‡Á…£…‘•‹†‡”ƒ–£‘’”‘„Ž‡£…‘-
–”‘˜‡”•ƒ–£ȏ͵ͲȐǤ
În baza dovezilor revizuirilor sistematice ale literaturii,
†‹–‡Ž‡Ž‹’•£‡•–‡ÁŽ‘…—‹–ǡ†‡’”‡ˆ‡”‹ì£ǡ…——‹’Žƒ–ƒ–…—…‘-
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싋ƒ†‹ƒ…‡ì‹•—–‹–ƒ…ì‹è‹Á…‘†‹ì‹‹’‡”ˆ‡…–‡Ǥ…‡ƒ•–£‡–‘†£
”‡’”‡œ‹–£…‡ƒƒ‹…‘•‡”˜ƒ–‘ƒ”‡è‹…‡ƒƒ‹dz„‹‘Ž‘‰‹…£dz‘’ì‹—-
‡†‡–”ƒ–ƒ‡–ǤB…ƒœ—ŽÁ…ƒ”‡†‹ì‹‹ƒ†‹ƒ…‡ì‹•—––£‹ƒì‹•ƒ—
‡…‡•‹–£†‡ƒϐ‹Á…‘”‘ƒì‹ǡ•—–’”‡ˆ‡”ƒ–‡ …‘˜‡ì‹‘ƒŽ‡
ȋ”ƒ–ƒƒ—ƒŽ£†‡‡è‡…ȂͳǡͳͶΨȌǤ–Ÿ–†‹’—…–†‡˜‡†‡”‡ƒŽ‘-
‰‡˜‹–£ì‹‹…Ÿ–苆‹’—…–†‡˜‡†‡”‡‡…‘‘‹…ǡƒ…‡•–‡†‘—£‘’-
싗‹†‡–”ƒ–ƒ‡–•—–•‹‹Žƒ”‡…—‘”ƒ–£†‡•—’”ƒ˜‹‡ì—‹”‡Žƒ
ͳͲƒ‹†‡ͺͻǡͶΨ’‡–”—…‘”‘ƒƒ—‹–ƒ”£’‡•—’‘”–†‡‹’Žƒ–
苆‡ͺͻǡʹΨ’‡–”— ’‡•—’‘”–†‡†‹ì‹ȏ͵͸ȐǤ
胆ƒ”ǡ†ƒ…£—‡…‡•‹–£‹–‡”˜‡ì‹‹…Š‹”—”‰‹…ƒŽ‡ǡ …‘-
˜‡ì‹‘ƒŽ‡’‡•—’‘”–†‡†‹ì‹’ƒ”ƒϐ‹ƒ‹’”‡˜‹œ‹„‹Ž‡Áƒ–‹-
‰‡”‡ƒ •—……‡•—Ž—‹ ‹‹ì‹ƒŽ ƒŽ –”ƒ–ƒ‡–—Ž—‹ …— ˜‹œ‹–‡ƒ‹ ’—싐‡
è‹–‹’†‡–”ƒ–ƒ‡–ƒ‹•…—”–Ǥ‘’Ž‹…ƒì‹‹Ž‡„‹‘Ž‘‰‹…‡ǡ’‘•‹-
„‹ŽǡŽ‹‹–‡ƒœ£–‹’—Ž†‡•—’”ƒ˜‹‡ì—‹”‡ƒ …‘˜‡ì‹‘ƒŽ‡ǡ’‡
…Ÿ†…‘”‘ƒ‡Ž‡—‹–ƒ”‡’‡•—’‘”–†‡‹’Žƒ–’”‡œ‹–£‘‹…‹-
†‡ì£ƒ‹ƒ”‡†‡…‘’Ž‹…ƒì‹‹–‡Š‹…‡Ǥƒ…£Ž—£Á…‘•‹†‡-
”ƒ”‡ …Š‡Ž–—‹‡Ž‹Ž‡ †‡ Á–”‡ì‹‡”‡ǡ ƒ˜ƒ–ƒŒ—Ž †‡ •…—”–£ †—”ƒ–£ ƒ
 …‘˜‡ì‹‘ƒŽ‡ƒ’ƒ”‡†‹‹—ƒ–Ǥ˜Ÿ†Á˜‡†‡”‡—£”—Ž
ƒ”‡†‡˜ƒ”‹ƒ„‹Ž‡…ƒ”‡ƒˆ‡…–‡ƒœ£†‡…‹œ‹‹Ž‡†‡–”ƒ–ƒ‡–ǡ‘•‘-
Ž—싇—‹˜‡”•ƒŽ‡ϐ‹…‹‡–£—‡š‹•–ƒǤ—’”ƒ˜‹‡ì—‹”‡ƒǡ•—……‡•—Žè‹
’”‘ϐ‹Ž—Ž †‡ ”‹•… ƒ ‘”‹…£”‡‹ ‘’ì‹—‹ †‡ ”‡•–ƒ—”ƒ”‡ ’”‘–‡–‹…£ —
–”‡„—‹‡ƒƒŽ‹œƒ–‡•‡’ƒ”ƒ–ǡ†ƒ”Á…‘„‹ƒì‹‡…—†‘”‹ì‡Ž‡’ƒ…‹-
‡–—Ž—‹è‹…ƒ’ƒ…‹–£ì‹Ž‡ˆ—”‹œ‘”—Ž—‹†‡–”ƒ–ƒ‡–ȏ͵ͲȐǤ
În ultimele decenii folosirea implanturilor în tratamentul
‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡ƒ…”‡•…—–ǡ‹ƒ”—–‹Ž‹œƒ”‡ƒ …‘˜‡ì‹‘-
ƒŽ‡ƒ•…£œ—–Ǥ‘–‹˜‡Ž‡ƒ…‡•–‡‹•…Š‹„£”‹ƒ—ˆ‘•–†‡–‡”‹ƒ–‡
†‡”ƒ–ƒƒ‹ƒ”‡†‡•—’”ƒ˜‹‡ì—‹”‡’‡–‡”‡Ž—‰ƒ‹’Žƒ-
–—”‹Ž‘” †‡–ƒ”‡ è‹ ƒŽì‹ ˆƒ…–‘”‹ǡ …— ƒ” ϐ‹ ‡˜‹–ƒ”‡ƒ †‡–‡”‹‘”£”‹‹
†‹ì‹Ž‘” ƒ–—”ƒŽ‹ ƒ†‹ƒ…‡ì‹ œ‘‡‹ ‡†‡–—Ž‘ƒ•‡Ǥ ‡”…‡’싃 ‡-
…‡•‹–£ì‹‹‹’Žƒ–—”‹Ž‘”‡•–‡Ž‹‹–ƒ–£Žƒ—Žì‹’ƒ…‹‡ì‹ǡÁ•£ƒ…-
…‡’–ƒ”‡ƒ –”ƒ–ƒ‡–—Ž—‹ …— ‹’Žƒ– ‡•–‡ ƒ‹ ƒ”‡ Žƒ ’ƒ…‹‡ì‹
…———£”ƒ‹ƒ”‡†‡†‹ì‹Ǥƒ…‹‡ì‹‹…‘•‹†‡”£…‘•–‹•‹–‘”
tratamentul cu implanturi. Cu toate acestea, având în vedere
’—„Ž‹…ƒì‹‹Ž‡†‹•’‘‹„‹Ž‡ǡ–”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡…—
‹’Žƒ–—”‹’ƒ”‡ƒϐ‹ƒ‹”‡–ƒ„‹Ž†‡…Ÿ––”ƒ–ƒ‡–—Ž…— …‘-
˜‡ì‹‘ƒŽ‡ȏͶͷȐǤ
‘…Ž—œ‹‹
ͳȌ ƒ”‹‹Ž‡†‡–ƒ”‡è‹ƒŽƒ†‹ƒ’ƒ”‘†‘–ƒŽ£•—–…ƒ—œ‡Ž‡ƒ-
Œ‘”‡ ƒŽ‡ ‡†‡–ƒì‹‡‹ ’ƒ”싃Ž‡Ǥ — ‡š‹•–£ ‘ …‘”‡Žƒì‹‡ Á–”‡
MJHS 17(3)/2018 87
89.4% for the unitary crown on implant support and 89.2%
for PFD on teeth [36].
Therefore, if it does not require surgery, conventional tooth-
supported PFDs appear to be more predictable in achieving
initial treatment success with fewer visits and shorter treat-
ment times. Biological complications may limit the survival
time of conventional PFDs, while unitary crowns on implant
support have a greater incidence of technical complications.
Taking into account maintenance costs, the short-term advan-
tage of conventional PFDs appears reduced. Given the large
number of factors that affect treatment decisions, a universal-
ly effective solution does not exist. The survival, success and
”‹•’”‘ϐ‹Ž‡‘ˆƒ›’”‘•–Š‡–‹…”‡•–‘”ƒ–‹˜‡‘’–‹‘•Š‘—Ž†‘–„‡
considered separately, but in combination with patient wishes
and the capabilities of the treatment provider [30].
In recent decades, the use of implants in the treatment of
single edentulism has increased, and the use of conventional
PFDs has decreased. The reasons for this change were due to
the higher rate of long-term survival of dental implants and
other factors, such as avoiding damage to the natural teeth
adjacent to the edentulous area. Perception of the need for
implants is limited in many patients, but the acceptance of
implant treatment is greater in patients with a larger number
of teeth. Patients consider the implant treatment expensive.
However, in view of the available publications, the treatment
of the single edentulism with implants appears to be more
cost-effective than conventional PFD treatment [45].
Conclusions
1) Dental caries and periodontal disease are the major
causes of the partial edentulism. There is no gender cor-
”‡Žƒ–‹‘ˆ‘”’ƒ”–‹ƒŽ‡†‡–—Ž‹•ƒ†ƒ‰‡Šƒ•ƒ•‹‰‹ϐ‹…ƒ–
effect. The prevalence of the permanent tooth edentu-
lism is 2.8-8.0% and is more common in the posterior
areas of the jaw.
2) Traditional methods of treating single edentulism are
closing of the edentulous gap with orthodontic meth-
ods, temporary or long-term prostheses, PFD (with 3
units, with extension, adhesive) and prosthetic resto-
rations on dental implant support. Conventional tooth-
based PFD and implant-based restorations aim for long-
term success (about 15-20 years) for the best aesthetic
ƒ†ˆ—…–‹‘ƒŽ”‡•—Ž–•ǣƒ•–‹…ƒ–‘”›…ƒ’ƒ…‹–›ǡƒ‡•–Š‡–‹…•ǡ
quality of life and patient satisfaction.
3) The specialized literature regarding the optimal treat-
ment of single edentulism clearly favors single crowns
on implant support. The treatment of single edentulism
with crown on implant support, compared to conven-
tional PFD, shows superior survival rates and long-term
•—……‡••ǡ ƒ ‘”‡ •‹‰‹ϐ‹…ƒ– ‹’”‘˜‡‡– ‹ ˆ—…–‹‘ǡ
aesthetics, quality of life, and patient satisfaction.
4) Single crowns on implant support are a cost-effective
long-term treatment option in clinical situations, involv-
ing teeth with minor restorations or without restorative
and/or favorable bone conditions.
88 ”ƒ–ƒ‡n–—Ž ’”o–‡–‹c ƒŽ ‡†‡n–ƒì‹‡‹ —n‹†‡n–ƒ”‡

•‡š‡ ’‡–”— ‡†‡–ƒì‹ƒ ’ƒ”싃Ž£ǡ ‹ƒ” ˜Ÿ”•–ƒ ƒ”‡ — ‡ˆ‡…– ‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‹‰‹–‡”‡•–•
•‡‹ϐ‹…ƒ–‹˜Ǥ ”‡˜ƒŽ‡ìƒ ‡†‡–ƒì‹‡‹ ——‹ †‹–‡ ’‡”ƒ- Nothing to declare.
‡– ‡•–‡ †‡ ʹǡͺǦͺǡͲΨ è‹ ‡•–‡ ƒ‹ ˆ”‡…˜‡–£ Á œ‘‡Ž‡
posterioare ale maxilarelor.
ʹȌ ‡–‘†‡Ž‡–”ƒ†‹ì‹‘ƒŽ‡†‡•‘Ž—ì‹‘ƒ”‡ƒ‡†‡–ƒì‹‹Ž‘”—‹-
†‡–ƒ”‡ •—–ǣ Á…Š‹†‡”‡ƒ „”‡è‡‹ †‡–ƒ”‡ ’”‹ ‡–‘†‡
ortodontice, protezele mobile temporare sau pe termen
Ž—‰ǡ   ȋ…— ͵ —‹–£ì‹ǡ …— ‡š–‡•‹‡ǡ ƒ†‡œ‹˜£Ȍ è‹ ”‡•–ƒ—-
”£”‹Ž‡ ’”‘–‡–‹…‡ ’‡ •—’‘”– †‡ ‹’Žƒ– †‡–ƒ”Ǥ   …‘-
˜‡ì‹‘ƒŽ‡ ’‡ •—’‘”– †‡ †‹ì‹ è‹ ”‡•–ƒ—”£”‹Ž‡ ’‡ •—’‘”–
†‡‹’Žƒ–˜‹œ‡ƒœ£’‡–”—•—……‡•’‡–‡”‡Ž—‰ȋ…‹”…ƒ
ͳͷǦʹͲ†‡ƒ‹Ȍǡ’‡–”—…‡Ž‡ƒ‹„—‡”‡œ—Ž–ƒ–‡‡•–‡–‹…‡è‹
ˆ—…ì‹‘ƒŽ‡ǣ…ƒ’ƒ…‹–ƒ–‡ƒƒ•–‹…ƒ–‘”‹‡ǡ‡•–‡–‹…ƒǡ…ƒŽ‹–ƒ–‡ƒ
˜‹‡ì‹‹è‹•ƒ–‹•ˆƒ…싃’ƒ…‹‡ì‹Ž‘”Ǥ
3) Literatura de specialitate privind tratamentul optimal al
‡†‡–ƒì‹‡‹—‹†‡–ƒ”‡ˆƒ˜‘”‹œ‡ƒœ£…Žƒ”…‘”‘ƒ‡Ž‡—‹–ƒ-
”‡’‡•—’‘”–†‡‹’Žƒ–Ǥ”ƒ–ƒ‡–—Ž‡†‡–ƒì‹‡‹—‹†‡-
ntare cu coroane pe suport de implant, comparativ cu
‹•–ƒŽƒ”‡ƒ   …‘˜‡ì‹‘ƒŽ‡ǡ ’”‡œ‹–£ ”ƒ–‡ •—’‡”‹‘ƒ”‡
†‡•—’”ƒ˜‹‡ì—‹”‡•‹†‡•—……‡•’‡–‡”‡Ž—‰ǡ‘Á„—£-
–£ì‹”‡ƒ‹‹’‘”–ƒ–£ƒˆ—…싇‹ǡ‡•–‡–‹…‹‹ǡ…ƒŽ‹–£ì‹‹˜‹‡ì‹‹
è‹•ƒ–‹•ˆƒ…싇‹’ƒ…‹‡ì‹Ž‘”Ǥ
4) Coroanele unitare pe suport de implant dentar repre-
œ‹–£‘‘’ì‹—‡”‡–ƒ„‹Ž£†‡–”ƒ–ƒ‡–’‡–‡”‡Ž—‰Á
•‹–—ƒì‹‹Ž‡…Ž‹‹…‡…ƒ”‡‹’Ž‹…£†‹ì‹…—”‡•–ƒ—”£”‹‹‘”‡
•ƒ—ˆ£”£”‡•–ƒ—”£”‹è‹Ȁ•ƒ—…‘†‹ì‹‹‘•‘ƒ•‡ˆƒ˜‘”ƒ„‹Ž‡Ǥ

‡…Žƒ”ƒì‹ƒ†‡…‘ϐŽ‹…–†‡‹–‡”‡•‡
Nimic de declarat.

‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡• 9. Dierens M., Vandeweghe S., Kisch J. ‡– ƒŽǤ Cost estimation of sin-
1. Park S., Oh S., Kim J. ‡– ƒŽǤ Single-tooth implant versus three-unit gle-implant treatment in the periodontally healthy patient after
ϐ‹š‡†’ƒ”–‹ƒŽ†‡–—”‡ǣƒ•–—†›‘ˆ‘”ƒŽŠ‡ƒŽ–ŠǦ”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡Ǥ 16-22 years of follow-up. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͳͷǢʹ͸ȋͳͳȌǣ
In–Ǥ Ǥ ”ƒŽǤ ƒš‹ŽŽoˆƒcǤ I’Žƒn–•ǤǡʹͲͳ͸Ǣ͵ͳȋʹȌǣ͵͹͸Ǧ͵ͺͳǤ 1288-1296.
2. AlZarea B. Oral health related quality-of-life outcomes of par- 10. Montero J., Castillo-Oyagüe R., Lynch C., Albaladejo A., Castaño A.
tially edentulous patients treated with implant-supported single Self-perceived changes in oral health-related quality of life after
…”‘™•‘”ϐ‹š‡†’ƒ”–‹ƒŽ†‡–—”‡•Ǥ Ǥ Ž‹nǤ Eš’Ǥ ‡n–ǤǡʹͲͳ͹ǢͻȋͷȌǣ ”‡…‡‹˜‹‰†‹ˆˆ‡”‡––›’‡•‘ˆ…‘˜‡–‹‘ƒŽ’”‘•–Š‡–‹…–”‡ƒ–‡–•ǣƒ
e666-e671. cohort follow-up study. Ǥ ‡n–ǤǡʹͲͳ͵ǢͶͳȋ͸ȌǣͶͻ͵ǦͷͲ͵Ǥ
3. Bortolini S., Natali A., Franchi M. OT Equator Bont Protetic Bio- 11. De Bruyn H., Raes S., Matthys C., Cosyn J. The current use of pa-
Ž‘‰‹…Ȃ—‘—…‘…‡’–Á’”‘–‡œƒ”‡ƒϐ‹š£ç‹‘„‹Ž£’‡‹’Žƒ–—”‹Ǥ –‹‡–Ǧ…‡–‡”‡†Ȁ”‡’‘”–‡†‘—–…‘‡•‹‹’Žƒ–†‡–‹•–”›ǣƒ•›•–‡-
–ƒŽ›ǣ‡†‹–‘”‡ǡ‹ƒ”‹†ƒ‹ƒǡʹͲͳͷǤʹͲͶ’ǤŠ––’ǣȀȀ‘–‹’Žƒ–Ǥ atic review. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͳͷǢʹ͸—’’ŽǤͳͳǣͶͷǦͷ͸Ǥ
com/images/ebook/eBook%20OT%20Equator%20Rumeno.pdf 12. Edelmayer M., Woletz K., Ulm C. ‡– ƒŽǤ Patient information on
4. Boardman N., Darby I., Chen S. A retrospective evaluation of aes- –”‡ƒ–‡– ƒŽ–‡”ƒ–‹˜‡• ˆ‘” ‹••‹‰ •‹‰Ž‡ –‡‡–Š Ȃ •›•–‡ƒ–‹… ”‡-
thetic outcomes for single-tooth implants in the anterior maxilla. view. E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤǡʹͲͳ͸Ǣͻ—’’ŽͳǣͶͷǦͷ͹Ǥ
Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͳ͸Ǣʹ͹ȋͶȌǣͶͶ͵ǦͶͷͳǤ 13. Cosyn J., Eghbali A., Hanselaer L. ‡– ƒŽǤ Four modalities of single
5. Nam J., Aranyarachkul P. Achieving the optimal peri-implant soft ‹’Žƒ––”‡ƒ–‡–‹–Š‡ƒ–‡”‹‘”ƒš‹ŽŽƒǣƒ…Ž‹‹…ƒŽǡ”ƒ†‹‘‰”ƒ’Š‹…ǡ
–‹••—‡ ’”‘ϐ‹Ž‡ „› –Š‡ •‡Ž‡…–‹˜‡ ’”‡••—”‡ ‡–Š‘† ˜‹ƒ ’”‘˜‹•‹‘ƒŽ and aesthetic evaluation. Ž‹nǤ I’Žƒn–Ǥ ‡n–Ǥ ‡Žƒ–Ǥ ‡•., 2013; 15
restorations in the esthetic zone. Ǥ E•–Š‡–Ǥ ‡•–o”Ǥ ‡n–Ǥ, 2015; 27 ȋͶȌǣͷͳ͹Ǧͷ͵ͲǤ
ȋ͵Ȍǣͳ͵͸ǦͳͶͶǤ 14. Jeyapalan V., Krishnan C. Partial edentulism and its correlation to
6. Johannsen A., Westergren A., Johannsen G. Dental implants from age, gender, socio-economic status and incidence of various ken-
–Š‡’ƒ–‹‡–•’‡”•’‡…–‹˜‡ǣ–”ƒ•‹–‹‘ˆ”‘–‘‘–ŠŽ‘••ǡ–Š”‘—‰Šƒ- ‡†›ǯ•…Žƒ••‡•ȂƒŽ‹–‡”ƒ–—”‡”‡˜‹‡™Ǥ Ǥ Ž‹nǤ ‹ƒ‰nǤ ‡•ǤǡʹͲͳͷǢͻȋ͸Ȍǣ
’—–ƒ–‹‘–‘‹’Žƒ–•Ȃ‡‰ƒ–‹˜‡ƒ†’‘•‹–‹˜‡–”ƒŒ‡…–‘”‹‡•Ǥ Ǥ Ž‹nǤ ZE14-17.
P‡”‹o†on–oŽǤǡʹͲͳʹǢ͵ͻȋ͹Ȍǣ͸ͺͳǦ͸ͺ͹Ǥ ͳͷǤ‹Ž‹ƒ”‹†‹•Ǥǡ‹†‹”ƒǤǡ‹”ƒ‹†‘—Ǥ‡– ƒŽǤ Treatment options for
͹Ǥ Š‹”ǤŠ‡’‡”‹Ǧ‹’Žƒ–‡•–Š‡–‹…•ǣƒ—ˆ‘”‰‡––ƒ„Ž‡‡–‹–›Ǥ Ǥ InǦ congenitally missing lateral incisors. E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤǡ 2016;
†‹ƒnǤ SocǤ P‡”‹o†on–oŽǤǡʹͲͳͳǢͳͷȋʹȌǣͻͺǦͳͲ͵Ǥ ͻ—’’ŽͳǣͷǦʹͶǤ
8. Roque M., Gallucci G., Lee S. Occlusal pressure redistribution with ͳ͸ǤŠ‡’–ƒƒ”—Ǥ”ƒ–ƒ‡–—Ž’”‘–‡–‹…Á‡†‡–ƒì‹ƒ—‹†‡–ƒ”£ǤB—Ǧ
single implant restorations. Ǥ P”o•–Šo†on–ǤǡʹͲͳ͹Ǣʹ͸ȋͶȌǣʹ͹ͷǦʹ͹ͻǤ Ž‡–‹n—Ž cƒ†‡‹‡‹ †‡ f–‹‹nì‡ ƒ oŽ†o˜‡‹Ǥ f–‹‹nì‡ ‡†‹cƒŽ‡ǡʹͲͳͷǢȋͳȌǣ
422-428.
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17. Polder B., Van’t Hof M., Van der Linden F., Kuijpers-Jagtman A. A 37. Lang N., Pjetursson B., Tan K., Brägger U., Egger M., Zwahlen M. A
meta-analysis of the prevalence of dental agenesis of permanent •›•–‡ƒ–‹…”‡˜‹‡™‘ˆ–Š‡•—”˜‹˜ƒŽƒ†…‘’Ž‹…ƒ–‹‘”ƒ–‡•‘ˆϐ‹š‡†
teeth. o—n‹–›Ǥ ‡n–Ǥ ”ƒŽǤ E’‹†‡‹oŽǤǡʹͲͲͶǢ͵ʹȋ͵Ȍǣʹͳ͹Ǧʹʹ͸Ǥ partial dentures (FPDs) after an observation period of at least 5
18. Terheyden H., Wüsthoff F. Occlusal rehabilitation in patients with ›‡ƒ”•Ǥ Ǥ ‘„‹‡† –‘‘–Š Ȃ ‹’Žƒ–Ǧ•—’’‘”–‡† •Ǥ Ž‹nǤ ”ƒŽǤ
congenitally missing teeth-dental implants, conventional pros- I’Žƒn–•Ǥ ‡•ǤǡʹͲͲͶǢͳͷȋ͸Ȍǣ͸Ͷ͵Ǧ͸ͷ͵Ǥ
thetics, tooth autotransplants, and preservation of deciduous 38. Pjetursson B., Brägger U., Lang N., Zwahlen M. Comparison of
–‡‡–ŠȂƒ•›•–‡ƒ–‹…”‡˜‹‡™ǤIn–Ǥ Ǥ I’Žƒn–Ǥ ‡n–ǤǡʹͲͳͷǢͳȋͳȌǣ͵ͲǤ •—”˜‹˜ƒŽ ƒ† …‘’Ž‹…ƒ–‹‘ ”ƒ–‡• ‘ˆ –‘‘–ŠǦ•—’’‘”–‡† ϐ‹š‡† †‡-
19. Patel J., Vohra M., Hussain J. Assessment of partially edentulous tal prostheses (FDPs) and implant-supported FDPs and single
’ƒ–‹‡–• „ƒ•‡† ‘ ‡‡†›ǯ• …Žƒ••‹ϐ‹…ƒ–‹‘ ƒ† ‹–• ”‡Žƒ–‹‘ ™‹–Š crowns (SCs). Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͲ͹Ǣͳͺ—’’Ž͵ǣͻ͹Ǧͳͳ͵Ǥ
gender predilection. In–Ǥ Ǥ Sc‹Ǥ S–—†›ǡʹͲͳͶǢʹȋ͸Ȍǣ͵ʹǦ͵͸Ǥ 39. Pjetursson B., Brägger U., Lang N. ‡– ƒŽǤ Comparison of survival
ʹͲǤŠ‘—†Šƒ”› Ǥǡ —ƒ” Ǥǡ ‹ Ǥǡ ƒŽ‹ Ǥ ‡‡†›ǯ• …Žƒ••‹ϐ‹…ƒ- ƒ†…‘’Ž‹…ƒ–‹‘”ƒ–‡•‘ˆ–‘‘–ŠǦ•—’’‘”–‡†ϐ‹š‡††‡–ƒŽ’”‘•–Š‡-
–‹‘ Ȃ ƒ •–—†› †‘‡ ƒ– †‘™ –‡”ƒ–‹‘ƒŽ ‡–ƒŽ ‘•’‹–ƒŽǤ Pƒ‹Ǧ ses (FDPs) and implant-supported FDPs and single crowns (SCs).
•–ƒnǤ ”ƒŽǤ ‡n–ƒŽǤ ǤǡʹͲͳ͸Ǣ͵͸ȋͶȌǣ͸͹͹Ǧ͸͹ͻǤ Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͲ͹Ǣͳͺ—’’Ž͵ǣͻ͹Ǧͳͳ͵Ǥ
ʹͳǤ ”‹„‡”‰Ǥ‘‡ƒ—‰‡–ƒ–‹‘ˆ‘”•‹‰Ž‡–‘‘–Š‹’Žƒ–•ǣƒ”‡˜‹‡™ 40. Pjetursson B., Tan K., Lang N. ‡– ƒŽǤ A systematic review of the sur-
of the literature. E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤǡʹͲͳ͸Ǣͻ—’’Žͳǣͳʹ͵Ǧͳ͵ͶǤ ˜‹˜ƒŽƒ†…‘’Ž‹…ƒ–‹‘”ƒ–‡•‘ˆϐ‹š‡†’ƒ”–‹ƒŽ†‡–—”‡•ȋ •Ȍƒˆ–‡”
22. Bäumer A., Pretzl B., Cosgarea R. ‡– ƒŽǤ Tooth loss in aggressive an observation period of at least 5 years. I. Implant-supported
’‡”‹‘†‘–‹–‹• ƒˆ–‡” ƒ…–‹˜‡ ’‡”‹‘†‘–ƒŽ –Š‡”ƒ’›ǣ ’ƒ–‹‡–Ǧ”‡Žƒ–‡† FPDs. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͲͶǢͳͷȋ͸Ȍǣ͸ʹͷǦ͸ͶʹǤ
and tooth-related prognostic factors. Ǥ Ž‹nǤ P‡”‹o†on–oŽ., 2011; 41. Pjetursson B., Thoma D., Jung R., Zwahlen M., Zembic A. A system-
͵ͺȋ͹Ȍǣ͸ͶͶǦ͸ͷͳǤ atic review of the survival and complication rates of implant-sup-
23. Abdel-Rahman H., Tahir C., Saleh M. Incidence of partial edentu- ’‘”–‡† ϐ‹š‡† †‡–ƒŽ ’”‘•–Š‡•‡• ȋ •Ȍ ƒˆ–‡” ƒ ‡ƒ ‘„•‡”˜ƒ–‹‘
lism and its relation with age and gender. ZƒncoǤ Ǥ ‡†Ǥ Sc‹., 2013; period of at least 5 years. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•Ǥ, 2012; 23 Suppl
ͳ͹ȋʹȌǣͶ͸͵ǦͶ͹ͲǤ ͸ǣʹʹǦ͵ͺǤ
24. Natto Z., Aladmawy M., Alasqah M., Papas A. Factors contributing 42. Jung R., Pjetursson B., Glauser R. ‡– ƒŽǤ A systematic review of the
–‘–‘‘–ŠŽ‘••ƒ‘‰–Š‡‡Ž†‡”Ž›ǣƒ…”‘•••‡…–‹‘ƒŽ•–—†›ǤS‹n‰ƒ’o”‡Ǥ 5-year survival and complication rates of implant-supported sin-
‡n–Ǥ ǤǡʹͲͳͶǢ͵ͷǣͳ͹ǦʹʹǤ gle crowns. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͲͺǢͳͻȋʹȌǣͳͳͻǦͳ͵ͲǤ
ʹͷǤڐ‹‰ ǤǡŽƒ‰ƒǤǡòŠŽ‹‰Ǥ‡– ƒŽǤ Tooth loss and pocket prob- 43. Pjetursson B., Tan K., Lang N. ‡– ƒŽǤ A systematic review of the sur-
‹‰ †‡’–Š• ‹ …‘’Ž‹ƒ– ’‡”‹‘†‘–ƒŽŽ› –”‡ƒ–‡† ’ƒ–‹‡–•ǣ ƒ ”‡–”‘- ˜‹˜ƒŽƒ†…‘’Ž‹…ƒ–‹‘”ƒ–‡•‘ˆϐ‹š‡†’ƒ”–‹ƒŽ†‡–—”‡•ȋ •Ȍƒˆ–‡”
spective analysis. Ǥ Ž‹nǤ P‡”‹o†on–oŽǤǡʹͲͲʹǢʹͻȋͳʹȌǣͳͲͻʹǦͳͳͲͲǤ an observation period of at least 5 years. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•Ǥ,
26. Marcus S., Drury T., Brown L., Zion G. Tooth retention and tooth ʹͲͲͶǢͳͷȋ͸Ȍǣ͸͸͹Ǧ͸͹͸Ǥ
Ž‘•• ‹ –Š‡ ’‡”ƒ‡– †‡–‹–‹‘ ‘ˆ ƒ†—Ž–•ǣ ‹–‡† –ƒ–‡•ǡ ͳͻͺͺǦ 44. Tan K., Pjetursson B., Lang N., Chan E. A systematic review of the
1991. Ǥ ‡n–Ǥ ‡•Ǥǡͳͻͻ͸Ǣ͹ͷ’‡…‘ǣ͸ͺͶǦ͸ͻͷǤ •—”˜‹˜ƒŽƒ†…‘’Ž‹…ƒ–‹‘”ƒ–‡•‘ˆϐ‹š‡†’ƒ”–‹ƒŽ†‡–—”‡•ȋ •Ȍ
ʹ͹Ǥ‘ƒ•‹Ǥǡ‡•–”ڏ Ǥǡ‡”‰Ž—†ŠǤ‘‰‡˜‹–›‘ˆ–‡‡–Šƒ†‹- after an observation period of at least 5 years. III. Conventional
’Žƒ–•Ȃƒ•›•–‡ƒ–‹…”‡˜‹‡™Ǥ Ǥ ”ƒŽǤ ‡Šƒ„‹ŽǤǡʹͲͲͺǢ͵ͷ—’’Žͳǣ FPDs. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͲͶǢͳͷȋ͸Ȍǣ͸ͷͶǦ͸͸͸Ǥ
23-32. ͶͷǤ
‘‘†ƒ…”‡Ǥǡƒ›Ž‘”Ǥ‹‰Ž‡‹’Žƒ–ƒ†…”‘™˜‡”•—•ϐ‹š‡†’ƒ”-
28. Hemmings K., Harrington Z. Replacement of missing teeth with –‹ƒŽ†‡–—”‡ǣƒ…‘•–Ǧ„‡‡ϐ‹–ǡ’ƒ–‹‡–Ǧ…‡–”‡†ƒƒŽ›•‹•ǤE—”Ǥ Ǥ ”ƒŽǤ
ϐ‹š‡†’”‘•–Š‡•‡•Ǥ‡n–Ǥ ’†ƒ–‡ǡʹͲͲͶǢ͵ͳȋ͵Ȍǣͳ͵͹ǦͳͶͳǤ I’Žƒn–oŽǤǡʹͲͳ͸Ǣͻ—’’ŽͳǣͷͻǦ͸ͺǤ
29. Cosyn J., Raes S., De Meyer S. ‡– ƒŽǤ An analysis of the decision- Ͷ͸Ǥ‡‹Ž‡”Ǥǡ Ž‡‹‰Ǥ…‘•‡•—•…‘ˆ‡”‡…‡ǣ‡…‘‘‹…‡˜ƒŽ-
making process for single implant treatment in general practice. uation of implant-supported prostheses. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•Ǥ,
Ǥ Ž‹nǤ P‡”‹o†on–oŽǤǡʹͲͳʹǢ͵ͻȋʹȌǣͳ͸͸Ǧͳ͹ʹǤ ʹͲͳͷǢʹ͸—’’Žͳͳǣͷ͹Ǧ͸͵Ǥ
30. 30.Karl M. Outcome of bonded vs all-ceramic and metal- ceramic 47. Pjetursson B., Zwahlen M., Lang N. Quality of reporting of clinical
ϐ‹š‡†’”‘•–Š‡•‡•ˆ‘”•‹‰Ž‡–‘‘–Š”‡’Žƒ…‡‡–ǤE—”Ǥ Ǥ ”ƒŽǤ I’ŽƒnǦ studies to assess and compare performance of implant-support-
–oŽǤǡʹͲͳ͸Ǣͻ—’’ŽͳǣʹͷǦͶͶǤ ed restorations. Ǥ Ž‹nǤ P‡”‹o†on–oŽǤǡʹͲͳʹǢ͵ͻ—’’Žͳʹǣͳ͵ͻǦͳͷͻǤ
31. 31.Sghaireen M., Al-Omiri M. Relationship between impact of 48. Moy P., Nishimura G., Pozzi A. ‡– ƒŽǤ Single implants in dorsal areas
ƒš‹ŽŽƒ”›ƒ–‡”‹‘”ϐ‹š‡†’”‘•–Š‘†‘–‹…”‡Šƒ„‹Ž‹–ƒ–‹‘‘†ƒ‹Ž›Ž‹˜- Ȃ ƒ •›•–‡ƒ–‹… ”‡˜‹‡™Ǥ E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤǡ ʹͲͳ͸Ǣ ͻ —’’Ž ͳǣ
‹‰ǡ•ƒ–‹•ˆƒ…–‹‘ǡƒ†’‡”•‘ƒŽ‹–›’”‘ϐ‹Ž‡•Ǥ Ǥ P”o•–Š‡–Ǥ ‡n–Ǥ, 2016; S163-172.
ͳͳͷȋʹȌǣͳ͹ͲǦͳ͹͸Ǥ 49. Scheuber S., Hicklin S., Brägger U. Implants versus short-span
32. Torabinejad M., Landaez M., Milan M., Sun C., Henkin J., Al-Ardah ϐ‹š‡† „”‹†‰‡•ǣ •—”˜‹˜ƒŽǡ …‘’Ž‹…ƒ–‹‘•ǡ ’ƒ–‹‡–•ǯ „‡‡ϐ‹–•Ǥ  •›•-
A. ‡– ƒŽǤ Tooth retention through endodontic microsurgery or tematic review on economic aspects. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•Ǥ,
–‘‘–Š”‡’Žƒ…‡‡–—•‹‰•‹‰Ž‡‹’Žƒ–•ǣƒ•›•–‡ƒ–‹…”‡˜‹‡™‘ˆ ʹͲͳʹǢʹ͵—’’Ž͸ǣͷͲǦ͸ʹǤ
treatment outcomes. Ǥ En†o†ǤǡʹͲͳͷǢͶͳȋͳȌǣͳǦͳͲǤ ͷͲǤŽǦ—”ƒ ǤǡŽǦ
ŠƒŽƒ›‹‹ǤǡŽǦ—ǯ„‹Ǥ‹‰Ž‡Ǧ–‘‘–Š”‡’Žƒ…‡‡–ǣ
33. Hjalmarsson L., Gheisarifar M., Jemt T. A systematic review of sur- factors affecting different prosthetic treatment modalities. B
vival of single implants as presented in longitudinal studies with ”ƒŽǤ ‡ƒŽ–ŠǤǡʹͲͳͳǢͳͳǣ͵ͶǤ
a follow-up of at least 10 years. E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤ, 2016; 9 ͷͳǤ‡„‡ŽǤǡ
ƒŒŒƒ”Ǥǡ‘ˆ•–‡†‡Ǥ‹‰Ž‡Ǧ–‘‘–Š”‡’Žƒ…‡‡–ǣ„”‹†‰‡
—’’ŽͳǣͳͷͷǦͳ͸ʹǤ vs. implant-supported restoration. Ǥ ƒnǤ ‡n–Ǥ ••ocǤǡ 2000; 66
34. Lutz R., Neukam F., Simion M., Schmitt C. Long-term outcomes of ȋͺȌǣͶ͵ͷǦͶ͵ͺǤ
„‘‡ƒ—‰‡–ƒ–‹‘‘•‘ˆ–ƒ†Šƒ”†Ǧ–‹••—‡•–ƒ„‹Ž‹–›ǣƒ•›•–‡ƒ–‹… 52. Petricevic N., Celebic A., Rener-Sitar K. A 3-year longitudinal
review. Ž‹nǤ ”ƒŽǤ I’Žƒn–•Ǥ ‡•ǤǡʹͲͳͷǢʹ͸—’’ŽͳͳǣͳͲ͵ǦͳʹʹǤ study of quality-of-life outcomes of elderly patients with implant-
35. Foundation for Oral Rehabilitation (FOR) consensus text on ǷŠ‡ ƒ† –‘‘–ŠǦ•—’’‘”–‡† ϐ‹š‡† ’ƒ”–‹ƒŽ †‡–—”‡• ‹ ’‘•–‡”‹‘” †‡–ƒŽ
‡Šƒ„‹Ž‹–ƒ–‹on oˆ ‹••‹n‰ S‹n‰Ž‡ ‡‡–Šdz. E—”Ǥ Ǥ ”ƒŽǤ I’Žƒn–oŽǤ, regions.
‡”o†on–oŽo‰›ǡʹͲͳʹǢʹͻȋʹȌǣ‡ͻͷ͸Ǧͻ͸͵Ǥ
ʹͲͳ͸Ǣͻ—’’Žͳǣͳ͹͵Ǧͳ͹ͺǤ
36. Pjetursson B., Lang N. Prosthetic treatment planning on the basis
‘ˆ•…‹‡–‹ϐ‹…‡˜‹†‡…‡Ǥ Ǥ ”ƒŽǤ ‡Šƒ„‹ŽǤǡʹͲͲͺǢ͵ͷ—’’Žͳǣ͹ʹǦ͹ͻǤ
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Morbid obesity with
respiratory manifestations
Victor Botnaru1, Alexandru Corlateanu1, Victoria Sircu1*,
Eugenia Scutaru1, Serghei Covantev1
1
‹˜‹•‹on oˆ ’n‡—oŽo‰› ƒn† ƒŽŽ‡”‰oŽo‰›ǡ ‡’ƒ”–‡n– oˆ ‹n–‡”nƒŽ ‡†‹c‹n‡ǡ
‹coŽƒ‡ ‡•–‡‹ìƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›ǡ Š‹•‹nƒ—ǡ
‡’—„Ž‹c oˆ oŽ†o˜ƒǤ
ƒ—•…”‹’–”‡…‡‹˜‡†‘ǣͲͶǤͲ͸ǤʹͲͳͺ
……‡’–‡†ˆ‘”’—„Ž‹…ƒ–‹‘‘ǣͲ͵ǤͲͻǤʹͲͳͺ
Corresponding author:
”Ǥ ‹c–o”‹ƒ S‹”c—
‹˜‹•‹on oˆ ’n‡—oŽo‰› ƒn† ƒŽŽ‡”‰oŽo‰›
‡’ƒ”–‡n– oˆ In–‡”nƒŽ ‡†‹c‹n‡
‹coŽƒ‡‡•–‡‹–ƒn— S–ƒ–‡ n‹˜‡”•‹–› oˆ ‡†‹c‹n‡ ƒn† PŠƒ”ƒc›
1ͼͻǡ S–‡ˆƒn c‡Ž ƒ”‡ •‹ Sˆƒn– ƒ˜‡Ǥǡ Š‹•‹nƒ—ǡ ‡’—„Ž‹c oˆ oŽ†o˜ƒǡ Ǧ͸ͶͶͺ
‡Ǧƒ‹Ž: •‹”c—Ǥ˜‹c–o”‹ƒ̻›ƒŠooǤco
Male patient, age 44, university professor, non-smoker,
presents pronounced dyspnea on exertion, at minimal effort,
orthopnea, choking during sleep, loud snoring during sleep,
breathing pauses during sleep reported by his wife, insomnias
during night, nocturia 4-5 times/night, nocturnal xerosto-
mia, nocturnal sweating, morning headache, fatigue, daytime
sleepiness and high blood pressure.
Patient mentions snoring for approximately 20 years, dur-
ing this period he added over 170 kg of weight, the last 8 years
he sleeps in half-seated position, hypertension for 16 years,
–›’‡ʹ†‹ƒ„‡–‡•‡ŽŽ‹–—•ˆ‘”ͺ›‡ƒ”•ǡ–”‡ƒ–‡†™‹–Š‡–ˆ‘”‹ǣ
glycated hemoglobin 7,5%.
‘”„‹†£ȋƒ•ƒαʹ͸ͷ‰ǡÁƒŽì‹‡ƒαͳͺʹ…ǡαͺͲ‰Ȁ2, Physical examination revealed male with morbid obesity
…‹”…—ˆ‡”‹ìƒ ‰Ÿ–—Ž—‹ α ͸Ͳ …ǡ …‹”…—ˆ‡”‹ìƒ ƒ„†‘‡—Ž—‹
α ͳͻͲ …Ȍǡ …— –‡‰—‡–‡ ’ƒŽ‹†‡ǡ ‡†‡‡ ‰ƒ„‹‡”‡ •‹‡–”‹…‡
’”‘—ìƒ–‡ǡ‘†‹ϐ‹…£”‹–”‘ϐ‹…‡ǡ…—’”‡œ‡ìƒ—Ž…‡”‡Ž‘”Á”‡‰‹—-
nea gambelor, bilateral (Figura 1). Este hipertensiv (200/110
mmHg), tahicardic (96 bpm), tahipneic (22 rpm), SaO2 70%
ȋˆ£”£•—’‘”–†‡‘š‹‰‡ȌǤ
—•…—Ž–ƒ–‹˜ǡ’”‡œ‹–£—”—”˜‡œ‹…—Žƒ”†‹‹—ƒ–ǡœ‰‘‘-
–‡Ž‡…ƒ”†‹ƒ…‡”‹–‹…‡ǡƒ–‡—ƒ–‡Ǥ„†‘‡—Ž£”‹–Á˜‘Ž—†‹
…‘–—Ž쇕—–—Ž—‹ƒ†‹’‘•ǡ‹†‘Ž‘”Žƒ’ƒŽ’ƒ”‡Ǥ…‘”—ŽƒŽŽƒ’ƒ–‹
ȋ™‡‹‰Š–αʹ͸ͷ‰ǡŠ‡‹‰Š–αͳͺʹ…ǡαͺͲ‰Ȁ2, neck cir-
…—ˆ‡”‡…‡ α ͸Ͳ …ǡ ƒ„†‘‹ƒŽ …‹”…—ˆ‡”‡…‡ α ͳͻͲ …Ȍǡ
pale skin, pronounced bilateral peripheral edema, trophic
changes with the presence of ulcers bilaterally on legs (Figure
1). He presents hypertension (200/100 mmHg), tachycardia
(96 bpm), tachypnea (22 bpm), SaO2 70% (without oxygen
support).
—”‹‰ ƒ—•…—Ž–ƒ–‹‘ Ȃ ”‡†—…‡† ˜‡•‹…—Žƒ” „”‡ƒ–Š •‘—†•ǡ
rhythmic and attenuated heart sound. Abdomen increased in
Ȃ…Žƒ•ƒǡ‹ƒ”•…‘”—Ž’™‘”–Š’‡–”—ƒ’”‡…‹‡”‡ƒ•‘‘Ž‡ì‡‹ volume from the adipose tissue, no pain during palpation. The
diurne a fost evaluat cu 16 puncte. Mallampati score was IV and Epworth Sleepiness Scale was 16
ƒ†‹‘‰”ƒϐ‹ƒ–‘”ƒ…‹…£‘”ƒŽ£ǡ
…—•‡‡†‡•—’”ƒ•‘Ž‹- points.
…‹–ƒ”‡ƒ˜‡–”‹…—Ž—Ž—‹†”‡’–Ǥ…‘
‡˜‹†‡ì‹ƒœ£†‹Žƒ–ƒ”‡ƒ‘- Chest X-ray was normal, ECG revealed signs of right ven-
†‡”ƒ–£ƒƒ„‡Ž‘”ƒ–”‹‹ǡˆ”ƒ…싃†‡‡Œ‡…싇•…£œ—–£ȋͶͳΨȌǡ˜‡- tricular strain. The EchoCG revealed moderate dilation of both
–”‹…—Ž—Ž †”‡’– ȋȌ †‹Žƒ–ƒ– —Ž– è‹ Š‹’‡”–‡•‹—‡ ’—Ž‘ƒ”£ atria, reduced ejection fraction (41%), severe right ventricle
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šƒ‡—Žˆ—…ì‹‘ƒŽƒ–‡•–£ǣ†‡͸ʹΨǡ ͷͲΨǡ‹†‹…‡Ž‡ monary artery systolic pressure 49 mm Hg). Spirometry at-
o”„‹† o„‡•‹–› ™‹–Š ”‡•’‹”ƒ–o”› ƒn‹ˆ‡•–ƒ–‹on• MJHS 17(3)/2018 91

Tiffeneau 79%, iar gazimetria sângelui arterial pune în evi- –‡•–• ͳ Ȃ ͸ʹΨǢ  Ȃ ͷͲΨǢ ‹ˆˆ‡‡ƒ— ‹†‡š Ȃ ͹ͻΨǡ ƒ†
†‡ì£‘Š‹’‘š‡‹‡…—Š‹’‡”…ƒ’‹‡—葃”£ȋ’α͹ǡͶ͵ǡƒ2αͷͲ arterial blood gases values highlights hypoxemia and mild hy-
mmHg, PaCO2αͷͺ‰ȌǤ ’‡”…ƒ’‹ƒȋ’α͹ǡͶ͵Ǣƒ2αͷͲ‰Ǣƒ2αͷͺ‰ȌǤ

B–”‡„£”‹ǣ Questions:
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‘•–‹…†‹ˆ‡”‡ì‹ƒŽǤ tial diagnosis.
͵Ȍƒ”‡‡•–‡–”ƒ–ƒ‡–—Žƒ…‡•–‡‹ƒŽƒ†‹‹ǫ ͵ȌŠƒ–‹•–Š‡–”‡ƒ–‡–‘ˆ–Š‹•†‹•‡ƒ•‡ǫ

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piratorii au fost înregistrate mai multe apnei cu durata peste 10 secunde,
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–”ƒ‹Ž –Š‡”‡ ™‡”‡ ”‡‰‹•–‡”‡† o”‡ ƒ’n‡ƒǡ o˜‡” 1Ͷ •‡con†•ǡ ƒcco’ƒn‹‡† „›
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Fig. 1 ƒ…‹‡–—ŽǤ‡‘–ƒ–‘„‡œ‹–ƒ–‡ƒ‘”„‹†£ç‹‰Ÿ–—Ž•…—”–ǡ
’‡‡„”‡Ž‡‹ˆ‡”‹‘ƒ”‡Ȃ•…Š‹„£”‹–”‘ϐ‹…‡Ǥ
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–”o’Š‹c cŠƒn‰‡• on Žo™‡” Ž‹„•Ǥ

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‹‰Ǥ͵Evaluarea terapiei cu BiPAP 17/11 cm H2O la 3 luni (evaluarea masei corporale.
…‘’Ž‹ƒì‡‹’ƒ…‹‡–—Ž—‹ȌǤ Fig. 4 Pƒ–‹‡n– ƒˆ–‡” on‡ ›‡ƒ” oˆ –”‡ƒ–‡n–Ǥ o „‡ no–‡† „o†›
Fig. 3 B‹PP 1ͽȀ11 c ͸ –Š‡”ƒ’› ‡˜ƒŽ—ƒ–‹on ƒˆ–‡” ͹ on–Š• ™‡‹‰Š– Žo••Ǥ
ȋƒ••‡••‹n‰ ’ƒ–‹‡n– co’Ž‹ƒnc‡ȌǤ
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mul de apnee în somn de tip obstructiv (SASO); (2) sindromul
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†”‡ƒ’–£Ǥ
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–‡†‡’ƒ”–‡‡”Ȍǡ•—‰‡”‡ƒœ£†‹ƒ‰‘•–‹…—Ž†‡Ǥ—Ž†‹–”‡
…‡‹ƒ‹‹’‘”–ƒì‹ˆƒ…–‘”‹†‡”‹•…’‡–”—‡•–‡…”‡è–‡”‡ƒ
’‘†‡”ƒŽ£Ǥ‡”‡‰—Ž£ǡ’ƒ…‹‡ì‹‹’”‡œ‹–£…‘‘”„‹†‹–£ì‹…ƒ”†‹‘-
˜ƒ•…—Žƒ”‡è‹‡–ƒ„‘Ž‹…‡ƒ•‘…‹ƒ–‡Ǥ
 ‡•–‡ ‘ ƒˆ‡…ì‹—‡ǡ Á …ƒ”‡ — ’ƒ…‹‡– •—’”ƒ’‘†‡”ƒŽ
— ”‡—è‡è–‡ •£ ”‡•’‹”‡ Á ‘† ƒ†‡…˜ƒ– Á –‹’—Ž •‘—Ž—‹ǡ
…ƒ—œŸ† Š‹’‘š‹‡ è‹ Š‹’‡”…ƒ’‹‡Ǥ ‡è‹  ’‘ƒ–‡ ϐ‹ ‘ ‡–‹–ƒ–‡
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adeseori, SOH se suprapune cu SASO. Simptomele sunt simi-
Žƒ”‡ …— …‡Ž‡ †‹ ǡ ‹ƒ” †‹ˆ‡”‡ìƒ ‡•–‡ ‘„•‡”˜ƒ–£ Á –‹’—Ž
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— †‹ƒ‰‘•–‹… †‡ ‡š…Ž—†‡”‡ǡ ’”‹ —”ƒ”‡ǡ –”‡„—‹‡ ‡˜ƒŽ—ƒ–‡ è‹
„‡œ‹–ƒ–‡ƒ o”„‹†£ c— ƒn‹ˆ‡•–£”‹ ”‡•’‹”ƒ–o”‹‹
Answers:
ͳȌŠ‡†‹ˆˆ‡”‡–‹ƒŽ†‹ƒ‰‘•‹••Š‘—Ž†‹…Ž—†‡ǣȋͳȌ‘„•–”—…-
tive sleep apnea syndrome (OSAS); (2) obesity hypoventila-
tion syndrome (OHS); (3) right heart failure. Patients with
decreased quality of sleep, snoring, tiredness during the day
and evidence of apneas during sleep (observed by the part-
ner) indicate a possible diagnosis of OSAS. One of the most
important risk factors for OSAS is increased weight.
Patients often have multiple cardiovascular and metabolic
comorbidities. OHS is a condition when an overweight patient
fails to breathe adequately during sleep, thus resulting in hy-
poxia and hypercapnia. Although, it can be a separate entity
patients frequently have episodes of apnea. Thus, most com-
monly OHS overlaps with OSAS. The symptoms are similar to
OSAS and the difference is usually seen during polysomnogra-
phy or cardiorespiratory polygraphy. OHS is a diagnosis of ex-
clusion and other conditions that can cause hypoventilation
should be evaluated.
ʹȌ‹•†‡ϐ‹‡†„›–Š‡ƒ••‘…‹ƒ–‹‘‘ˆ‘„‡•‹–›ȋη͵Ͳ
ƒŽ–‡…‘†‹ì‹‹…‡’‘–†‡–‡”‹ƒŠ‹’‘˜‡–‹Žƒì‹ƒǤ
kg/m2) with alveolar hypoventilation and awake daytime hy-
ʹȌ‡•–‡†‡ϐ‹‹–’”‹ƒ•‘…‹‡”‡ƒ‘„‡œ‹–£ì‹‹ȋη͵Ͳ‰Ȁ
percapnia (PaCO2ηͶͷ‰ǡƒ2 <70 mm Hg). OSAS is de-
m2Ȍ…—Š‹’‘˜‡–‹Žƒì‹ƒƒŽ˜‡‘Žƒ”£ǡÁ•‘ì‹–£†‡Š‹’‡”…ƒ’‹‡Á–‹-
ϐ‹‡†„›–Š‡—„‡”‘ˆ”‡•’‹”ƒ–‘”›‡˜‡–•ȋƒ’‡ƒǡŠ›’‘’‡ƒȌ
pul zilei (PaCO2ηͶͷ‰ǡƒ2δ͹Ͳ‰ȌǤ‡•–‡†‡ϐ‹-
ηͷ’‡” Š‘—” ȋƒ’‡ƒȀŠ›’‘’‡ƒ ‹†‡š Ȃ ȌǤ  ‹• ƒ••‘…‹-
‹–’”‹’”‡œ‡ìƒ—£”—Ž—‹†‡‡˜‡‹‡–‡”‡’‹”ƒ–‘”‹‹ȋƒ’‡‹ǡ
ated with OHS in about 90% of cases.
Š‹’‘’‡‹Ȍηͷ’‡‘”£ȋ‹†‹…‡Ž‡†‡ƒ’‡‡ȀŠ‹’‘’‡‡ȂȌǤ
•‡ƒ•‘…‹ƒœ£…—Áƒ’”‘š‹ƒ–‹˜ͻͲΨ†‹…ƒœ—”‹Ǥ‹•–ƒ†‡†‹-
ƒ‰‘•–‹…†‹ˆ‡”‡ì‹ƒŽƒŽ’‘ƒ–‡‹…Ž—†‡ǣƒˆ‡…ì‹—‹Ž‡‘„•–”—…-
–‹˜‡•‡˜‡”‡ǡ„‘Ž‹Ž‡’—Ž‘ƒ”‡‹–‡”•–‹ì‹ƒŽ‡ƒ˜ƒ•ƒ–‡ǡ†‡ˆ‘”ƒì‹‹
•‡˜‡”‡ƒŽ‡’‡”‡–‡Ž—‹–‘”ƒ…‹…ȋ†‡‡š‡’Ž—ǡ…‹ˆ‘•…‘Ž‹‘œ£ȌǡŠ‹’‘–‹-
roidismul sever, boli neuromusculare, sindromul de hipoven-
–‹Žƒì‹‡…‘‰‡‹–ƒŽ£ȋ”ƒ”‹•‹ȌǤ
͵Ȍ”ƒ–ƒ‡–—Ž‹…Ž—†‡˜‡–‹Žƒì‹ƒ‡‹˜ƒœ‹˜£ǡ…Š‹”—”‰‹ƒ
„ƒ”‹ƒ–”‹…£è‹ƒƒ‰‡‡–—Ž…‘‘”„‹†‹–£ì‹Ž‘”Ǥ‡”ƒ’‹ƒ…—
͵ȌŠ‡Ž‹•–‘ˆ†‹ˆˆ‡”‡–‹ƒŽ†‹ƒ‰‘•‹•ƒ›‹…Ž—†‡ǣ•‡-
vere obstructive respiratory diseases, severe interstitial lung
disease, severe chest-wall disorders (e.g., kyphoscoliosis),
severe hypothyroidism, neuromuscular disease, congenital
hypoventilation syndrome (extremely rare).
4) The treatment of OHS includes non-invasive ventilation,
bariatric surgery and management of comorbidities. CPAP
can be initiated in order to eliminate obstructive panes and
’‘ƒ–‡ϐ‹‹‹ì‹ƒ–£’‡–”—ƒ‡Ž‹‹ƒ‡˜‡‹‡–‡Ž‡‘„•–”—…–‹˜‡è‹
Ž‹‹–£”‹Ž‡ϐŽ—š—Ž—‹Ǥƒ…£ƒ2•‡‡ì‹‡•—„ͻͲΨ’‡–”—ƒ‹
mult de 20% din durata somnului, pe fundal de CPAP, sau pa-
cientul este intolerant la o presiune mai mare pe CPAP (14 cm
H2Ȍǡ ‡…‡•ƒ”£ ’‡–”— ƒ ÁŽ£–—”ƒ ƒ’‡‡Ž‡ȀŠ‹’‘’‡‡Ž‡ǡ ƒ–—…‹
ϐŽ‘™Ž‹‹–ƒ–‹‘•Ǥˆ–Š‡ƒ2 is below 90% for longer than 20%
of the sleep time on the background of CPAP or the patient
is intolerant to a greater CPAP pressure (14 cm H2O) needed
to remove the apnea/hypopnea, then the patient should be
switched to bi-PAP. The difference between IPAP and EPAP
•‡ —–‹Ž‹œ‡ƒœ£ ‹Ǧ—ŽǤ ‹ˆ‡”‡ìƒ †‹–”‡  è‹  –”‡„—‹‡
•£ ϐ‹‡ǡ †‡ …‡Ž ’—싐ǡ ͺǦͳͲ … 2Ǥ ƒ…£ •ƒ–—”ƒì‹ƒ •‡ ‡ì‹‡
•—„ͻͲΨǡ‡•–‡‡…‡•ƒ”£ƒ•‘…‹‡”‡ƒ‘š‹‰‡‘–‡”ƒ’‹‡‹Ǥ—’£…‡’ƒ-
cientul este stabilizat, acesta va necesita un tratament supli-
‡–ƒ”ǡ’‡–”—…‘”‹Œƒ”‡ƒ‰”‡—–£ì‹‹…‘”’—Ž—‹è‹…‘‘”„‹†‹–£ì‹Ž‘”Ǥ
Comentarii
Pacientul a fost diagnosticat cu SOH conform rezultatelor
’‘Ž‹‰”ƒϐ‹‡‹ …ƒ”†‹‘”‡•’‹”ƒ–‘”‹‹ è‹ Ǣ ƒ…‡ƒ•–ƒ ‡•–‡ ‘ …‘†‹ì‹‡ǡ
ƒ†‡•‡‘”‹ǡ‰”‡è‹–†‹ƒ‰‘•–‹…ƒ–£Ǥ’”‡œ‹–£•‡‡è‹•‹’–‘-
me complexe, cu IMC <40 kg/m2, PaCO2δͶͷ‰è‹†‹•ˆ—…-
싇—Ž–‹’Ž£†‡‘”‰ƒ‡ȏͳǡʹȐǤƒ…‹‡ì‹‹•—–‹–‡”ƒì‹Á•’‹–ƒŽ
…—‹•—ϐ‹…‹‡ì£”‡•’‹”ƒ–‘”‹‡Š‹’‡”…ƒ’‹…£è‹—苔†‡…‘‘”„‹-
†‹–£ì‹ǣ †‹ƒ„‡– œƒŠƒ”ƒ– †‡ –‹’ ʹǡ •‹†”‘ ‡–ƒ„‘Ž‹…ǡ †‹•ˆ—…싇
…ƒ”†‹ƒ…£ǡŠ‹’‡”–‡•‹—‡’—Ž‘ƒ”£è‹‹ϐŽƒƒì‹‹•‹•–‡‹…‡ȏͳȐǤ
„‡œ‹–ƒ–‡ƒ‘”„‹†£…—ƒ‹ˆ‡•–£”‹”‡•’‹”ƒ–‘”‹‹‡•–‡ǡƒ†‡-
•‡ƒǡ†‹ƒ‰‘•–‹…ƒ–£‡”‘ƒ–…ƒƒ•–„”‘è‹…•ƒ—ǡ†‡è‹—
†‹ƒ‰‘•–‹… ƒŽ  è‹ ƒŽ  •‡ ’‘ƒ–‡ …‘–—”ƒ …— ƒ”‡ ’”‘-
should be at least 8-10 cm H2O. If the SaO2 is still below 90%
then supplemental O2 is required. After the patient is stabi-
lized he will require further treatment for correcting weight
and comorbidities.
Comments
The patient was diagnosed with OHS based on cardiore-
spiratory polygraphy and acid-base balance. It is a frequently
misdiagnosed condition. It presents complex signs and symp-
toms with a BMI <40 kg/m2, a PaCO2 <45 mm Hg and multiple
organ dysfunction [1, 2]. The patients are typically admitted to
the hospital with hypercapnic respiratory failure and a list of
comorbid conditions which include type 2 diabetes, metabolic
syndrome, cardiac dysfunction, pulmonary hypertension, and
‡˜‹†‡…‡‘ˆ•›•–‡‹…‹ϐŽƒƒ–‹‘ȏʹȐǤ
The morbid obesity with respiratory issues is often misdi-
agnosed as asthma or COPD, although a diagnosis of obstruc-
tive sleep apnea and obesity hypoventilation syndrome is
o”„‹† o„‡•‹–› ™‹–Š ”‡•’‹”ƒ–o”› ƒn‹ˆ‡•–ƒ–‹on• MJHS 17(3)/2018 93

„ƒ„‹Ž‹–ƒ–‡ †‘ƒ” Á „ƒœƒ –ƒ„Ž‘—Ž—‹ …Ž‹‹…Ǥ ”‹ —”ƒ”‡ǡ ‡š‹•–£ǡ more likely due to the clinical picture. Therefore there is often
—‡‘”‹ǡ‘Ž‹’•£†‡…‘è–‹‡–‹œƒ”‡ƒƒ…‡•–‡‹ƒˆ‡…ì‹—‹Á”Ÿ†—Ž a lack of awareness among physician about this condition [2].
medicilor [2]. In the presented case, non-invasive ventilation with oxy-
B …ƒœ—Ž ’”‡œ‡–ƒ–ǡ ƒ ˆ‘•– ‹‹ì‹ƒ–£ ˜‡–‹Žƒì‹ƒ ‡‹˜ƒœ‹˜£ …— gen therapy was initiated. An optimal titration was obtained,
‘š‹‰‡‘–‡”ƒ’‹‡Ǥ Ǧƒ ‘„싐—– ‘ –‹–”ƒ”‡ ‘’–‹£ǡ …— ‹†‹…‡Ž‡  with a remaining AHI index of 1.7 per hour, IPAP 17 cm H2O
”‡•–ƒ–†‡ͳǡ͹’‡‘”£ǡͳ͹…2è‹ͳͳ…2O. SpO2
‡†‹‡‘…–—”£ͻ͵ΨǢ’2‹‹£ǣͺ͹ΨǤ˜ƒŽ—Á†’ƒ…‹‡–—Ž
Žƒ͵Ž—‹†‡–‡”ƒ’‹‡…—‹ǡ…‘’Ž‹ƒìƒƒˆ‘•–ˆ‘ƒ”–‡„—£ǡ†‡
100%, cu o medie de utilizare a aparatului de 7 ore 15 minute
ÁʹͶ†‡‘”‡Ǥ…ƒŽƒ†‡‡˜ƒŽ—ƒ”‡ƒ•‘‘Ž‡ì‡‹’™‘”–Šƒƒ”£–ƒ–
—•…‘”†‡Ͷ’—…–‡Ǥƒ…‹‡–—Žƒ•Ž£„‹–…—ʹͳ‰ǡ‹…Ž—•‹˜ǡ†ƒ–‘-
”‹–£”‡‰”‡•‹‡‹‡†‡‡Ž‘”Ǥ
Nevoia de terapie cu O2•…ƒ†‡•‡‹ϐ‹…ƒ–‹˜Žƒ’ƒ…‹‡ì‹‹
ƒ†‡”‡ì‹Ǥ ƒ ͵ Ž—‹ǡ ’‡–”— ƒ ‡˜ƒŽ—ƒ ‡˜‘‹ƒ †‡ –‡”ƒ’‹‡ …— 2,
’ƒ…‹‡–—Žƒˆ‘•––‹–”ƒ–”‡’‡–ƒ–è‹ǡ…ƒ”‡œ—Ž–ƒ–ǡƒˆ‘•–‡š…Ž—•2. La
ͳƒ†‡–”ƒ–ƒ‡–ǡƒ•ƒ’ƒ…‹‡–—Ž—‹ƒ•…£œ—–’Ÿ£Žƒʹͳͷ‰Ǥ
‡–‹Žƒì‹ƒ ‡‹˜ƒœ‹˜£ ‡•–‡ — ’—…–Ǧ…Š‡‹‡ Á ‰‡•–‹‘ƒ”‡ƒ
’ƒ…‹‡–—Ž—‹ …— Ǥ ‡”ƒ’‹ƒ …—  ’‘ƒ–‡ ϐ‹ ‹‹ì‹ƒ–£ ’‡–”—
ƒ ‡Ž‹‹ƒ ƒ’‡‡Ž‡ ‘„•–”—…–‹˜‡ǡ Š‹’‘’‡‡Ž‡ è‹ Ž‹‹–£”‹Ž‡ ϐŽ—š—-
lui. BiPAP este utilizat pentru a elimina CO2”‡œ‹†—ƒŽè‹Á…ƒ-
œ—ŽŠ‹’‘˜‡–‹Žƒì‹‡‹’‡”•‹•–‡–‡•—„Ǥ2 suplimentar este
necesar în cazurile în care, pe fundalul tratamentului, SaO2 se
‡ì‹‡•—„ͻͲΨȏͶȐǤ
ƒ•’‡…–‹’‘”–ƒ–ƒŽ–”ƒ–ƒ‡–—Ž—‹‡•–‡‘†‹ϐ‹…ƒ”‡ƒ•–‹-
Ž—Ž—‹†‡˜‹ƒì£è‹’‹‡”†‡”‡ƒÁ‰”‡—–ƒ–‡ǡ…‘”‹Œƒ”‡ƒ‘„‡œ‹–£ì‹‹’‡
–‡”‡Ž—‰’‘ƒ–‡†‡–‡”‹ƒ•…£†‡”‡ƒ‘”–ƒŽ‹–£ì‹‹Ǥ†ƒ–£…—
•–ƒ„‹Ž‹œƒ”‡ƒ’ƒ…‹‡–—Ž—‹ǡ‘‘’ì‹—‡†‡–”ƒ–ƒ‡–‡•–‡‹–‡”˜‡-
싃 …Š‹”—”‰‹…ƒŽ£ „ƒ”‹ƒ–”‹…£ǡ †‡è‹ ‡š‹•–£ —Ž–‡ ’”‘˜‘…£”‹ Žƒ ’ƒ-
…‹‡ì‹‹…—‘„‡œ‹–ƒ–‡‘”„‹†£ǡ†‡•‡‘”‹ǡ†‹ϐ‹…‹Ž†‡”‡œ‘Ž˜ƒ–ȏʹǡͷȐǤ
‡ˆ‡”‹ì‡Ȁ”‡ˆ‡”‡…‡•
ͳǤ ƒ”‹Ǥǡ‡•ƒ‹ǤŠƒ”ƒ…–‡”‹•–‹…•‘ˆ’ƒ–‹‡–•™‹–Š–Š‡ǷƒŽ‹‰ƒ–
and EPAP 11 cm H2O. SpO2 nocturnal average 93%; minimum
SpO2ǣ ͺ͹ΨǤ ˜ƒŽ—ƒ–‹‰ –Š‡ ’ƒ–‹‡– ƒˆ–‡” ͵ ‘–Š• ‘ˆ ‹
–Š‡”ƒ’›ǡ –Š‡”‡ ™ƒ• ƒ ˜‡”› ‰‘‘† …‘’Ž‹ƒ…‡ Ȃ ͳͲͲΨǡ ™‹–Š ƒ
average use of the device 7 hours 15 minutes / 24 hours. Ep-
worth’s Sleepiness Scale showed a score of 4 points. The pa-
tient lost 21 kg, also due to regression of edema.
The need for O2–Š‡”ƒ’›†‡…”‡ƒ•‡••‹‰‹ϐ‹…ƒ–Ž›‹ƒ†Š‡”‡–
PAP patients. After 3 months, in order to evaluate the need for
O2 therapy, the patient was repeatedly titrated and as a result
O2™ƒ•‡š…Ž—†‡†Ǥˆ–‡”ͳ›‡ƒ”‘ˆ–”‡ƒ–‡–Ȃ’ƒ–‹‡–ǯ•™‡‹‰Š–
decrease to 215 kg.
Non-invasive ventilation is a key point in management of
the patient with OHS. CPAP can be initiated to eliminate ob-
•–”—…–‹˜‡ ƒ’‡ƒ•ǡ Š›’‘’‡ƒ• ƒ† ϐŽ‘™ Ž‹‹–ƒ–‹‘•Ǥ ‹ ‹•
used to eliminate residual CO2 and in case of persistent hypox-
ia on the background of CPAP. Supplemental O2 is required in
cases when despite the treatment SaO2 is still below 90% [4].
Lifestyle changes and weight loss are crucial elements in
treating patients. Correcting obesity may lead to a long-term
decreased mortality. Once with the patient stabilization, a
treatment option is the bariatric surgery, although there are
ƒ›†‹ˆϐ‹…—Ž––‘•‘Ž˜‡…ŠƒŽŽ‡‰‡•‹’ƒ–‹‡–•™‹–Š‘”„‹†‘„‡-
sity [2, 5].
ͶǤ ‘ŠŽ‡•‹Ǥ„‡•‹–›Š›’‘˜‡–‹Žƒ–‹‘•›†”‘‡ǣƒ•–ƒ–‡Ǧ‘ˆǦ–Š‡Ǧƒ”–
‘„‡•‹–›Š›’‘˜‡–‹Žƒ–‹‘•›†”‘‡dzƒ†‹––‡†–‘ƒǤ
o—”nƒŽ oˆ review. ‡•’‹”ƒ–o”› cƒ”‡ǡʹͲͳͲǢͷͷȋͳͲȌǣͳ͵Ͷ͹Ǧ͸ʹǤ
In–‡n•‹˜‡ ƒ”‡ ‡†‹c‹n‡ǡʹͲͳ͵ǢʹͺȋʹȌǣͳʹͶǦ͵ͲǤ 5. Sjostrom L., Narbro K., Sjostrom C., Karason K., Larsson B., Wedel
2. Tatusov M., Joseph J., Cuneo B. A case report of malignant obesity H. ‡– ƒŽǤ Effects of bariatric surgery on mortality in Swedish obese
Š›’‘˜‡–‹Žƒ–‹‘•›†”‘‡ǣƒ™‡‹‰Š–›’”‘„Ž‡‹‘—”•Ǥ‡•’‹Ǧ •—„Œ‡…–•Ǥ Š‡ ‡™ ‰Žƒ†
‘—”ƒŽ ‘ˆ ‡†‹…‹‡ǡ ʹͲͲ͹Ǣ ͵ͷ͹ ȋͺȌǣ
”ƒ–o”› ‡†‹c‹n‡ ƒ•‡ ‡’o”–•ǡʹͲͳ͹ǢʹͲǣ͵ͺǦͶͳǤ 741-52.
͵Ǥ ‹’‡”Ǥǡ
”—•–‡‹Ǥ„‡•‹–›Š›’‘˜‡–‹Žƒ–‹‘•›†”‘‡ǣ‡…Šƒ-
nisms and management. ‡”‹cƒn
o—”nƒŽ oˆ ‡•’‹”ƒ–o”› ƒn†
”‹–‹cƒŽ ƒ”‡ ‡†‹c‹n‡ǡʹͲͳͳǢͳͺ͵ȋ͵ȌǣʹͻʹǦͺǤ
94
‡˜‹•–ƒ†‡f–‹‹ì‡ƒŽ‡££–£ì‹‹†‹‘Ž†‘˜ƒ
Moldovan Journal of Health Sciences
Ghidul autorului
Criterii pentru publicare
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ƒAuthors’ contributions
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‡–‹ϐ‹…Ž‹–‡”ƒ–—”‡ȋŽ‹‹–‡†–‘ͳǦ͵•‡–‡…‡•ȌǤ
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Abstract
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study;
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ted and specify the applied statistics;
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ƒ ConclusionsȂƒ„”‹‡ˆ‘˜‡”˜‹‡™‘ˆ–Š‡ϐ‹†‹‰•ǡ™‹–Š’‘••‹„Ž‡
implications for further studies.
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Înregistrarea trialului clinic
Introduction
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cu accentuarea celor noi.
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Material and methods
Dzƒ–‡”‹ƒŽ•ƒ†‡–Š‘†•dz•‡…–‹‘•Š‘—Ž†’”‡•‡–Á•—ˆϐ‹…‹‡–†‡-
tails all carried out procedures. Here should be described protocols
and supporting information on the used methods. It will include
study design, subjects’ recruitment procedure, clear description
of all interventions and comparisons and applied statistics. în the
manuscript text the generic names of drugs should be used. When
drug brands are used their trade name will be shown în parenthe-
ses. For studies on humans or animals a statement about ethical
approval and informed consent of study subjects should be include.
Please specify date and number of Ethics Committee (EC) decision,
chair of the EC as well as institution within EC is organized.
Results
Results and discussion should be presented în separate sections.
Authors must present results în a clear and accurate manner. Results
•Š‘—Ž†„‡‡š’Žƒ‹‡†ȋ‘–Œ—•–‹ϐ‹‡†‘”…‘’ƒ”‡†Á–Š‹••‡…–‹‘Ȍƒ†
include fundamental statements related to hypothesis behind the
study. The results should be presented concisely and logically, em-
phasizing on new original data.
Discussion
‡•…”‹„‡–Š‡‹’ƒ…–ǡ”‡Ž‡˜ƒ…‡ƒ†•‹‰‹ϐ‹…ƒ…‡‘ˆ–Š‡‘„–ƒ‹‡†
”‡•—Ž–•ˆ‘”–Š‡ϐ‹‡Ž†ǤŠ‡”‡•—Ž–•ƒ”‡…‘’ƒ”‡†™‹–Š–Š‘•‡ˆ”‘’”‡-
vious publications and draw potential future research directions.
‹•…—••‹‘••Š‘—Ž†‹…Ž—†‡‹’‘”–ƒ–‹–‡”’”‡–ƒ–‹‘•‘ˆ–Š‡ϐ‹†‹‰•
and results compared with previous studies. Also, study limitations
and potential bias should be mentioned.
Conclusions
This section should conclude laconically entire study, and high-
light the added-value brought on the studied issue. The conclusions
should not provide new information or double (repeat) those pre-
•‡–‡†Á–Š‡Dz‡•—Ž–•dz•‡…–‹‘Ǥ
Abbreviations
Use only standard abbreviations. Other abbreviations may be
†‡ϐ‹‡†ƒ†’”‘˜‹†‡†™Š‡ƒ”‡—•‡†ˆ‘”–Š‡ϐ‹”•––‹‡Á–Š‡ƒ—-
•…”‹’–Ǥ„„”‡˜‹ƒ–‹‘•Á–Š‡ϐ‹‰—”‡•ƒ†–ƒ„Ž‡•™‹ŽŽ„‡‡š’Žƒ‹‡†ÁŽ‡‰-
end. Abbreviations should be used as rare as possible.
‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–‘ˆ‹–‡”‡•–•
Following publication, persons or organizations involved în the
•–—†› „‡…‘‡ ’—„Ž‹… ƒ† –Š—• –Š‡‹” ”‡’—–ƒ–‹‘ ƒ› „‡ ‹ϐŽ—‡…‡†Ǥ
Š‡”‡ˆ‘”‡ǡƒ—–Š‘”•—•–†‹•…Ž‘•‡ϐ‹ƒ…‹ƒŽƒ†‘Ǧϐ‹ƒ…‹ƒŽ”‡Žƒ–‹‘-
•Š‹’™‹–Š’‡‘’Ž‡‘”‘”‰ƒ‹œƒ–‹‘•ƒ†–‘†‡…Žƒ”‡…‘ϐŽ‹…–•‘ˆ‹–‡”‡•–
related to the data presented în the manuscript. în accordance with
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‰—‹†‡Ž‹‡•ǡƒ—–Š‘”•—•–ˆ—Žϐ‹ŽŽƒ•–ƒ–‡‡–‘ˆ…‘ϐŽ‹…–•‘ˆ
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Abrevieri
‘Ž‘•‹ì‹—ƒ‹ƒ„”‡˜‹‡”‹•–ƒ†ƒ”†Ǥ‡ƒ•‡‡‡ƒǡ’‘–ϐ‹ˆ‘”—Žƒ–‡
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˜‘” ϐ‹ †‡•…‹ˆ”ƒ–‡ Á Ž‡‰‡†£Ǥ „”‡˜‹‡”‹Ž‡ –”‡„—‹‡ ˆ‘Ž‘•‹–‡ …Ÿ– ƒ‹ ”ƒ”
posibil.
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interest, which will be published at the end of the article.
‘’Ž‡‡–‹‰–Š‡†‡…Žƒ”ƒ–‹‘‘ˆ…‘ϐŽ‹…–•‘ˆ‹–‡”‡•––Š‡ˆ‘ŽŽ‘™-
ing will be taken into consideration
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ƒ•’‡…‹ˆ› ™Š‡–Š‡” ƒ› ‘”‰ƒ‹œƒ–‹‘ Šƒ• ϐ‹ƒ…‹ƒŽ ”‡Žƒ–‹‘•Š‹’
with research presented în the manuscript, including funding,
salary, reimbursements;
ƒmentioned, if the article has any impact on the eventually in-
 MJHS 17(3)/2018 99

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ˆ‘”ƒ–ǣ Dz conc‡‹˜‡† –Š‡ •–—†› ƒn† ’ƒ”–‹c‹’ƒ–‡† Án •–—†› †‡•‹‰n
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ƒŽŽˆ‘—”‘ˆˆ‘ŽŽ‘™‹‰…”‹–‡”‹ƒǣ
1. has made a substantial personal contribution în desi-gning,
developing research protocol, or collected, analyzed and in-
terpreted data;
•‹‰‹ϐ‹…ƒ–‹–‡ŽŽ‡…–—ƒŽ…‘–”‹„—–‹‘Ǣ
3. ƒ’’”‘˜‡†–Š‡ϐ‹ƒŽ˜‡”•‹‘‘ˆ–Š‡ƒ—•…”‹’–”‡ƒ†›ˆ‘”’—„-
lication;
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search and submitted manuscript and to assure that all ques-
tions relating to accuracy or completeness of the work was
adequately assessed and resolved.
Note:‡”•‘•™Š‘Šƒ˜‡…‘–”‹„—–‡†–‘–Š‡™‘”ǡ„—–‘–ϐ‹––Š‡
four criteria mentioned above cannot be considered as authors.
Their contribution will be mentioned în the “Acknowledgment and
‘ˆ‘” ”‡…‘ƒ†£”‹Ž‘” ‘‹–‡–—Ž—‹ –‡”ƒì‹‘ƒŽ ƒŽ †‹–‘”‹Ž‘”
Revistelor Medicale, ICMJE, (www.icmje.orgȌǡ †”‡’– ƒ—–‘” ’‘ƒ–‡ ϐ‹
…‘•‹†‡”ƒ–£’‡”•‘ƒƒ…ƒ”‡•‡Á…ƒ†”‡ƒœ£Á–‘ƒ–‡…‡Ž‡Ͷ…”‹–‡”‹‹ǣ
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‡Žƒ„‘”£”‹‹ †‡•‹‰Ǧ—Ž—‹ …‡”…‡–£”‹‹ǡ •ƒ— ƒ …‘Ž‡…–ƒ–ǡ ƒƒŽ‹œƒ– •ƒ—
ˆ—†‹‰•‡…–‹‘dz‘ˆ–Š‡ƒ—•…”‹’–ǤŽ•‘ǡ’‡‘’Ž‡™Š‘Šƒ˜‡‘Ž›„‡‡
involved în data collection, monitoring, technical assistance and
funding, are not eligible as coauthors, but they may be mentioned în
–Š‡Dz…‘™Ž‡†‰‡‡–•ƒ†ˆ—†‹‰dz•‡…–‹‘Ǥ‡”‡’‘•‹–‹‘‘ˆŠ‡ƒ†
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…‘–”‹„—싇‹–‡Ž‡…–—ƒŽ£‹’‘”–ƒ–£Ǣ
3. ƒƒ’”‘„ƒ–˜‡”•‹—‡ƒϐ‹ƒŽ£ƒƒ—•…”‹•—Ž—‹ǡ‰ƒ–ƒ’‡–”—’—„-
licare;
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ƒ–‡ †‡ …‡”…‡–ƒ”‡ƒ ‡ˆ‡…–—ƒ–£ ç‹ †‡ ƒ—•…”‹•—Ž †‡’—• ’‡–”—
’—„Ž‹…ƒ”‡ç‹•£†‡ƒƒ•‹‰—”ƒ”‡ǡ…£–‘ƒ–‡Á–”‡„£”‹Ž‡”‡ˆ‡”‹–‘ƒ”‡Žƒ
†—…–‡†ǡ™‹–Š‘—–ˆ—Žϐ‹ŽŽ‹‰ƒŽŽˆ‘—”
right to be a coauthor of the work.
Acknowledgements and funding
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ysis and interpretation, manuscript preparation and editing, offered
general or technical support, contributed with essential materials
to the study, but do not meet ICMJE authorship criteria will not be
100
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Á‘†…‘”‡•’—œ£–‘”Ǥ
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— •‡Á…ƒ†”‡ƒœ£ Á –‘ƒ–‡ …‡Ž‡ Ͷ …”‹–‡”‹‹‡—ìƒ–‡ ƒ‹ •—•ǡ — ’‘– ϐ‹
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•‡…ì‹—‡ƒ Ƿ—Žì—‹”‹ ç‹ ϐ‹ƒìƒ”‡dz ƒ ƒ—•…”‹•—Ž—‹Ǥ ‡ ƒ•‡‡‡ƒǡ
persoanele care au fost implicate doar în colectarea datelor, su-
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†‡ì‹‡”‡ ƒ ˆ—…싇‹ †‡ 燈 †‡ —‹–ƒ–‡ǡ †‡’ƒ”–ƒ‡– •ƒ— ‹•–‹–—싇ǡ Á
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considered as authors, but their contribution will be mentioned în
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stitutions who have contributed to the work and manuscript can be
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Tables
Content of each table should be double-spaced and placed on
a separate page after the text of the manuscript. Tables numbering
will be done using consecutive Arabic numerals în the order of their
ϐ‹”•–…‹–ƒ–‹‘Á–Š‡–‡š–Ǣ‹–‹••Š‘—Ž†„‡™”‹––‡Á„‘Ž†ǡƒŽ‹‰–‘Ž‡ˆ–
and place above the table. Each table should have a concise title that
Ͷ”‡…‘ƒ†£”‹ƒŽ‡
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™‹–Š‹–Š‡–ƒ„Ž‡ǤŽ‡ƒ•‡ˆ‘ŽŽ‘™–Š‡‡šƒ’Ž‡ǣ
—Žì—‹”‹ç‹ϐ‹ƒìƒ”‡
Table 1. Intra-anesthetic and immediately post-extubation adverse
Persoanele care au contribuit la elaborarea †‡•‹‰n-ul studiului, events
…‘Ž‡…–ƒ”‡ƒ †ƒ–‡Ž‘”ǡ ƒƒŽ‹œƒ ç‹ ‹–‡”’”‡–ƒ”‡ƒ ƒ…‡•–‘”ƒǡ Žƒ ’”‡‰£–‹”‡ƒ
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Control Cohort
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ȋαͳͲͲȌ
nu îndeplinesc criteriile ICMJE de A—–‘”ǡ—˜‘”ϐ‹…‘•‹†‡”ƒ–‡†”‡’– ȋαͳͲͲȌ
—–‘”‹ǡ†ƒ”…‘–”‹„—싃Ž‘”˜ƒϐ‹‡ì‹‘ƒ–£Á•‡…ì‹—‡ƒǷ—Žì—‹”‹
›•”Š›–Š‹ƒ 6.0% 30% 0.49
ç‹ ϐ‹ƒìƒ”‡dzǤ ‘– Á ƒ…‡ƒ•–£ •‡…ì‹—‡ •‡ ˜‘” ‡ì‹‘ƒ •—”•‡Ž‡ †‡
Hemodynamic instability 7.0% 1.0% 0.034
ϐ‹ƒìƒ”‡ ƒŽ‡ Ž—…”£”‹‹Ǥ ‡ì‹‘ƒ”‡ƒ ’‡”•‘ƒ‡Ž‘” ϐ‹œ‹…‡ •ƒ— Œ—”‹†‹…‡ǡ
…ƒ”‡ ƒ— …‘–”‹„—‹– Žƒ ”‡ƒŽ‹œƒ”‡ƒ Ž—…”£”‹‹ ç‹ ƒ—•…”‹•—Ž—‹ǡ ’‘ƒ–‡ ϐ‹ Prolonged awakening* 11.0% 4.0% 0.19
ˆ£…—–£†‘ƒ”†—’£‘„싐‡”‡ƒ—‡‹’‡”‹•‹—‹†‡Žƒϐ‹‡…ƒ”‡†‹–”‡‡Ž‡Ǥ PONV† post-intubation 8.0% 27.0% 0.007

Strong pain on awakening 17.0% 19.0% 1.0

Tabelele
‹‡…ƒ”‡–ƒ„‡Ž˜ƒϐ‹…”‡ƒ–…—†—„Ž—Ǧ•’ƒì‹‡”‡ç‹ƒ’Žƒ•ƒ–’‡‘’ƒ‰‹£ ‘–‡ǣȗȂ—•—ƒŽŽ›•Ž‘™ƒ™ƒ‹‰ǡƒˆ–‡”–Šƒ–…‡”‡„”ƒŽ…‘…‡–”ƒ–‹‘
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…‘•‡…—–‹˜£ǡ…—…‹ˆ”‡ƒ”ƒ„‡ǡÁ‘”†‹‡ƒ’”‹‡‹Ž‘”…‹–£”‹Á–‡š–ǡ•…”‹• ƒ—•‡ƒƒ†˜‘‹–‹‰Ǥ•‡†•–ƒ–‹•–‹…ƒŽƒƒŽ›•‹•ǣ ‹•Š‡”ǯ•‡šƒ…––‡•–Ǥ
cu caractere grase (boldȌǡƒŽ‹‹‡”‡ƒȂ’‡•–Ÿ‰ƒǡ†‡ƒ•—’”ƒ–ƒ„‡Ž—Ž—‹Ǥ
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ƒŽ‡ȋ”‡‰—Žƒ”Ȍ•—„—£”—Ž–ƒ„‡Ž—Ž—‹Ǥ——–‹Ž‹œƒì‹…ƒ”ƒ…–‡”‡„‘Ž†Á abbreviations should be explained în footnotes, using the following
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ț‡–…Ǥ
Tabelul 1. ˜‡‹‡–‡ƒ†˜‡”•‡‹–”ƒǦƒ‡•–‡œ‹…‡ç‹‹‡†‹ƒ– Applied statistical tests and the type of presented data should be
post-extubare also mentioned. Make sure that each table is cited în the text. If you
use data from another published or unpublished source, you must
Lot experimen- Lot control obtain permission and cited the source below the table.
p
–ƒŽȋαͳͲͲȌ ȋαͳͲͲȌ
Figures
Disritmii 6,0% 3,0% 0,49
Figures will be included în the main manuscript, and also sub-
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‹––‡†ƒ••‡’ƒ”ƒ–‡ϐ‹Ž‡•ǤŠ‡ƒ—•…”‹’–ϐ‹‰—”‡••Š‘—Ž†„‡’”‡•‡–‡†ǡ
”‡œ‹”‡’”‡Ž—‰‹–£ȗ 11,0% 4,0% 0,19 each one on a separate page and should be numbered consecutively
GVPO post-extubare
†
8,0% 27,0% 0,007 with Arabic numerals în the order of their citation în the text. Figure
—”‡”‡‹–‡•£Žƒ–”‡œ‹”‡ 17,0% 19,0% 1,0 numbering will be written abbreviated (Fig. 1), using bold fonts, left
ƒŽ‹‰‡–ǡƒ†’Žƒ…‡†—†‡”–Š‡ϐ‹‰—”‡Ǥƒ…Šϐ‹‰—”‡•Š‘—Ž†Šƒ˜‡ƒŽƒ-
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reziduurilor de anestezice a trecut sub pragul de inducere a hipnozei; ‘ˆ–Š‡ϐ‹‰—”‡ǯ•—„‡”Ǥ
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abrevierile non-standard se vor explica în notele de subsol, folosind
—”£–‘ƒ”‡Ž‡•‹„‘Ž—”‹ǡÁ—”£–‘ƒ”‡ƒ‘”†‹‡ǣȗǡȘǡșǡȚǡȁȁǡțǡȗȗǡȘ
ȘǡșșǡȚȚǡȁȁȁȁǡțț‡–…Ǥ
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the original source and submit the written permission to reproduce
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both the author and the publisher, except the documents of public
domain.
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I., Bubulici E. Les aspects pharmaco-economiques dans la gestion de la
For more details, please contact:
douleur perioperatoire. Mise au point. nn ” n‡•–Š ±ƒn‹ǡʹͲͳʹǢ͵ͳǣ
Adrian Belîi, PhD, university professor
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Editor-in-chief
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1. Datele de contact ale autorului corespondent:

2.
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Moldovan Journal of Health Sciences

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‡š‡’Ž—ǣ Ǥ ‡ŽÁ‹ǡ
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‡ì‹‘ƒ–‡ƒ‹Œ‘•Ǥ
Categoria 1
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…Š‹œ‹ì‹ƒ†‡†ƒ–‡ǣ , , , ;
ƒŽ‹œƒç‹Ȁ•ƒ—‹–‡”’”‡–ƒ”‡ƒ†ƒ–‡Ž‘”ǣ , , , .
Categoria 2
Žƒ„‘”ƒ”‡ƒȋ†”ƒˆ–‹‰Ǧ—ŽȌƒ—•…”‹•—Ž—‹ǣ , , , ;
‡˜‹œ—‹”‡ƒ•‡‹ϐ‹…ƒ–‹˜£ƒƒ—•…”‹•—Ž—‹ǡ…—‹’Ž‹…ƒ”‡‹–‡Ž‡…–—ƒŽ£•‡‹ϐ‹…ƒ–‹˜£ǣ , .
Categoria 3
’”‘„ƒ”‡ƒ˜‡”•‹—‹‹Ƿ‰ƒ–ƒ’‡–”—–‹’ƒ”dzƒƒ—•…”‹•—Ž—‹ȋ–”‡„—‹‡‡ì‹‘ƒ–‡—‡Ž‡–—–—”‘”ƒ—–‘”‹Ž‘”Ȍǣ
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…‘–”‹„—ì‹‹•—„•–ƒì‹ƒŽ‡†‹’ƒ”–‡ƒ‘Ǧƒ—–‘”‹Ž‘”Ǥ
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—‡Ž‡ƒ—–‘”—Ž—‹ȋ–‹’£”‹–Ȍ  ‡£–—”ƒƒ—torului Data

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