MAF- TM (GM) videoendoscop hibrid, portabil, pentru   bronhoscopii si intubatii dificile oricând si în orice loc.

Endoscop flexibil portabil ce are încorporat sursa de lumina cu LED si sistem de înregistrare a imaginilor la o greutate de numai 540 grame. Are un ecran LCD rotativ. Poate memora pâna la 2063 imagini de înalta rezolutie sau pâna la 2 ore de film.

Date contact:

Ing. Catalin Stupu Email: [email protected] Mobil: 0744552454 Tel. /Fax.: 0232213107

Fiz. Veronica Balabaneanu Email: [email protected] Mobil: 0757057803 Tel.: 0212524650 Fax.: 0212524667

X-RAY TUBES AND RADIOLOGY EQUIPMENT

Prof.dr.ing Pompiliu MANEA

I. THE RÖNTGEN TUBES

No more than 114 years have past since X-rays have been discovered. By all means, this is one of the greatest, if not even the greatest discovery of the 9th century. It happened on the evening of 8/9 November 1895, when Professor Wilhelm Conrad Röntgen (1845-1923) was investigating the external effects of a Hittorf type vacuum tube. According to Ph. Lenard’s indications, the tube was covered with black cardboard. This experiment had been performed at the Röntgen’s laboratory from the Physics Institute in Wűrtzburg.

When trying to investigate the effects of the invisible cathode rays produced by a Hittorf’s tube, Röntgen’s assistant noticed a fluorescent effect on a small cardboard screen painted with barium platinocyanide and situated at a certain distance from the tube

After seven weeks of thorough experimental work, W. C. Röntgen reports to the Medical Physics Society of the Wűrtzburg University his original paper entitled “Über eine neue Art von Strahlen” On A New Kind Of Rays). Dated 28^th of December 1895, his paper remains noteworthy in the annals of sciences. Initially called “X-rays”, the electromagnetic radiations had been later called “Röntgen radiations”, in the name of their discoverer. On the occasion of this denomination, the grate German physicist Max Planck was saying “Röntgen’s spark was enough to shine upon the interior of the human body”

The Röntgen tube or the radiogenic tube is the generator or the X-ray source. It consists of a vacuumed balloon, made of a special type of glass called Pyrex glass. As with any vacuum tube, there is a cathode (K), which emits electrons into the vacuum and an anode (A) to collect the electrons, thus establishing a flow of electrical current, known as the beam, through the tube. A high voltage power source is connected across cathode and anode to accelerate electrons. Electrons from the cathode collide with the target (the anode) material, usually tungsten, molybdenum or copper, and accelerate other electrons, ions and nuclei within the anode material. Up to 0.3+3% of the kinetic energy of the accelerated electrons is transferred to the electrons extracted from the target, thus producing what we call the braking radiation or Bremsstrahlung. The rest of the energy is released as heat.

All along their history, Röntgen tubes have had different shapes and working principles. Yet in 1897, 32 Röntgen tubes were presented in the Revue Scientifique Industriale, France. Amongst them we find the tube patented by the Romanian physicist Dragomir Hurmuzescu (1865-1954) and manufactured together with Victor Chabaud.

In our collection we have the following Röntgen type tubes:

a) The Gas tubes were the first tubes, coming of the Crookes and Hittorf tubes. They have been called like that because of their vacuum which was not so advanced. The free electrons and the negative ions produced by gas dissociation inside the balloon were accelerated towards the anode, whilst the positive ions, also produced by gas dissociation, were accelerated towards the cathode.

The concept of “anti-cathode” has been presented to the French Academy of Sciences by Louis Benoist and Dragomir Hurmuzescu, the 17^th of February 1896. The anti-cathode is the part of the vacuum tube, opposite the cathode. Upon it the cathode rays (electrons and negative ions) impinge. Nowadays, the anticathode is simply called the ”anode”, because of the positive electric charge it carries. Beacuse of the advanced vacuum (10^-7 – 10^-8 mmHg), the cathodic beam is exclusively composed of the electrons accelerated by the Röntgen tube’s filament which is the cathode (-). Two gas tubes from our collection are presented below.

The anodes of the above mentioned X-ray tubes were cooled with air. With the first tube (fig. 1) a direct cooling on the glass was used, whilst. Subsequently, the cooling systems have been improved by using distiled water as a thermal agent. Water circulation was ensured by ”thermosyphon”.

b) The Coolidge tubes, also called “hot cathode tubes”. Sir William David Coolidge (1873-1975), a gentleman who has celebrated his centenary, invented in 1913 the first X-ray tube with “thermoelectric emission”. That was a major breakthrough in the radiological technique which lasts until nowadays. Like Emanuel R. N. Grigg said, that was the beginning of the “golden age” in radiology.

Even though the “filament” is known since 1879 and the “law of thermoelectric emission” also known as the “Edison effect” was already published, by Richardson, 12 years ago (1901), nobody before Coolidge has come with the idea of adding a Tungsten filament to an X-ray tube and to bring it to incandescence by heating it with an electric current generated by a transformer. So it was possible to obtain a cathodic beam exclusively made of electrons and to focus it by using a negatively charged electrostatic electrode. Thus the anodic current (Ia) is considerably increased, the electrons being dragged on the anodic target and the X-ray tube’s power increased to 10kW. That allows for reducing the patient’s exposure time and its radiation dose as well.

The publication of this invention in Physical Revue no. 6/1913 was followed by through investigations on creating a manufacturing technology for the new X-ray tubes. The use of the Gaede molecular pump allowed for getting a much more advanced void (10^-8 mmHg), so the electrons doesn’t collide anymore with the gas ions in the tube. Increasing the power delivered to the anode required for its cooling. Hector Pilon, holds the patent no. 478-273/July 1914 and the exclusivity worldwide for its distilled water based anode cooling system.

It forth noting that, by the same period (1913), Julius Lilienfeld (1882-1963) attempted to increase the number of electrons by building a filament based X-ray tube. However, he didn’t come with the idea of heating the filament to incandescence.

Our collection holds more than 15 Coolidge type water cooled X-ray tubes but we shell only present here the oldest of them (fig. 4, 5, 6 and 7).

c) The Metalix tubes: manufactured after 1925, when Albert Bowers, a diploma engineer from Utrecht succeeds to weld, centrally on the X-ray’s glass tube, a metallic hoop made of chromate steel. The Metalix tube is serially produced by the Dutch company Philips.

The metallic hoop, provided with an output gate for the radiation beam and covered with a 2.5 mm thick lead layer, allows for the absorption of the neutralizing radiations. The metallic hoop, also used for securing the X-ray tube on the device, is electrically connected to the ground thus allowing for balancing the anodic voltage and neutralizing the scattered electrons. Later on, a fully radiological protection of the X-ray tube was accomplished by using electro-insulating tubes made of pertinax, lined with rubber containing lead salt. Tube cooling is accomplished using either distilled water (stored in a tank) or forced air (with anode fins).

Our collection holds 10 Metalix tubes, three of which being presented in figures 8, 9 and 10.

d) Douglas tubes (Dopellglass), built in 1931, only six years later than the Metalix tube. Consists of two concentric glass tubes of which the inner is voided and contains the two electrodes (the anode and the cathode). The metallic hoop with the gate for the useful radiation beam is welded on the outer glass tube. So it was possible to get an X-ray tube with increased power at the node and with a uniformly distributed anode voltage along the tube. By placing the tube inside a porcelain arch (the housing), a maximum radio- and electro-protection was ensured, according to the standards of that time.

A forced cooling system consisting of radiating fins and a fan driven by an AC series motor was used. Two of the five Douglas tubes owed by our collection are presented in figs. 11 and 12.

e) X-ray tubes, with fixed anode and oil cooling. After the occurrence of the electro-insulated high voltage cables, a proper protection of both the patients and the personnel became possible. Inserting the X-ray tubes into the housing also became possible.

Several types of protection were provided by the housing: a mechanical one, to prevent the glass made tube from braking, an electrical one, to prevent both patients and the personnel from high voltage electrocution, and a radiological one, to prevent people from overirradiation.

The housing also provides a better cooling of the X-ray tube, by dissipating the heat developed at the anode. A special type of electro-insulating oil, with a high capacity of taking over the heat and of transferring it to the housing and the exterior walls (convection) is used. The oil circulates due to the difference in temperature between the anode and the cathode, the principle being known as thermosiphon.

All these accomplishments allowed for reducing the size and weight of the X-ray tubes, by keeping the same power developed at the anode. Thereby, a 10 kW Metalix tube of 635 mm length and weighting 5kg, was three times longer and six times heavier than the oil cooled tube of the same power (220mm and 0.8kg). Beside the considerable material savings, oil cooled tubes bring a grater ease in their manipulation and use. Combinations of oil, water and air cooling systems can also be used.

Three oil cooled X-ray tubes from our collection are presented in figs. 13, 14 and 15.

f) Rotating anode X-ray tube. Only four years after inventing the Metalix tube, the same Dutchman Albert Bowers, a Philips engineer this time, has succeeded in 1929 to present to the German Society of Radiology his new Rotalix X-ray tube containing the first “rotating anode”. It is true that the idea belongs to the Wood Englishman. He suggested in 1897 to revolve the X-ray tube so the radiation point might continuously change in position, thus avoiding dangerous anode’s overheating.

The fixed anode X-ray tubes were able to deliver at the anode a maximum power of 15kW but, only when the anode voltage was generated either by a four kenotrons Graetz bridge or by a six kenotrons three-phase bridge.

Conversely, the maxim power of a rotating anode X-ray tube increases to 42kW/100kV.

A grate desideratum was achieved once the rotating anode X-ray tube has been discovered:

achieving an optical focus as small as to get a better picture resolution and the same time to an outbreak more heat to dissipate as heat developed at the anode and to increase the intensity of the radiation beam.

The anode is made of tungsten, the melting point at 38,000 C, in plate form and rotated by an asynchronous electric motor with 3000 rpm.

The first rotating anode X-ray tubes completed in 1933 by Philips Bauart were cooled by forced air ventilation.

Less than a decade, to reduce materials consumption, and reducing size and weight, getting at the same time an increase of power, at the end of fourth decade, Compagnie Générale de Radiologie (CGR), accomplish the X-ray tube with rotating anode, oil cooled, Movix-CGR type, in which both length and weight are reduced by half, compared to the same air-cooled X-ray tubes.

From our collection we present the following three tubes, with rotating anode, oil cooled, different powers, mounted in whole armour-plated and protected housings, GD-125 – TUR Dresden type, in figures 17, 18 and19.

g)      Radioterapy X-ray tubes. As x-ray tubes for radiodiagnostic are featured by the anodic tensions, that can riched up to a maximum of 125kV (nowadays 150kV), high anodic currents that vary between 300 mA and 1.000 mA. While X-ray tubes for radiotherapy, are featured by high anodic tensions (60-400 kV) and low anodic currents (7-15mA). Operating times for tubes used in radiodiagnostic are very short, from order of thousandths of seconds until few seconds, while at radiotherapy tubes, operating times are of the order of minutes, even to 15-20 minutes. Having a long standing life, radiotherapy tubes benefit of combined cooling agents (water + oil) and in a high flow between 1.5-20 l/min.

Radiotherapy tubes are built-up only with rotating anod, with power up to a maximum of 8kW and not very different compare to the tubes for radiodiagnostic, in terms of constructive.

From our collection we present three Röntgen type tubes for radiotherapy: figure 20, 21, 22.

II. MEDICAL RADIOLOGY EQUIPMENT

In the technological evolution of medical devices for radiology and their applications in medicine, we can define these stages:

• is a suite of technological explosion, due to discoveries in all fields of science pioneers;
• , period of steady progress and prosperity;
• , a new period of technical explosion, thanks to the introduction of electronics to medical equipment;
• 1970 until nowadays, still a wholesome time, remarkable advances that have led to the digital image, tele-radiology and minimizing the harmful effects of radiation.

Due to the introduction of digital substraction, we obtain a much higher X-ray image proccesing superior to conventional radiography. Digital processing of radiological image enable storege on various media (X-ray film, magnetic strip, electronical support etc), and by introduction of fiber optics and satelitte communications, can be connected by networks, radiological devices in a laboratory, hospital, city, state, country, continent or even intercontinental.

From our collection we present only three devices, figures 23, 24 si 25:

Rx dentar digital wireless PROX cu radioviziograf si dispozitiv de vizualizare – procesare imagine X VISION

Senzor CCD , ľ cm , 12 biti

Procesor PDA 4,3’’ , touch screen

Permite vizualizarea imediata , memorarea si prelucrarea imaginilor si salvarea pe card SD

3D Modeling of the Induced Electric Field of Transcranial Magnetic Stimulation

D. Rafiroiu1, S. Vlad¹, L. Cret¹, R. Ciupa

¹ Technical University of Cluj Napoca/Electrical Engineering Department, Cluj Napoca, Romania

Abstract— The objective of our study was to make use of the MQS solver available under SEMCAD-X simulation environment and the high-resolution 3D head-and-brain model available through the IT’IS Foundation, to make a full 3D analysis of the TMS procedure. The electromagnetic field induced by two typical stimulating coils has been modeled, and their efficiencies compared. The comparison was made based on the distributions of the induced electric field, the activation function and the induced current density distribution.

Keywords— Transcranial magnetic stimulation, 3D modeling, inhomogeneous brain tissue, figure-of-eight coil, Cadwell type coil

INTRODUCTION

Currents of high magnitude inside the body can lead to a stimulation of muscle and nerve tissue. Targeted stimulation of certain areas is used in many medical applications like cardiac pacing, pain treatment, wound healing, Alzheimer disease, Parkinson disease being just a few to name [1]. However, the electric stimulation technique (EST) suffers from serious drawbacks. Surface electrodes can not be used for the stimulation of deeper structures and the implantation of electrodes comes along with the need of surgical treatment.

The magnetic stimulation technique (MST) is a noninvasive method to excite peripheral and brain neurons. Weak electric currents are induced in the tissue by rapidly changing magnetic fields (electromagnetic induction). Its major advantage over the EST comes from the possibility to penetrate highly resistive tissues (like the skull in the brain stimulation) and a grater focality which allows for a selective stimulation of the nervous tissue. The first non-invasive magnetic stimulation of human and animal peripheral nerves was reported by Bickford and Freeming in 1965 [2]. Throughout the 1970’s Barker analyzed the interaction of short, pulsed magnetic fields for use in nerve stimulation, leading to the first demonstration of cortical magnetic stimulation in 1985 [3]. Over its 20-years history, trans-cranial magnetic stimulation (TMS) has evolved into a tool for human brain mapping, a way to dissect cognitive and perceptual processes and as a treatment for psychiatric diseases [4]. Contrary to electrical stimulations, TMS treatments are relatively painless and easy to perform.

Fig. 1 Typical TMS equipment. a) Principle, b) RLC circuit in TMS, c) The exponentially decaying stimulation current and its time derivative

Typical TMS equipment consists of a main unit creating a high current pulse connected to a hand-held stimulation coil (see Fig. 1 a). A simplified schematic diagram depicting the four functional units of a magnetic stimulator is drafted in Fig. 1 b. It consists of a charging circuit, energy storage, a discharging circuit and the stimulating coil.

In all commercially available stimulators, the energy is stored in large, high-voltage capacitors, typically fed by a charging system connected to the power line. During the discharge, the energy stored in the capacitor is transferred into the coil, typically using a thyristor, which is capable of switching large currents in a few microseconds. The stimulation coil is normally housed in a plastic cover. Due to its low electrical resistance and high heat conduction capacity, copper is the material of choice for the coil windings. Two different coil designs are in widespread use: a circular coil and a figure-of-eight coil. Circular coils typically consist of approximately ten windings with a radius ranging from 3-5 cm. The size of a figure-of-eight coil is similar, typically consisting of two times ten windings. Other TMS coil types have also been reported [5].

Several authors have calculated the induced current distribution during a TMS pulse in high resolution models of the brain, using numerical methods [6], [7], [8], [9]. Amongst the numerical methods frequently used for such simulations, finite element method and finite difference method are the most popular. Due to the high computational effort of these calculations only the dominant frequency in the spectrum of the TMS pulse was taken into account. Because of the short pulses used in TMS, a time-harmonic approximation is no longer valid and transient effects have to be considered. Other approaches, like the one based on the Scalar Potential Finite Difference (SPFD) method [1] makes it possible to perform a full Fourier analysis of the induced currents in a reasonable time.

In the last decades, the Finite-Difference Time-Domain method (FDTD [10], [11]) has proven to be an efficient and powerful numerical method. Especially for interactions of complex human body models and electromagnetic fields, the FDTD method is highly valuable to assess electromagnetic compatibility at radio frequencies. At lower frequencies, the FDTD method becomes inefficient due to the explicit time integration scheme. However, the electro and magneto quasi-static approximations (EQS and MQS) to Maxwell equations have been implemented using the finite element method (FEM) in frequency domain and the non-uniform but rectilinear computational grid of the FDTD method has been reused, to benefit from both methods [12].

The objective of our study was to make use of the MQS solver available under SEMCAD-X simulation environment [13] and a high-resolution 3D head-and-brain model available through the IT’IS Foundation [14], to make a full 3D numerical analysis of the TMS procedure.

Methods

To achieve our goal, the real geometrical features of the human head as well as the electrical characteristics of the brain and its surrounding tissue had to be considered. To represent the geometry of the head and the brain, the male head part of the “Enhanced Virtual Family Model”, graciously provided by Speag AG, has been used. Figure 2 show the CAD images of the 6 parts of the head-and-brain model: the scalp, the skull, the grey matter, the white matter, the cerebrospinal fluid (CSF) and the cerebellum.

Fig. 2 The geometrical head-and-brain model: a) scalp, b) skull, c) grey matter, d) white matter, e) CSF, f) cerebellum

At 5 mm above the surface of the scalp (8 mm above the brain surface), two systems of stimulating coils have been placed: a conventional figure-of-eight system of coils (Fig. 3 a) and a Cadwell-type [5] system of pointed coils (Fig. 3 b). The two circular lobes of the first stimulating system are 25 mm in radius. The characteristic dimensions of the second stimulating system are illustrated in Fig. 3 c, their values being: , , , . Eight turns were considered for each lobe of the stimulating coil and the excitation current loops have been set in such a way that at the central part of the coil the currents have the same direction. A detailed analysis of various TMS stimulating coils’ characteristics and their efficiencies, including the ones’ mentioned above, can be found in [15].

Table Conductivity and permittivity of the biological tissues used in the model of the head

Fig. 3 The positioning and the shape of the two modeled stimulating systems of coils: a) figure-of-eight stimulating system, b) Cadwell stimulating system, c) characteristic dimensions of the Cadwell system

Normally, the excitation current flowing through the stimulating coils is a short pulse current like the one illustrated in Fig. 1 c. In our simulation, a time-harmonic approximation of the current pulse, with frequency and amplitude was used. Each lobe of the stimulating coils consists of 8 turns, thus giving a total excitation current of 12 kA. The total exposure from the pulse signal which is applied can easily be determined by decomposing the pulse into a Fourier series and run multiple simulations at the different harmonics , specifying the corresponding material parameters. Finally, the results can be extracted and subsumed.

While modeling the induced currents in tissues, the results of the field equations will depend on the dielectric properties assumed for the tissues and for this reason it is important to consider the mean value of the conductivity at frequencies that are close to those involved in magnetic stimulation [8]. The conductivity and permittivity values that have been used in our model, for the different cerebral tissues are presented in Table 1, together with their reference. As the values available in the literature are sometimes different, their mean value was chosen. Everywhere in the brain, the relative permeability was set to .

TISSUE TYPE	s [S/m]	er	REF.
Scalp		4e3
Skull		5.2e5
Grey matter		5e7
White matter		3e7
CSF		11e3
Cerebellum	Not relevant for the model

SIMULATION rESULTS

Each of the two models (a figure-of-eight and a Cadwell type stimulating coil placed in the same position relative to the head model) have been voxelized, resulting in total number of 75,500 Mcells for each of the two models. The total simulation time for each model was 16 minutes, on a P4 3.6 GHz computer.

The first to be investigated was the magnetic field distribution, at the moment when the excitation current reaches its peak value ( ). Figure 4 shows the distribution of the magnetic flux density in the coil plane (transversal plane) and in a plane perpendicular to the coil (“coronal” plane). In order to have a better representation of the field distribution, a logarithmic scale (in dB) was used for plotting. All values are normalized to the maximum value within the plane. A high concentration of the magnetic field at the surface of each coil is observed. The magnetic field concentration is higher in the case of the Cadewll coil (Fig. 4 b and Fig. 4 d) compared to the figure-of-eight coil (Fig. 4 a and Fig. 4 c). Figure 4 e shows the logarithmic scale that has been used in all plots.

For a quantitative view on the magnetic field distribution, the magnetic flux densities along several extraction lines, parallel to the transversal plane, have been plotted (Fig. 5).

Typical values for the TMS magnetic field are: about 2 T on the coil surface and 0.5 T in the cortex [20]. Yet our results show a magnetic field almost twice as strong on the coil surface and more than 6 times weaker in the cortex. This can easily be explained by the high concentration of the total electric current within a single filamentary current loop which makes the gradient of the magnetic field to be very high.

e)

Fig. 4 Distribution of the magnetic flux density within the transversal plane (a and b) and within the “coronal” plane (c and d) of the two modeled coils: figure-of eight (left), Cadwell (right)

Fig. 5 Distribution of the magnetic flux density along extraction lines situated at different depths within brain and parallel to the coil’s transversal plane (distances d from the brain surface are 0, 10, 20, 30 and 40 mm). On the left hand side of the figure the distributions of the magnetic induction B along each coil’s axis is plotted.

The next to be analyzed was the electric field induced in the head. Figure 6 show the distribution of the electric fields induced by the two stimulating coils in the “coronal” plane of the head, while considering it as a homogeneous tissue with s=0.33 S/m and e_r=11,000. Again, the logarithmic scale was used for plotting. The maximum values, E_max, of the overall induced electric fields within the plane at wt p/2 are 165 V/m for the figure-of-eight coil and 163.5 V/m for the Cadwell coil respectively.

a) b)

Fig. 6 Distribution of the overall induced electric field in the “coronal” plane of the homogeneous head model by the figure-of-eight coil (a) and by the Cadwell coil (b).

Fig. 7 Distribution of the Ex component of the induced electric field, along an extraction line parallel to the Ox axis, at 30 mm from the surface of the brain and the corresponding activation function

Even though the maximum electric field induced by the Cadwell coil is a little bit smaller that the one induced by the figure-of-eight coil, its distribution within the brain is different and could be more important to certain applications. Along the extraction line illustrated in Fig. 6 for example (at 30 mm inside the brain), the E_x component of the induced electric field is higher for the Cadwell coil than for the other coil (Fig. 7). When an action potential has to be generated along the axon of a nerve cell which is oriented along the x axis, the required activation function is defined as [15]. Figure 7 show both the component of the induced electric field and its derivative along an extraction line parallel to the Ox axis and situated at 30 mm from the surface of the brain. In the case of the Cadwell coil, both and the activation function have grater values than in the case of the figure-of-eight coil. The negative values of the activation function determine the depolarization (excitation) of the axon membrane while the positive ones determine its hipper-polarization (inhibition). So, the activation function produced by the Cadwell coil is more prone to axon excitation than the one produced by the figure-of-eight coil. In other situations, action potentials are to be generated in the synaptic regions (dendrites). In such cases, the activation function is proportional to the and again the Cadwell coil seams to be more effective.

Another interesting plot has been obtained when running the model with an inhomogeneous brain tissue (Fig. 8). Again the Cadwell coil seamed to have a higher penetration power than the figure-of-eight one.

a) b)

Fig. 8 Distribution of the overall induced electric field in the “coronal” plane of the inhomogeneous head model by the figure-of-eight coil (a) and the Cadwell coil (b).

A better view of the induced electric field can be obtained when restricting the plot area to the inhomogeneous brain tissue. Figure 9 show the distribution of the overall electric field induced in the cerebrospinal fluid, in the grey matter and in the white matter by the Cadwell coil exclusively. Note the difference between the values of the conductivity and the relative permittivity of the three tissues (Table 1). The highest value of the induced electric field is in the cerebrospinal fluid and in the grey matter (43.25 V/m in the “coronal” plane and 16.55 V/m in the transversal plane, at 30 mm from the brain surface).

a) b)

Fig. 9 Distribution of the overall electric field in the “coronal” and transversal plane of the inhomogeneous brain model (CSF, GM and WM) induced by the Cadwell coil .

Fig. 10 Distribution of the overall electric field in the inhomogeneous brain model (CSF, GM and WM) induced along an extraction line in the “coronal” plane at different distances d from the surface of the brain. The dashed and full lines correspond to the electric field induced by the Cadwell coil and by the figure-of- eight coil respectively

A comparison of the electric fields induced by the two coils at different depths in the brain tissue is made in figure 10. Everywhere the electric field induced by the Cadwell coil is stronger than the one induced by the other coil.

Lastly, the distribution of the current density within the brain was analyzed. This is strongly affected by the differences in conductivity between the three brain tissues. The stimulated area is primarily the motor cortex, mostly composed of grey matter (GM) [8]. The tissues surrounding the GM are primarily the cerebrospinal fluid (CSF), and the white matter (WM); therefore it is important to study the effects of conductivity changes at the interfaces between those tissues. The CSF is highly conductive relative to the other tissues, and its influence on the current distribution within the brain is a fundamental aspect that should be described in three dimensions. Figure 11 shows the current density distribution within the brain, in the “coronal” and transversal planes, at 30 mm from the brain surface. The high concentration of the current density in the CSF and in the GM is evident. Its maximum values within the “coronal” and transversal planes are 48.7 A/m² and 10.7 A/m² respectively.

Fig. 11 Distribution of the current density induced in the “coronal” and transversal planes, at 30 mm from the brain surface by the Cawell coil

CONCLUSIONS

The magneto quasi-static (MQS) solver under Semcad X has proved to be a reliable tool for investigating the basic phenomena underlying transcranial magnetic stimulation. Its robustness and rapidity in getting reliable solutions for complex 3D models are its primary winning cards.

Through its optimization module, Semcad X also offers the possibility to step forward in trying to perform optimization tasks for the TMS coils. The three geometric parameters of the Cadwell coil, for instance, could be optimized in order to get the best field distribution at the stimulation site, depending on patient specific conditions.

ACKNOWLEDGMENT

This work was made possible by the support of Speag AG team. The valuable assistance of Dr. Peter Futter is gratefully acknowledged. Our work was funded by the Romanian University Research Council, within the grant no: ID_1078

REFERENCES

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Bickford R.G, Freeming B.D. (1965) Neuronal stimulation by pulsed magnetic fields in animals and man. Digest of the 6^th Int. Conf. of Medical Electronics in Biology and Engineering, pp 112

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Yang S., Xu G., Wang L., Chen Y., Wu H., Li Y., Yang O. (2006) 3D realistic head model simulation based on transcranial magnetic stimulation. Conf. Proc. IEEE Eng. Med. Biol. Soc., Vol. Supp., Issue , Aug. 30 2006-Sept. 3 2006 pp:6469 – 6472

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Benkler S., Chavannes N., Kuster N. (2008) Highly detailed low frequency full body electromagnetic field simulations in 3-D Proc. of the XIX General Assembly of the International Union of Radio Science (URSIGA 2008)

Schmid & Partner Engineering AG, SEMCAD-X Reference Manual, July 2008

https://www.itis.ethz.ch/index/index_humanmodels.html

L. Cret, Contributii privind studiul si optimizarea tehnicii de stimulare magnetica a sistemului nervos. PhD thesis, UT Cluj Napoca, 2007

Ramon C., Schimpf PH., Haueisen J. (2004) Effect of model complexity on EEG source localozations, Neurology and Clinical Neurophysiology 2004:81

https://dnl.ucsf.edu/users/dweber/dweber_docs/eeg_scd.html

Herman I.P. Physics of the human body, Biological and Medical Physics, Biomedical Engineering series, Springer, 2007

Miklavcic D., Pavselj N. Electric Properties of Tissues, Wiley Encyclopedia of Biomedical Engineering, John Wiley & Sons, Inc. 2006

„TMS terminilogy“, BioMag Laboratory at Helsinki University Central Hospital: www.biomag.hus.fi/tms/terminology.html

Author: Dan Rafiroiu

Institute: Technical University of Cluj Napoca

Street: 15, C. Daicoviciu

City:       Cluj Napoca

Country: Romania

Email:     [email protected]

EVALUAREA ETIOPATOGENETICĂ sI TERAPEUTICĂ A BOLNAVILOR ATEROSCLEROTICI PRIN METODA ANALIZEI NON LINEARĂ (NLS)

Puia Oana Alina, Drd., As. Univ. Fiziopatologie, UMF „Iuliu Hatieganu” Cluj-Napoca, medic specialist chirurgie vasculara

Prof. dr. Luminita Plesca Manea – conducator stiintific doctorat

REZUMAT

Studiul s-a efectuat la Centrul Medical ELMAVITAL din Cluj-Napoca pe un numar de 100 indivizi umani, divizati în 4 loturi: lotul martor – sanatos si 3 loturi având caracteristici diferite clinice si umorale ce-i încadreaza în sindrom metabolic. Celor 3 loturi li s-a dat diferite preparate ce influenteaza patologia vasculara (Vitis+jeleu de catina, Omega 3-6-9, Rosuvastatina,). S-a determinat cu aparatul METATRON profilul glicemic, profilul lipemic, indicele de masa corporala (IMC) si evolutia diferentiata sub tratament.

IPOTEZA DE LUCRU

Analiza NLS poate depista în stadiul precoce leziunile vasculare aterosclerotice, reducând astfel riscul complicatiilor. Analiza NLS poate evidentia procese aterosclerotice simultan în mai multe arii: cerebrale, carotidiene, coronariene, abdominale si membre inferioare etc., cu gradient diferit de afectare.

Fig. 1- NLS cu ATS în diferite arii vasculare topografice

Aparatul Methatron care implementeaza acest sistem de analiza, functioneaza în acord cu principiul amplificarii semnalului de initiere a unei stari entropice noi, în urma emisiei unui vortex magnetic asupra creierului, modulat la frecventa theta Θ cerebrala. Aceasta favorizeaza modificarea activitatii creierului, fiind posibila accesarea informatiilor de la nivelul subconstientului. (1,2)

În termeni fizici Methatron este un generator non-linear cuantic de oscilatii electromagnetice ce interfereaza cu biocâmpul informational al creierului.

Metoda se bazeaza pe emisia si detectia biocâmpurilor ca proces de interactiune dintre receptor–emitator si structurile extra- si intracelulare. Modificarile vortexului câmpurilor magnetice sunt determinate de activitatea metabolica celulara si a transferarii de informatie între sistemele reglatoare (sistem nervos). Aceasta legatura permite diagnosticarea si influentarea activitatii prin emitere de câmpuri modulatoare cu rol terapeutic. Zgomotul de fond tisular (mediu statistic) reflecta astfel starea de sanatate sau boala a unui sistem de organe sau a unor elemente intracelulare; totodata putându-se identifica o cauzalitate complexa pe baza receptiei câmpurilor si a analizei spectrale si statistice a acestora. Holograma matricei electromagnetice este determinata dinamic permitând si efectuarea unor diagnostice predictive. (1,2)

MATERIAL sI METODĂ

Grupul de studiu cuprinde 100 de barbati si femei divizati în 4 clase d.p.d.v. al riscului vascular aterosclerotic.

Lot I martor - Clasa cu risc scazut:

IMC= 25-29 kg/m2 si talie sub 94 cm la barbati sau sub 80 cm la femei

Fara factori de risc.

Lot II - Clasa cu risc moderat:

IMC= 25-29 kg/m2 si talie 94-101 cm la barbati sau 80-87 cm la femei

Factori de risc nutritional

Risc cardiovascular

Terapie cu Vitis + jeleu de catina

Lot III - Clasa cu risc crescut:

IMC peste 30 kg/m2 cu talie crescuta sau

IMC 25-29 kg/m2 si talie peste 102 cm la barbati sau peste 88 cm la femei

Factori de risc cardiovascular

Patologie cardiovasculara aterosclerotica

Terapie cu Omega 3-6-9

Lot IV - Clasa cu risc foarte crescut

IMC peste 40 kg/m2 cu talie crescuta

Factori multipli de risc cardiovascular

Patologie cardiovasculara aterosclerotica

Comorbiditate multipla.

Terapie cu Rosuvastatina

Studiu clinic a fost efectuat în perioada ianuarie-septembrie 2009 în Centrul Medical ELMAVITAL sub egida Conf. dr. Liana Marginean, fiziopatolog, neurolog si homeopat, pionera în România în statuarea metodei de explorare neconventionala prin biorezonanta magnetica NLS.

REZULTATE sI DISCUŢII

Tabel 1. Profilul lipemic, glicemic, tensional si somatic al pacientilor investigati

Pacientii au fost investigati prin NLS computerizat si Echo Doppler carotidian, pentru a putea aprecia metabolismul energetic celular si riscul aterogen in teritoriul circulatiei cerebrale, ca si reactia la stres, respectiv nivelul hormonilor de stres ( cortizol, adrenalina)

Reevaluarea cazurilor s-a facut dupa 90 de zile prin aceeasi metodologie.

Tabel 2. Evaluare dupa 3 luni

Parametri media aritmetica	Lot I martor	Lot II Vitis + jeleu	Lot III Omega 3-6-9	Lot IV Rosuvastatina
IMC	<25	>25	>26	>30
TG mg%
HDL mg%	≥60 mg
Tensiune arteriala
Glicemie	≥100 mg%	93mg%	97mg%	98mg%

DISCUŢII:

La o reevaluare dupa 3 luni s-a observat:

l        O scadere semnificativa a IMC-ului la loturile II si III, mai putin lotul IV.

l        Loturile II si III au înregistrat cea mai mare scadere a trigliceridelor.

l        Cea mai importanta crestere a HDL-ului s-a înregistrat la loturile II si III.

l        Tensiunea arteriala a scazut considerabil in loturile care au folosit vitis si catina (II,III).

l        O scadere a glicemiei s-a observat in toate cele trei loturi tratate cu diversi antioxidanti

• Procesul aterosclerotic la nivelul vaselor mari ale trunchiului evaluat prin NLS (entropie 4) coexista cu un proces de vasculita posibil alergica, deoarece raspunsul vascular la alergenii infectiosi se manifesta inclusiv si prin tensiunea arteriala scazuta.

La nivelul vaselor mari ale trunchiului valoarea colesterolului este mult crescuta, aceasta fiind evaluata printr-un indice de asemanare spectrala mic si o entropie mare (2).

Fig. 2. Evaluarea prin NLS a evolutiei sub tratament a unui pacient

Cresterea entropiei atesta progresul procesului aterosclerotic la care se adauga, ca si factori concomitenti, prezenta microorganismelor oportuniste. Hipertrofia benigna de prostata si infectiile din micul bazin determina o depresie imunitara care împreuna cu fumatul reprezinta factori de risc în aparitia aterosclerozei; Analiza  NLS poate depista în stadiul precoce leziunile vasculare reducând astfel riscul complicatiilor; Observam un proces de ateroscloreza vasculara în evolutie la un pacient care nu are simptomatologie relevanta; Analiza NLS poate evidentia procese simultan în mai multe arii: cerebrale, carotidiene, coronariene, abdominale si membre inferioare etc., cu gradient diferit de afectare.

Avantaje generale ale Analizei non-lineare computerizate în studiul nostru

Metode este noninvaziva, cu caracter repetitiv la 3 luni.

Evalueaza parametri multipli functionali, organici, informationali într-un interval scurt de timp.

Depisteaza precoce unii factori de risc, unele predispozitii morbide si modificari functionale precoce aflate în stadiul preclinic.

Evalueaza stresul acut sau cronic însotitor al oricarui proces patologic.

Evalueaza agresiunea câmpurilor electro-magnetice externe, a iradierii si a altor forme de câmpuri nocive.

Depisteaza încarcarea microbiana, toxica si alergica.

Ajuta medicul în alegerea celor mai potrivite optiuni terapeutice.

Evalueaza biocompatibilitatea oricarui tip de agent terapeutic, inclusiv patoalimentatia.

CONCLUZII:

1. Analiza non-lineara permite elaborarea unui diagnostic precoce în ateroscleroza si monitorizarea factorilor de risc în absenta unei patologii clinice declarate (stadiul precoce).
2. Utilizarea analizei nonlineare împreuna cu tehnicile imagistice în aterogeneza, crescând acuratetea diagnosticarii prin dimensiunea dinamica si predictiva.
3. Remarcam pe lânga efectele oarecum asteptate cu privire la scaderea în greutate, normalizarea valorilor trigliceridelor si a HDL colesterolului, efectul  hipoglicemiant al tuturor produselor testate, dar mai ales impactul statinelor si al Omega 3-6-9 în stoparea agravarii procesului aterogenetic.

Aceste rezultate ne permit sa aprofundam studiul corelatiilor clinico paraclinice ale alimentelor homeopate si alopate cu impact asupra homeostaziei vasculare umane insistând în special pe corectarea factorilor de risc din sindromul X metabolic, determinând cresterea calitatii vietii.

ABSTRACT

This study was performed at Cluj-Napoca Elmavital Medical Center on 100 human subjects, divided in 4 lots: control lot – healthy and 3 lots with different humoral and clinical characteristics of metabolic syndrome. These 3 lots have received different substances that influence the vascular pathology (Vitis + jelly of catina, Omega 3-6-9, Rosuvastatina,). Glycemia and lipidic profile, body mass index (BMI) and the different evolution under treatment were determined with Metatron apparatus.

Bibliografie

Plesca-Manea L, Marginean L, Sfrângeu C, Puia O, Luput G, Margineanu A.M., Toparlan E, Bujoreanu I. - Aportul NLS (analizei non-lineare) multidimensionale în diagnosticul precoce al bolii vasculare periferice. Revista de Economie si Administratie Sanitara, 2009, Vol.53-54 (nr. 1-2), 62-70.

Marginean L, Plesca-Manea L, Sfrângeu C, Luput G, Margineanu A.M., Toparlan E, Bujoreanu I. - Analiza non-lineara computerizata (NLS) – noua metoda de diagnostic si terapie neconventionala. Revista de Economie si Administratie Sanitara, 2009, Vol.53-54 (nr. 1-2), 55-61.

SEROPREVALENŢA INFECŢIEI ANAMNESTICE TORCH ÎN POPULAŢIA GENERALĂ sI LA FEMEILE DE VÂRSTĂ FERTILĂ DIN TERITORIUL CENTRULUI REGIONAL DE SĂNĂTATE PUBLICĂ CLUJ

Radu Rodica¹, Mîrza Tudor Valentin¹, Molnar Anamaria¹, Coroiu Zoe Edita¹, Rebreanu Romana¹, Mîrza Camelia Manuela², Radu Rares Nicolae³, Molnar Mirel²

Centrul Regional de Sanatate Publica Cluj

U.M.F. „Iuliu Hatieganu” Cluj-Napoca

student, U.M.F. „Iuliu Hatieganu” Cluj-Napoca

Rezumat

A fost realizat un studiu epidemiologic transversal, care a urmarit seroprevalenta anticorpilor IgG antitoxoplasma gondii, antirubeolici, anticitomegalici si antiherpetici pe un lot populational de 973 persoane din 11 judete ale Transilvaniei, din care a fost selectat un esantion de 407 femei aflate la vârsta fertila. Prevalenta infectiei anamnestice în populatia generala a fost de 60,33% pentru toxoplasmoza, 66,19% pentru rubeola, 72,76% pentru infectia cu CMV si 25,80% pentru infectia cu virus herpetic tip II. Prevalenta medie a infectiei anamnestice la populatia feminina de vârsta fertila din cele 11 judete, a fost de 63,14% pentru toxoplasma, pentru rubeola, pentru CMV si pentru infectia cu virus herpetic.

În sublotul de femei la vârsta fertila, populatia la risc pentru infectie a fost de 36,86% pentru toxoplasma, de 32,92% pentru rubeola, de 25,80% pentru infectia CMV si de 72,24% pentru infectia cu virus herpetic tip II. În acelasi sublot, riscul anual estimat de infectie a atins valori maxime la vârste cuprinse între 15-24 ani pentru toxoplasmoza (5,72%), rubeola (8,39%) si infectie CMV (0,64%) si între 35-44 ani pentru infectia cu virus herpetic tip II (0,8%).

Cuvinte cheie: infectie TORCH, prevalenta, risc anual estimat de infectie

Introducere

Dintre toate infectiile care pot determina malformatii congenitale, cele cu Toxoplasma gondii, virus rubeolic si citomegalovirus par a fi cele mai importante. Herpesul poate cauza si el defecte congenitale dar mai rar. Exista presupuneri ca si virusurile zona-zosterian, rujeolic, urlian si precum si virusurile hepatitice au influenta asupra fatului, dar studii de cohorta pentru malformatiile congenitale care au cuprins aceste infectii, nu au gasit nici o relatie cauzala semnificativa. Termenul TORCH reprezinta acronimul de la: toxoplasmoza, rubeola, infectia cu citomegalovirus si infectia herpetica.

Scop

Scopul acestui studiu a fost determinarea seroprevalentei infectiei TORCH în populatia de vârsta fertila din teritoriul arondat Centrului Regional de Sanatate Publica (CRSP) Cluj comparativ cu prevalenta infectiilor TORCH în populatia generala din teritoriul CRSP Cluj si a riscului de infectie în populatia feminina de vârsta fertila. Datele epidemiologice s-au obtinut din cele 11 judete ale Transilvaniei arondate Centrului.

Material si metode

A fost realizat un studiu epidemiologic transversal, care a urmarit seroprevalenta anticorpilor IgG antitoxoplasma gondii, antirubeolici, anticitomegalici si antiherpetici la populatia din cele 11 judete din Transilvania, în functie de varietatea unor factori epidemiologici ca vârsta, genul sau distributia geografica.

Determinarea marimii esantionului s-a facut utilizând programul EpiInfo 3.5.1 si aplicatia online smarQuest [1].

Rezultate

S-a calculat un esantion reprezentativ de 973 persoane, cuprinzând toate grupele de vârsta OMS. Dupa calculul esantionului, s-a realizat stratificarea pe judete si stratificarea pe grupe de vârsta. Esantionul a cuprins populatia din arii geografice diferite – cele 11 judete din Transilvania – iar structura pe medii (urban/rural) a esantionului a fost de 47,79% din mediul urban si 52,21% din mediul rural. Din cele 973 de persoane studiate, 34,3% au fost de gen masculin iar 65,7% au fost de gen masculin. Din totalul femeilor, 407 (63,69%) au fost de vârsta fertila iar 232 (36,30%) s-au încadrat în restul grupelor de vârsta. Esantionul de femei fertile a cuprins grupele de vârsta începând cu 15-19 ani pâna la 40-44 ani.

Prevalenta infectiei anamnestice în populatia generala a fost de 60,33% pentru toxoplasmoza, 66,19% pentru rubeola, 72,76% pentru infectia cu CMV si 25,80% pentru infectia cu HSV tip II (tabel 1).

Tabel 1. Seroprevalenta anticorpilor IgG pozitivi din esantionul populational studiat

Prevalenta medie a infectiei anamnestice la populatia feminina de vârsta fertila din cele 11 judete studiate este de 63,14% pentru toxoplasma, pentru rubeola, pentru CMV si pentru infectia cu herpes virus.

În sublotul femeilor de vârsta fertila, seroprevalenta anticorpilor IgG antitoxoplasma se situeaza în intervalul 53,85% – 65,33%, valoarea minima fiind la 15-19 ani iar maxima la 20-24 ani, seroprevalenta anticorpilor IgG antirubeolici se situeaza în intervalul 55,38% – 74,24%, valoarea minima fiind la 15-19 ani iar maxima la 30-34 ani, seroprevalenta anticorpilor IgG anti-CMV se situeaza în intervalul 68,85% – 79,17%, valoarea minima fiind la 40-44 ani iar maxima la 35-39 ani iar seroprevalenta anticorpilor IgG anti-HSV se situeaza în intervalul 23,08% – 33,82%, valoarea minima fiind la 15-19 ani iar maxima la 25-29 ani ( fig.1).

Fig 1. Seroprevalenta infectiei anamnestice TORCH la femeile de vârsta fertila

Prevalenta medie a infectiei anamnestice în populatia de femei la vârsta fertila din teritoriul studiat (1049980 femei) si riscul anual estimat de infectie pentru sublotul de 407 femei fertile din esantionul reprezentativ studiat sunt prezentate în tabelele 2 si 3.

Tabel 2. Prevalenta infectiei anamnestice în populatia de femei la vârsta fertila

Tabel 3. Riscul anual estimat de infectie, în sublotul de femei la vârsta fertila

Discutii

Distributia pe grupe de vârsta a esantionului a evidentiat modificarea structurii pe grupe de vârsta a populatiei, adica îmbatrânirea ei. Ca o consecinta a scaderii natalitatii, populatia din grupele de vârsta 0-4 ani, a cuprins un numar scazut de subiecti.

Distributia anticorpilor TORCH a fost similara pentru cele doua loturi, exceptie facând toxoplasma; frecventa acestor anticorpi a fost mai mare în populatia generala, fata de sublotul femeilor fertile. Rata infectiei pentru toxoplasma a fost mai mare la femeile fertile, comparativ cu aceleasi grupe de vârsta din populatia generala.

Prevalenta anticorpilor antitoxoplasma variaza în functie de grupele populationale, depinzând de circulatia parazitului si de receptivitatea populatiei. Rezultatele studiului nostru sunt conforme cu datele din literatura [2, 3, 4, 5].

Din totalul lotului populational (973 persoane) au fost pozitive 587 persoane pentru anticorpi anti-toxoplasma. Dintre acestea, 312 persoane au fost din mediu rural unde seropozitivitatea a fost de 61%, diferenta fiind statistic semnificativa comparativ cu prevalenta pe întreg teritoriul Transilvaniei. Se impune o prima observatie ca în rural incidenta anticorpilor anti-toxoplasma este mai mare decât în urban. Analizând rezultatele serologice pozitive la lotul populational si lotul de femei fertile constatam ca rata pozitivitatii variaza între 35,62%-72,62% la lotul populational si 25%-76,32% la lotul de femei fertile. Populatia feminina la risc pentru toxoplasmoza este de 36,86%, riscul anual estimat de infectie, în sublotul de femei la vârsta fertila fiind maxim în perioada 15-24 ani (5,72%).

Campaniile de imunizare fata de rubeola având ca tinta femeile de vârsta fertila au ridicat provocari logistice multiple, si au fost ulterior complicate de dificultatea evitarii vaccinarii femeilor gravide. Rezultatele prezentului studiu indica un contingent semnificativ de femei de vârsta fertila, susceptibile la rubeola (32,92%), riscul anual estimat de infectie, în sublotul de femei la vârsta fertila fiind de 8,39% în la vârste cuprinse între 15-24 ani si de 5,4% la vârste cuprinse între 25-34 ani. Imunitatea la rubeola depinde de mai multi factori [6]. Exista o crestere a nivelului imunitatii fata de rubeola odata cu vârsta. Prevalenta anticorpilor antirubeolici nu a prezentat diferente mari între grupele de vârsta ale femeilor fertile, dar în populatia generala a fost mai scazuta.

Trend-ul seroprevalentei în functie de vârsta depinde de acoperirea vaccinala la diferitele grupe de vârsta. Acoperirea vaccinala este mare la grupele de vârsta tinere. Constatarea ca anticorpii antirubeolici au fost prezenti la 67,08% din femeile fertile corespunde cu datele din literatura. Anticorpii au fost gasiti la peste 80% dintre femeile adulte din Europa, Anglia, SUA, Australia si Canada [7]. Diferente în seroprevalenta rubeolei între populatia urbana si rurala sunt diverse si contradictorii de la o tara la alta. Femeile din rural sunt mai susceptibile dec t în urban, dar susceptibilitatea nu este semnificativa statistic. Diferentele între urban si rural se pot datora unei expuneri mai reduse si unei izolari a persoanelor în zona.

Citomegalovirus-ul este endemic în toata lumea afectând aproape toata populatia iar seroprevalenta anticorpilor CMV IgG variaza în functie de varietatea factorilor epidemiologici: vârsta, distributia geografica, statusul socio-economic, statusul marital si paritatea [8, 9]. În Rom nia, prevalenta variaza între 70% si 80% iar în studiul nostru rata prevalentei (72,76%) se pliaza între aceste valori. S-a observat o crestere pas cu pas a seropozitivitatii, odata cu cresterea vârstei, atingând un maxim de 96,80% la grupa de vârsta 55-59 ani. Prevalenta anticorpilor CMV în perioada de vârsta fertila variaza în functie de grupurile populationale. Prezentul studiu arata un risc anual estimat de infectie CMV în sublotul de femei la vârsta fertila, maxim la vârsta cuprinse între 15-24 ani (0,64%), populatia feminina fertila la risc fiind de 25,80%.

La noi în tara nu exista studii privind prevalenta infectiei cu virus herpetic tip II, cu toate ca exista intentia de a introduce o strategie de screening dupa realizarea unui studiu pilot la femei sub 25 ani care nu au fost însarcinate si care sunt la risc de a dezvolta infectii cu transmitere sexuala (ITS). Investigatia populationala din studiul nostru demonstreaza ca ponderea reala a infectiei cu virusul herpetic este de 25,80% ceea ce corespunde cu datele din literatura, cu diferente în functie de vârsta, mediul de provenienta al cazurilor si judet. În sublotul femeilor fertile, prevalenta este de 27,76%, valori crescute înregistrându-se la grupele de vârsta 15-19 ani si 20-24 ani. Dintre femeile la vârsta fertila din teritoriul arondat CRSP Cluj, populatia feminina la risc este de 72,24%, riscul anual estimat de infectie cu virus herpetic tip II, calculat pentru sublotul de 407 femei fiind maxim la 35-44 ani (0,80%).

Concluzii

1.Studiul demonstreaza ca infectia TORCH este raspândita printre femeile de vârsta fertila. Asocierea dintre factorii epidemiologici (vârsta, distributie geografica) cu infectia TORCH sugereaza ca femeile de vârsta fertila sunt expuse acestor infectii.

2. Studiul prezent, bazat pe date epidemiologice si pe probele serologice efectuate, demonstreaza riscul infectiei cu agenti TORCH la toate vârstele.

3. Datele prezentate de noi nu constituie o imagine completa a prevalentei anticorpilor anti-TORCH în populatia generala si populatia de femei fertile din zona noastra geografica, pentru aceasta fiind necesare o supraveghere epidemiologica si un program de screening.

Bibliografie

1. *** – smarQuest – Aplicatii de calcul. https://www.smarquest.ro/ro/resources.html

2. VAN DER VEEN J., POLAK M.F.: Prevalence of toxoplasma antibodies according to age with comments on the risk of prenatal infection. J. Hyg., Camb., (1980), 85, 165.

3. REMINGTON J.S., MCLEOD R, DESMONTS G.: Toxoplasmosis. In: Remington JS and Klein JO (eds.): Infectious diseases of the fetus and newborn infant, 4th ed., W.B. Saunders Co., Philadelphia, 1995:140-266.

4. LAMB G.A., FELDMAN H.A.: Risk in acquiring toxoplasma antibodies; a study of 37 "normal" families. JAMA,

5. BERGER F., GOULET V., LE STRAT Y., DESENCLOS J.C.: Toxoplasmose chez les femmes enceintes en France: évolution de la séroprévalence et de l’incidence et facteurs associés, 1995-2003, Rev Epidemiol. Sante Publique,

6. USTAÇELEBI S., KÖKSAL İ., CANTÜRK H. et al: Detection of antibodies against TORCH in pregnants. Mikrobiol Bul., 1986:20:1-8.

7. ROBERTSON S.E., FEATHERSTONE D.A., GACIC-DOBO M., HERSH B.S.: Rubella and congenital rubella syndrome: global update. Rev. Panam. Salud. Publica, 2003;14(5):306-15.

8. MATHUR A., JINDAL I., CHATURVEDI U.C.: A serological study of Cytomegalovirus infection at Lucknow. Ind. J. Med. Res., 1981; 73:678-681.

9. NETO W.C., RUBIN R., SHULTE J., GIUGLIANI R.: Newborn Screening for Congenital infectious Disease. Emerg. Infect. Dis., 2004, 1(6): 1069-1073.

Abstract

A transverse epidemiological study was made, following antitoxoplasma, anti-rubella, anti-CMV and anti-HSV type II IgG seroprevalence on a sample of 973 people from 11 counties in Transylvania, from which a group of 407 women of childbearing age was selected. The prevalence of infection in the general population was 60.33% for toxoplasmosis, 66.19% for rubella, 72.76% for CMV infection and 25.80% for type II HSV infection. The average prevalence of the anamnetic infection in the female population of childbearing age, in the 11 studied counties, was 63.14% for toxoplasmosis, 67.08% for rubella, 74.20% for CMV and 27.76% for the HSV infection.

In the 407 group of women of childbearing age, the population at risk for infection is 36.86% for toxoplasmosis, 32.92% for rubella, 25.80% for CMV infection and 72.24% for HSV type II infection. In the same group, the estimated annual risk of infection reached maximum at ages 15-24 years for toxoplasmosis (5.72%), rubella (8.39%) and CMV infection (0.64%) and between 35-44 years for type II HSV infection (0.8%).

Keywords: TORCH infection, prevalence, estimated annual risk of infection

EFECTELE SUPLIMENTĂRII DE CUPRU ASUPRA BALANŢEI OXIDANŢI-ANTIOXIDANŢI ÎN CONDIŢII DE EFORT FIZIC

Mîrza Camelia Manuela¹, Mîrza Tudor Valentin², Plesca-Manea Luminita Eugenia¹, Uifalean Ana¹, Popa Dorina¹, Caldare Elena¹

1. Catedra de Fiziopatologie UMF „Iuliu-Hatieganu” Cluj-Napoca

2. Centrul Regional de Sanatate Publica Cluj-Napoca

Rezumat

n lucrarea de fata ne-am propus sa urmarim efectele prooxidante si antioxidante ale Cu la animalele supuse efortului fizic, carora li s-a asigurat un supliment de cupru în ratia alimentara. Cercetarile au fost efectuate pe 3 loturi a câte 10 sobolani albi, rasa Wistar: lotul I - animale care au efectuat efort fizic, timp de 4 saptamâni, prin proba de înot; lotul II - animale la care s-a administrat prin gavaj bucofaringian Cu 2 doze/saptam nal, timp de 4 saptam ni; lotul III - animale care au efectuat efort fizic dupa programul lotului I si, carora li s-a administrat cupru dupa programul lotului II. S-a recoltat sânge venos din sinusul retroorbitar în zilele 1, 15 si 29, din care s-au dozat: parametrii antioxidanti: acidul uric, ceruloplasmina; parametrii stresului oxidativ: lipoperoxizii – MDA legata. Rezultatele ne-au indicat cresterea capacitatii an-tioxidative totale (cresterea acidului uric si ceruloplasminei) si scaderea stresului oxidativ (scaderea lipoperoxizilor). Cercetarile efectuate demonstreaza efectul protector al Cu, de adaptare la stresul oxidativ, prin îmbunatatirea mecanismelor de aparare antioxidative.

Cuvinte cheie: cupru, efort fizic, antioxidanti.

Introducere

Cuprul este un microelement (oligoelement), care se gaseste în organism în cantitati foarte mici. Absenta din alimentatie determina, dupa o perioada mai lunga sau mai scurta de timp, maladia caracteristica.

O atentie deosebita se acorda alimentatiei în sportul de performanta. Efortul fizic, prin natura sa, determina cresterea potentialului de formare a SRO, desi doar o mica parte de oxigen este utilizata n acest scop. Suplimentarea cu antioxidante (nutritive si medicamente) previne stresul oxidativ de efort, grabeste recuperarea postefort si creste performanta sportiva. La sportivii de performanta trebuie supravegheate cu atentie concentratiile serice de Cu si de ceruloplasmina

n lucrarea de fata ne-am propus sa urmarim efectele prooxidante si antioxidante ale Cu la animalele supuse efortului fizic, carora li s-a asigurat un supliment de cupru n ratia alimentara. Scaderile valorilor serice ale Cu la animalele neantrenate, ca urmare a pierderilor si biodistributiei consecutive a acestui oligoelement, ne-a determinat sa studiem influenta su-plimentarii de Cu asupra balantei oxidanti/antioxidanti la animale antrenate la efort.

Materiale si metode

Cercetarile au fost efectuate pe 3 loturi a câte 10 sobolani albi, rasa Wistar, masculi cu greutatea cuprinsa între 160-200 g, alimentati normal pe durata experimentului: lotul I - animale care au efectuat efort fizic, timp de 4 saptamâni, prin proba de înot; lotul II - animale la care s-a administrat prin gavaj bucofaringian Cu (Granois de Cuivre, Monaco): 0,02 mg/100 g/doza, 2 doze/saptam nal, timp de 4 saptam ni; lotul III - animale care au efectuat efort fizic dupa programul lotului I si, carora li s-a administrat cupru dupa programul lotului II.

Pentru determinarea nivelului plasmatic al indicatorilor serici, la 1, 15 si 29 zile s-a recoltat sânge venos din sinusul retroorbitar din care s-au dozat: parametrii antioxidanti: acidul uric [3]; ceruloplasmina [4]; parametrii stresului oxidativ: lipoperoxizii – MDA legata [5, 6].

Rezultate

1. La lotul I, cuprinzând sobolani supusi efortului, prin proba de înot, se constata: cresteri semnificative ale ceruloplasminemiei si acidului uric dupa 2 si 4 saptamâni de antrenament; cresteri foarte semnificative ale lipoperoxizilor (MDA).

2. La lotul II, cuprinzând sobolani care au primit supliment de cupru, se constata: cresteri semnificative ale ceruloplasminemiei si acidului uric; scaderi semnificative ale lipoperoxizilor.

3. La lotul III, cuprinzând sobolani care au primit supliment de cupru si care au fost supusi unui program de antrenament zilnic prin înot, se constata: cresteri foarte semnificative ale ceruloplasminei, acidului uric, fata de valorile bazale initiale; scaderi foarte semnificative ale lipoperoxizilor, fata de valorile initiale.

Rezultatele noastre pentru acidul uric la loturile studiate arata:

pentru probe perechi - pentru lotul I valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul II valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul III valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29

pentru probe neperechi - pentru ziua 1 valori semnificativ mai mici (p < 0,05), la loturile I si II fata de lotul III; pentru ziua 15 valori mai mici, intens semnificativ (p < 0,001), la loturile I si II fata de lotul III; pentru ziua 29 valori mai mici, intens semnificativ (p < 0,001), la loturile I si II fata de lotul III

Pentru ceruloplasmina rezultatele la loturile studiate arata:

pentru probe perechi - pentru lotul I valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul II valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul III valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29

pentru probe neperechi - pentru ziua 1 valori mai mici, intens semnificative (p < 0,001), la lotul I fata de loturile II si III; pentru ziua 15 valori mai mari, intens semnificative (p < 0,001), la lotul I fata de lotul II; valori mai mici, intens semnificative (p < 0,001), la lotul II fata de lotul III; pentru ziua 29 valori mai mari, intens semnificative (p < 0,001), la lotul I fata de lotul II; valori mai mici, intens semnificative (p < 0,001), la lotul II fata de lotul III;

Rezultatele noastre pentru MDA la loturile studiate arata:

pentru probe perechi - pentru lotul I valori mai mici, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul II valori mai mari, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29; pentru lotul III valori mai mari, intens semnificativ (p < 0,001), în ziua 1 fata de zilele 15 si 29 si în ziua 15 fata de ziua 29

pentru probe neperechi - pentru ziua 1 valori semnificativ mai mari (p < 0,05), la lotul I fata de lotul III; valori mai mari, intens semnificative (p < 0,001), la lotul II fata de lotul III; pentru ziua 15 valori mai mari, intens semnificative (p < 0,001), la lotul I fata de loturile II si III; pentru ziua 29 valori mai mari, intens semnificative (p < 0,001), la lotul I fata de loturile II si III; valori semnificativ mai mari (p < 0,05), la lotul II fata de lotul III.

Fig. 1. Acidul uric la loturile studiate. Valori medii. Semnificatie statistica

Fig. 2. Ceruloplasmina la loturile studiate. Valori medii. Semnificatie statistica

Fig. 3. MDA la loturile studiate. Valori medii. Semnificatie statistica

Discutii

Stresul oxinitroxidativ (SON) reprezinta totalitatea deteriorarilor oxidative produse de speciile reactive ale oxigenului (SRO) si ale azotului (SRN) la nivelul celulei sau la nivelul ntregului organism. El este asociat cu perturbarea balantei prooxidante/antioxidante (PO/AO), n favoarea primei componente [7, 8, 9, 10, 11]. Sunt bine cunoscute efectele benefice ale efortului fizic în promovarea sanatatii si prevenirea diferitelor îmbolnaviri. Totusi, efortul cronic reprezinta o forma de SO asupra organismului, stres care poate altera echilibrul între prooxidanti si AO.

Datorita stabilitatii sale puternice si corelatiei pozitive între concentratia sa plasmatica si cea a Cu, se sugereaza ca dozarea ceruloplasminei ar putea fi un indicator pentru apre­cierea statusului Cu în organism. Prin activitatea sa feroxidazica, ceruloplasmina reprezinta o veriga de legatura între metabolismul Fe si Cu. Ceruloplasmina limiteaza cantitatea de radicali liberi ca antioxidant neenzimatic (antiperoxidant). Metaloproteinele ce contin cupru (hemocupreina, hepatocupreina, cerebrocupreina, citocupreina etc.) sunt superoxiddismutaze (Cu-SOD), în prezenta lor având loc o dismutare accelerata a superoxidului în oxigen si peroxid. Superoxiddismutaza (SOD), cunoscuta si sub denumirea de metalotioneina este ubicuitara, fiind nt lnita de la bacterii p na la om. Cu-SOD au structuri dimerice cu localizare citosolica si tetramerica cu localizare extracelulara si legata de membrana

Antrenamentul de rezistenta poate determina o scadere marcata a Cu în ser, a capacitatii totale de legare a Fe, a saturarii transferinei si o modificare a raportului ceruloplasmina enzimatica/ceruloplasmina imunoreactiva. Reducerea nivelului de Cu poate afecta activitatea biologica a ceruloplasminei si a functiilor fiziologice legate de activitatea AO. La sportivii de performanta trebuie supravegheate cu atentie concentratiile serice de Cu si de ceruloplasmina [14].

Conform datelor din literatura, la nivel muscular, concentratia Cu a fost crescuta la grupul masculilor supusi exercitiului fizic. A fost raportat faptul ca mioglobina musculara a fost crescuta în muschii care au fost direct supusi efortului. Ceruloplasminemia a fost de asemenea mai mare la femele decât la masculi. Exista doua teorii care explica activitatea crescuta a ceruloplasminei asociata cu efortul fizic. În primul rând, cresterea ceruloplasminei asociata exercitiului fizic poate fi cauzata de o conditie de stres fizic, deoarece ceruloplasmina serica creste în conditii de stres. În al doilea rând, cresterea ceruloplasminei poate fi legata de trans-portul de Fe si activitatea eritropoietica. Desi Cu este un micronutrient esential, aportul excesiv poate fi toxic. Multe dintre efectele toxice ale Cu, precum cresterea peroxidarii lipi­delor în membranele celulare, alterarea proteinelor si a acizilor nucleici, sunt legate de rolul Cu în ge-nerarea radicalilor liberi ai oxigenului. Ficatul este cel mai sensibil organ în ceea ce priveste toxicitatea Cu. Scopul acestui studiu a fost evaluarea schimbarilor nivelului de peroxidare a lipidelor (concentratiile de malonilaldehida si 4-hidroxialchene: MDA si 4HNE), concentratia de glutation redus (GSH), precum si activitatea unor enzime antioxidante ca: glutation peroxidaza (GPX) si superoxid dismutaza (SOD) în ficatul sobolanilor intoxicati cu Cu si supusi efortului fizic. Rezultatele dovedesc faptul ca intoxicatia cu Cu si efortul unic, actionând simultan, intensifica în mod considerabil (într-o maniera cumulativa) stresul oxidativ în ficatul sobolanilor [15].

Suplimentarea de Cu poate influenta direct capacitatea de efort fizic, prin stimularea activitatii sistemelor AO enzimatice - CuZnSOD - si prin cresterea semnificativa a ceruloplas-minei, indicatorul cel mai fidel al nivelului cupremiei. În mod indirect, prin influentarea neuromediatiei, prin dopamina si noradrenalina, Cu ar putea determina activarea simpatoadre-nala si modificarile consecutive adaptative ale organismului la efort [16].

Efectele favorabile ale administrarii de Cu asupra capacitatii de efort fizic la animale se produc prin influentarea metabolismului energetic muscular. Cercetarile sunt de acord cu unele date din literatura privind efectele Cu asupra activitatii motorii controlate la subiectii sedentari sau la sportivi. Lotul supus efortului caruia i-am administrat suplimente de Cu prezinta o crestere semnificativa a performantelor la proba de înot, ceea ce ne confirma rolul antioxidant al Cu în conditii de stres oxidativ. Însa administrarea în doze repetate de Cu va induce un efect prooxidant, dovada fiind scaderea capacitatii de efort dupa o luna de antrenament.

Rezultatele noastre aduc o dovada indirecta cu privire la efectele favorabile ale supli­mentarii de Cu, în raspunsul adaptativ al organismului la stresul oxidativ indus prin efort fizic. Administrarea suplimentelor de Cu determina modificari ale balantei oxidanti/antioxidanti: scaderi ale lipoperoxizilor postexpunere, simultan cu cresteri ale apararii antioxidative totale, dovada cresterile acidului uric si ale apararii antioxidative extracelulare, tradusa prin cresterea ceruloplasminei, pentru toate loturile. Modificarile ceruloplasminei - cresterile postexpunere la efort fizic fata de valorile initiale, la lotul care a primit suplimente de Cu, pledeaza pentru efectul protector al acestuia asupra apararii antioxidative extracelulare neenzimatice, prin ceruloplasmina.

Concluzii

mbunatatirea performantelor la proba de înot este asociata cu cresterea capacitatii an-tioxidative totale (cresterea acidului uric si ceruloplasminei) si scaderea stresului oxidativ (scaderea lipoperoxizilor).

2. Cercetarile efectuate demonstreaza efectul protector al Cu, ca procedeu fiziologic de marire a capacitatii de adaptare la stresul oxidativ, prin îmbunatatirea mecanismelor de aparare antioxidative.

3. Procedeul utilizat de noi pot fi încadrat între metodele sustinatoare de efort, utile pen-tru îmbunatatirea performantelor la sportivi.

  Bibliografie

1. MÎRZA C.M., TACHE S.: Actualitati cu privire la rolul cuprului, zincului, manganului si litiului n organism. Sibiul Medical, 2000, XI/1, 18-22.

2. LUMINIŢA PLEsCA-MANEA, CUCUIANU M., CRÂSNIC I., BRUDAsCĂ I.: Biochimie clinica. Fundamentare fiziopatologica. Ed. Argonaut, Cluj-Napoca, 2003, 302-307.

3. MIHELE D.: Biochimie clinica. Metode de laborator, ed. a III-a, Ed. Medicala Bucuresti.

4. PACKER L.: Oxidative damage to proteins: spectrometric method for carbonyl assay. Methods Enzymol., 1994, 233:347-357.

5. SATOH K.: Serum lipid peroxide in cerebrovascular disorders determined by a new colorimetric method. Clin. Chim. Acta, 1978, 90:37-43.

6. CHEESEMAN K.: Determination of aldehydic lipid peroxidation products: malonalde­hyde and 4-hydroxynonenal. Methods Enzymol., 1994, 186:406-13.

7. SEN C.K.: Antioxidants in exercise nutrition. Sports Med., 2001, 31(13):891-908.

8. TACHE S. - Stresul oxidativ si antioxidantii în efortul fizic. În Dejica D. – Antioxidanti si terapie antioxidanta, Casa Cartii de stiinta, Cluj-Napoca, 2001, 6:198-210.

9. VASSILAKOPOULOS T., KARATZA M.H., KATSAOUNOU P. et al: Antioxidants attenuate the plasma cytokine response to exercise in humans. J. Appl. Physiol., 2003, 94:1025-1032.

10. CHEVION S., MORAN D.S., HELED Y., ET AL - Plasma antioxidant status and cell injury after severe physical exercise. PNAS, 2003, 100(9):5119-5123.

11. BAILEY D.M., YOUNG I.S., MCENENY J., ET AL - Regulation of free radical outflow an isolated muscle bed in exercising humans. Am J. Physiol. Heart Circ. Physiol, 2004, 287:H1689-H1699.

12. CÂRMACIU R. (sub red.) - Guyton. Fiziologie. ed. a 5-a, Ed. Med. Amaltea, Bucuresti, 1996, VIII/30:290-294; XIV/57:577-583.

13. GUYTON A.C., HALL J.E. - Textbook of medical physiology. 9^th ed., Saunders & Comp., Philadelphia, 1996, VII, 42:542; VIII, 43:549-552.

14. TACHE S., DUMA E., DUMA L. - Antioxidantii si influenta asupra stresului oxidativ indus de efortul fizic. Palestrica Mileniului III, 2000, I/2:41-47.

15. PAWLAS M.G., TRACZ J., DZIĘGIEL J. - Induction of oxidative stress in livers of rats under influence of isolated and combined exposure to copper and physical effort, Adv. Clin. Exp. Med., 2002; 11(4):457-466.

16. O'DELL B.L. - Roles of zinc and copper in the nervous system. Prog. Clin.Biol.Res., 1993, 380: 147-

Abstract

In the present study we intended to follow prooxidant and antioxidant effects of copper in animals subjected to physical exercise, which received an extra copper ratio. Researches have been conducted on 3 groups of 10 white Wistar rats: group I - animals that have made exercise for 4 weeks, through the swimming test, group II – animals which received copper, 2-dose weekly for 4 weeks, group III - animals which performed exercise and received copper. Venous blood from the retroorbitary sinus was collected in days 1, 15 and 29, in order to determine the antioxidant parameters (uric acid, ceruloplasmin) and the oxidative stress parameters (lipoperoxids - MDA related). The results have shown an increase of total antioxidant capacity (increased uric acid and ceruloplasmin) and reduced oxidative stress (decreased lipoperoxids). Researches showed that copper has a protective effect, which helps the organism to adapt to oxidative stress by improving antioxidative defence mechanisms.

Keywords: copper, physical exercise, antioxidants.

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EVOLUŢIA INFECŢIILOR RESPIRATORII ACUTE sI A GRIPEI

ÎN SEZONUL 2009-2010 ÎN TERITORIUL

CENTRULUI REGIONAL DE SĂNĂTATE PUBLICĂ CLUJ

Mîrza Tudor Valentin¹, Radu Rodica¹, Mîrza Camelia Manuela², Munteanu Cornelia¹, Radu Rares Nicolae³

Centrul Regional de Sanatate Publica Cluj

U.M.F. „Iuliu Hatieganu” Cluj-Napoca

student, U.M.F. „Iuliu Hatieganu” Cluj-Napoca

Rezumat

Supravegherea infectiilor respiratorii acute este esentiala pentru semnalarea debutului unei noi epidemii/pandemii, datele de morbiditate si mortalitate fiind necesare pentru a întelege impactul asupra sanatatii publice si a elabora strategii de supraveghere si control.

Daca în aprilie 2009 se înregistra un cumul de morbiditate si mortalitate prin influenza-like (Mexic), în iunie erau semnalate cazuri de gripa A(H1N1) pe toate continentele Lumii si OMS anunta necesitatea implementarii gradului 6 de alerta pandemica, declarând pandemica raspândirea infectiei cu noul tip de virus A(H1N1).

În teritoriul CRSP Cluj primele cazuri de gripa cu virus nou au fost diagnosticate în luna iulie 2009. Initial cazurile diagnosticate au fost de import, dar în toamna au aparut cazuri secundare, numarul lor crescând, odata cu începerea anului scolar.

Cuvinte cheie: supraveghere, infectii respiratorii acute, gripa A(H1N1), pandemie.

Introducere

Supravegherea infectiilor respiratorii acute (IACRS) este esentiala pentru identificarea unor infectii cu noi virusuri gripale A, care ar putea semnala debutul unei pandemii. Date despre mortalitate si morbiditate sunt necesare pentru a întelege mai bine impactul IACRS asupra sanatatii populatiei si a stabili strategii de supraveghere si control. Dupa identificarea primelor doua cazuri de infectie cu noul virus gripal A(H1N1) în SUA, pe 15.04.2009, CDC a cerut tuturor departamentelor de sanatate locale si de stat sa implementeze o supraveghere sporita pentru toate virusurile gripale A carora nu li se poate stabili subtipul. În 25.04.2009, directorul general OMS declara stare de urgenta de sanatate publica de importanta internationala în urma aparitiei de cazuri umane de infectie cu virus gripal A(H1N1) în SUA si Mexic. În 27.04.2009 s-a decis mentinerea sistemului de supraveghere pentru gripa si infectii respiratorii în România. În 30.04.2009 a avut loc întâlnirea Ministrilor Sanatatii din UE, unde s-a stabilit necesitatea implementarii sistemului de raportare zilnica în tarile membre.

Clinicians, epidemiologists and virologists in the 53 countries in the WHO European Region constitute the network reporting to EuroFlu.

Scop

Supravegherea are drept scop cunoasterea raspândirii geografice a activitatii gripale, a intensitatii bolilor acute respiratorii în populatie, a tendintei bolilor respiratorii, stabilirea anuala a continutului de vaccin datorita cunoasterii circulatiei virusurilor si raspunsul la pandemia (H1N1) 2009.

Metode

Clinicienii, medicii de familie, epidemiologii si virusologi din teritoriul CRSP Cluj constituie reteaua de raportare catre CNCSBT Bucuresti. The laboratory network consists of WHO-recognized national influenza centres, a WHO collaborating centre for reference and research on influenza and two WHO H5 reference laboratories. Laboratorul recunoscut ca centru de gripa la nivel national este cel din Institutul Cantacuzino, Bucuresti, un centru de colaborare cu OMS si ECDC, pentru referinta si de cercetare cu privire la gripa. Acesta a prelucrat secretiile nazofaringiene prelevate de la persoanele cu suspiciune de gripa A(WHO/Europe publishes a weekly surveillance report in English and Russian, which is based on data covering the Region's total population of 883 million./H1N1) 2009.

Rezultate si discutii

Începând cu saptamâna 40 a anului trecut (28.09.- 04.10.2009) s-au înregistrat cresteri ale numarului de îmbolnaviri prin IACRS, mai ales la grupa de vârsta 0-4 ani si 5-14 ani dar acestea sunt sub nivelul maxim sezonier, în teritoriul CRSP Cluj.

Rata incidentei prin IACRS la nivel regional a fost de 343,99^o/_oooo. Judetele în care se înregistreaza o rata de incidenta crescuta fata de media regionala sunt Covasna, Salaj si Bistrita.

Rata de incidenta prin gripa creste de la 0^o/_oooo în saptamâna 40 de supraveghere la 1,48^o/_oooo în saptamâna de supraveghere. Judetele în care se înregistreaza o rata de incidenta crescuta fata de media pe teritoriu CRSP Cluj sunt Cluj, Mures si Sibiu.

Din analiza stratificata pe grupe de vârsta se constata ca ratele de incidenta cele mai crescute atât pentru IACRS cât si pentru gripa se înregistreaza la grupa de vârsta 0-4 ani.

Astfel, la grupa 0-4 ani, rata de incidenta prin IACRS creste de la 2109,09^o/_oooo în saptamâna 40 la 3191,50^o/_oooo în saptamâna 45 (02.11.- 08.11.2009) dupa care scade la 1172,13 în saptamâna 53 (28.12.2009-03.01.2010). La aceeasi grupa de vârsta, rata de incidenta prin gripa creste de la 0^o/_oooo în saptamâna 2,87^o/_oooo în saptamânile 51 (14.12.-20.12.2009) si 52 (21.12.-27.12.2009) dupa care scade pâna la 0.41^o/_oooo în saptamâna 02 (11.01.-17.01.2010).

La grupa 5-14 ani, rata de incidenta prin IACRS atinge un maxim de 2309,39^o/_oooo în saptamâna 50 (07.12.-13.12.2009) iar rata de incidenta prin gripa creste de la 0 la 4,32^o/_oooo în saptamâna 48 (23.11.-29.11.2009). La grupa 15-29 ani, rata de incidenta prin IACRS creste de la 326,08^o/_oooo la 773,86^o/_oooo în saptamâna 47 (16.11.-22.11.2009) iar rata de incidenta prin gripa atinge un maxim de 4,49^o/_oooo în saptamâna 48 (23.11.-29.11.2009). La grupa de 30-64 ani, valorile maxime de incidenta sunt de 273,44^o/_oooo pentru IACRS în saptamâna 50 (07.12.-13.12.2009) si de 2,39^o/_oooo pentru gripa în saptamâna 51 (14.12.-20.12.2009). În fine, peste 65 de ani, incidentele maxime sunt atinse în saptamâna 46 (09.11-15.11.2009) pentru IACRS (161,48^o/_oooo) si saptamânile 50 (07.12.-13.12.2009), 53 (28.12.2009-03.01.2010) si 02 (11.01.-17.01.2010) pentru gripa (0,46^o/_oooo).

Având în vedere ca grupa de vârsta 0-4 ani pare sa fie în continuare cea mai afectata, prezentam mai jos distributia geografica a ratelor de incidenta prin IACRS si gripa.

Fig. 1. Incidenta IACRS si a gripei la grupa de vârsta 0-4 ani, în 11 judete din Transilvania, în perioada 28.09.2009 – 24.01.2010

Având în vedere ca perioada analizata cuprinde vacantele de sarbatori, cresterea incidentei din ultima vreme poate fi datorata revenirii la raportari complete.

În cursul anului 2009 s-au înregistrat 15 decese prin gripa în cele 11 judete arondate CRSP Cluj: 5 cazuri în judetul Cluj, 2 cazuri în judetul Bihor, 2 cazuri în judetul Alba, 3 cazuri în judetul Mures, 1 caz în judetul Sibiu si 2 cazuri în judetul Maramures. Au fost raportate si 5 decese prin IACRS, toate înregistrate în judetul Cluj.

În anul 2009 s-au înregistrat si 25 decese prin pneumonii, repartizate astfel: 6 cazuri în judetul Bihor, 7 decese în judetul Maramures, 3 decese în judetul Salaj, 3 decese în judetul Bistrita-Nasaud, 2 decese în judetul Mures, si câte 1 deces în judetele Cluj, Alba si Satu Mare.

În anul 2009 s-au înregistrat 678 cazuri clinice de gripa sezoniera, din care au fost internate 486 cazuri, numarul cel mai mare de cazuri fiind diagnosticate în cele 3 centre universitare medicale: Cluj (204 cazuri), Sibiu (146 cazuri) si Mures (137 cazuri).

Tabel 1. Cazuri clinice de gripa în anul 2009, în 11 judete din Transilvania

Judetele participante la supravegherea infectiilor respiratorii în sistem santinela, în teritoriul nostru sunt: Bihor, Cluj, Maramures, Mures si Sibiu. În cadrul sistemului santinela de supraveghere a infectiilor respiratorii, numarul solicitarilor la Serviciul de ambulanta înregistrate în cele 5 judete, a fost de 50662 în trimestrul IV al anului, mai mic decât în trimestrul III al aceluiasi an. Cel mai mare numar de solicitari la ambulanta s-a înregistrat la grupa de vârsta 0-4 ani, pentru IACRS si la grupa de vârsta >65 ani pentru pneumonii.

În luna iulie 2009, au fost diagnosticate primele cazuri de gripa cu virus nou în teritoriul CRSP Cluj. Initial cazurile diagnosticate au fost de import, pentru ca din toamna sa apara cazuri secundare si numarul lor sa creasca vertiginos, odata cu începerea anului scolar. Pâna în prezent în teritoriul nostru au fost înregistrate 684 cazuri de gripa cu tipul A(H1N1). Din total, 582 de cazuri au fost confirmate prin analize de laborator iar restul de 102 au fost confirmate clinic si prin link epidemiologic.

Tabel 2. Repartitia cazurilor de gripa cu virus nou în teritoriul CRSP Cluj

Toate cazurile au fost simptomatice, simptomele predominante fiind: febra, debutul brusc, astenia, tusee, rinoreea, mialgiile, curbatura. Toate cazurile internate au fost tratate cu Oseltamivir, durata tratamentului fiind în general de 7 zile. Cazurile izolate la domiciliu au primit antitermice, simptomatice, conform recomandarilor Ministerului Sanatatii.

De la începutul sezonului de supraveghere pentru gripa 2009-2010 si pâna în prezent Centrul de referinta pentru gripa de la Institutul Cantacuzino Bucuresti a izolat 571 tulpini de virus gripal nou. Pe lânga faptul ca virusurile au suferit mutatii, datorita carora pot apare forme foarte grave de infectii ale cailor respiratorii si complicatii, conditiile meteorologice si temperaturile schimbatoare, au constituit un factor agravant al acestor probleme de sanatate.

Statistic vorbind, mortalitatea în aceasta pandemie este mai mica decât în celelalte pandemii ale secolului XX (1, 3), dar impactul populational mai scazut nu justifica inactivitatea sanatatii publice (2).

Concluzii

1. Gripa sezoniera, care a beneficiat de o acoperire vaccinala larga atât în 2008 cât si în 2009 a crescut semnificativ în teritoriul arondat CRSP Cluj (678) cu un numar mai mare de cazuri înregistrate în judetele cu clinici medicale universitare.

2. Din luna iulie 2009, au fost diagnosticate primele cazuri de gripa cu virus nou, în teritoriul CRSP Cluj, initial cazurile fiind de import, pentru ca din toamna sa apara cazuri secundare si numarul lor sa creasca, odata cu începerea anului scolar.

3. Pâna în prezent în teritoriul nostru au fost înregistrate 684 cazuri de gripa cu tipul A(H1N1), confirmate cu laboratorul sau clinic si prin link epidemiologic.

Datele de morbiditate si mortalitate sustin necesitatea vaccinarii grupelor la risc.

Bibliografie

1. European Centre for Disease Prevention and Control: ECDC documentation on previous pandemics. https://ecdc.europa.eu/en/healthtopics/Pages/Pandemic_Influenza.aspx

2. HALL I.M. et al.: Real-time epidemic forecasting for pandemic influenza. Epidemiol. Infect., 2007, 135(3): 372-85.

3. KILBOURNE E.D.: Influenza pandemics of the 20^th century. Emerg. Infect. Dis, 2006, 12(1): 9-14.

Abstract

Surveillance of acute respiratory infections is essential for signalling the beginning of a new epidemic/pandemic, the morbidity and mortality data being necessary in order to understand the impact on public health and to develop strategies for monitoring and control.

If in April 2009 an accumulation of influenza-like morbidity and mortality was recorded in Mexico, in June cases of A(H1N1) influenza were reported all around the world and WHO announced the need to implement the pandemic alert level 6, and declared pandemic the spread of the infection with the new type of A(H1N1) virus.

In the CRSP Cluj territory, the first cases of A(H1N1) influenza were newly diagnosed in July 2009. Initially the diagnosed cases were imported, but secondary cases occurred in autumn, their number increasing with the start of the school year.

Keywords: surveillance, acute respiratory infections, A(H1N1) influenza, pandemics.

CT Cone beam maxilo facial ORION- VOLUX , produs de Ritter Imaging Germania in colaborare cu GENORAY – Coreea de Sud

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Programul permite planificare completa a implantului , fara necesitatea unui software aditional, cu managementul canalului mandibular si planseului.

Informatii rapide : Tibi Poraczky 0744 60 69 44 [email protected]

Mircea Puia      0745 34 80 34 [email protected]

Cluj-Napoca District University Hospital

Manager dr. Cristian Ciortea

Cluj District University Hospital is a traditional medical institution, with national and international recognition.

Cluj District University Hospital is the biggest hospital facility in Romania and has a complex structure, with 1592 beds in almost all medical and surgical specialties, specialized laboratories, Emergency Unit, complex Ambulatory Care structure, Mental Health Center, Dental Care structures, Family Planning structures, Infection Disease department, and other specialized departments.

The hospital functions in more than 25 buildings and has more than 3000 employees.

The activity of the hospital is structured on three important domains: medical assistance, medical university education and medical scientific research.

The medical personnel consist of medical professionals with high professional background, national and international recognized for their performance.

The beneficiaries of the services offered by the hospital are the patients from the North Western Region of Romania, through the emergency, preventive and therapeutically services performed, and also the students and all the medical staff which attend the educational courses organized in the hospital.

The development strategy of the hospital comprises all the three main activity domains, together with the strategy for an efficient organizational management, focused on raising accessibility for medical services, quality management, communication, satisfaction of patients and staff, correlation of the need for medical services with the hospital offer of services.

The mission of the hospital is:

1. Satisfying of patients needs, by providing medical services respecting basic principles: quality, cost control, patient and staff satisfaction, access to medical services.

2. Organizing the institutional frame for progress in medical knowledge.

The values promoted by Cluj District University Hospital are:

1. Universality: all community members have access to essential health services, with reasonable costs.

2. High quality medical services.

3. Cost-efficient medical services, based on needs and results.

4. Respect for personal dignity (patients and staff).

5. Solid system of data, used in rational strategic planning and decision making.

6. Integrated model for providing medical services.

7. Accent on long term strategies regarding medical assistance, medical education and medical scientific research. The vision of Cluj District University Hospital is: “To excellencies, through competence, professionalism and dedication, for people interest”.

	Dermato-Venerealogy Clinic		Ophthalmology Clinic

DONGWU OPTICAL INSTRUMENT

UV 100 UV 801 Autorefractokerato - metru

TIBOR PORACZKY 0744606944 RMK 200

No.46-Janvier 2010 Report of the IX Workshop

Willem J. Mulder                               Cluj-Napoca, ROMANIA

[With input from Ramunas Kondratas]

The IX Workshop of the Association was held in Cluj-Napoca in Romania from 2 till 6 September. The main host was the TEMCO Company of our member Prof. Dr Pompiliu Manea.

The official opening took place in the very beautiful Museum of Ethnography of Transylvania (thanks to Mrs. Prof. Simona Munteanu, the director) and was attended by the President of the Romanian Academy Acad. Ionel Haiduc, who specially came over from Bucharest and the Prefect of the city of Cluj-Napoca, Prof. Dr. Florin Stamatian. Also present were the Presidents Prof.dr Marius Bojița and Prof.dr. Radu Munteanu of the Medical and Technical University, both of Cluj-Napoca and also Prof.dr. Alexandre Herlea from the Université de Technologie de Belfort-Montbéliard, specialist in the history of science and technology. The attendance of those officials proves that the Romanian scientific and museum society searches for affiliation with the western museum world.

The scientific program was divided into three main themes: Radiology, Dermatology, and Ophthalmology collections.

Dr. Manea, being an expert himself in the field of radiology, owns a spectacular collection of radiology tubes - from several very early ones to more recent examples. He also has a vast collection of electro-physiotherapy apparatuses. Both collections are now in the newly opened, section of the National History Museum of Transylvania - the History Museum of Pharmacy, Medicine, and Medical Equipment. Extensive reports/illustrated talks were given about these collections and a visit to this very nice museum was part of the program. The pharmacy collection is extraordinary and spectacular. The medical collection is just beginning to grow with 20^th century instrumentation.

A visit to the dermatology cast collection of the Derma-Venereal Clinic of the Pharmacy and Medicine “Iuliu Hațieganu” University was also a part of our program. Prof. Dr. Alexandru Tataru gave a wonderful overview of the history of Romanian dermatology and demonstrated a splendid collection of moulages, photos, aquarelles, and books.

Prof. Dr. Cristian Bârsu, a medical historian, presented an illustrated history of the Medical University of Cluj-Napoca, especially explaining the importance of a great number of famous professors.

Willem Mulder followed, and in the spirit of the workshop, presented a practical museum application – a draft form (template) that could be used to describe and catalogue old medical photographs, such as those in the Utrecht University collection.

Our well-known colleague and long-time member of EAMHMS, Mrs. Dr. Eva Crișan, presented a very interesting overview of the ophthalmology collection in the Ophthalmology Clinic of the Pharmacy and Medicine “Iuliu Hațieganu” University and its history.

We also had an opportunity to visit that collection and meet Assoc.prof. Simona Talu, one of its caretakers. The housing of this collection is still poor and some advice was given to improve the conditions and care. Unfortunately, there was not enough time to do any practical work on the collections as such. In future workshops we, again, hope to return to our earlier practices and pay more attention to this aspect.

A “who knows what” question was presented by the Lithuanian delegation from the Lithuanian Museum of the History of Medicine and Pharmacy in Kaunas. This concerned some special electro-physiotherapy instruments in their collections that they had very little information about.

The experts in the audience were able to provide them with important information and further leads.

In order to clear our heads, a visit was organized to the very beautiful Botanical Garden of Cluj-Napoca. On top of that we had 2 post- workshop excursions: one to Sighisoara, a charming old walled-city on top of a hill, with a small pharmacy and medical collection in the Clock Tower Museum and a building marked as the birthplace of Dracula; and the other, on the last day of the workshop, to Romania’s most extensive Hydro-Power Station.

The workshop was attended by 17 participants outside of Romania, (Estonia, Russia, Sweden, Lithuania, USA, Netherlands), and another 12 local people. We regret that due to the world financial crisis, several colleagues had to cancel their participation and we hope this will change in the future, since we decided to continue these workshops. It is not clear yet which country and institution will host us next. In any case, it was very useful and nice to see old colleagues, meet new ones, and to discuss the very real and actual problems/issues facing medical museums, and museums in general, today.

All participants want to thank the European Association of Museums of the History of Medical Sciences for their kind support. Obviously, we also wish to thank our host Dr. Pompiliu Manea and TEMCO for their generosity and hospitality.

♦ Rapport du IXe Workshop ŕ Cluj-Napoca, Roumanie

Le IXe Workshop de l’association s’est tenu ŕ Cluj-Napoca, Roumanie, du 2 au 6 septembre 2009. Notre hôte principal était la société TEMCO, dont le directeur est un de nos membres, le Dr Pompiliu Manea.

La cérémonie d’ouverture a eu lieu dans le trčs beau Musée d’Ethnographie de Transylvanie (nous remercions le Pr Simona Munteanu, son directeur), ŕ laquelle ont assisté le président de l’Académie Roumaine, Ionel Haiduc, , qui est venu spécialement de Bucarest, et le préfet de Cluj-Napoca, le Dr Florin Stamatian. Etaient présents aussi les Prs Marius Bojita et Radu Munteanu de l’université de Technologie et Médicine, de Cluj-Napoca, ainsi que le Pr Alexandre Herlea de l’université de Technologie de Belfort – Montbéliard, spécialisé dans l’histoire des sciences et de la technologie. La présence de ces personnalités montre que le monde scientifique et les musées de Roumanie recherchent des contacts avec le monde des musées de l’Ouest. Le programme scientifique était divisé en trois thčmes principaux: collections de radiologie, dermatologie et ophtalmologie. Le Dr Manea, lui-męme expert dans le domaine de la radiologie, possčde une collection spectaculaire de tubes de radiologie – des plus anciennes aux plus récentes. Il a également une grande collection d’appareils d’électro-physiothérapie. Les deux collections se trouvent désormais dans la section «musée d’histoire de la pharmacie, de la médicine et de l’équipement médical» récemment ouverte au Musée national de l’histoire de la Transylvanie. Des rapports approfondis et des conférences ont été donnés autour de ces agréable musée faisait partie du programme. La collection de pharmacie est extraordinaire et spectaculaire. La collection médicale s’enrichit d’instruments du XXe sičcle. Il y eut aussi une visite de la collection appartenant ŕ la clinique de dermato-vénérologie de l’université du pharmacie et médicine «Iuliu Hatieganu». Le Pr Alexandru Tataru a fait un résumé magistral de l’histoire de la dermatologie en Roumanie et montré une collection splendide de moulages, photos, aquarelles et ouvrages. Le Pr Christian Barsu, historien de la médecine, a présenté une histoire illustrée de l’université de médicine de Cluj-Napoca, expliquant plus particuličrement l’importance d’un grand nombre de professeurs éminents.

Willem Mulder a ensuite présenté, dans l’esprit du workshop, une application pratique – un formulaire (template) qui pourrait ętre utilisé pour décrire et cataloguer de vieilles photographies médicales, comme celles de la collection de l’université d’Utrecht. Notre collčgue bien connue et depuis longtemps membre de l’AEMHSM, Mme Eva Crisan, a présenté la collection de la clinique d’ophtalmologie de l’université de pharmacie et de médecine «Iuliu Hatieganu» et son histoire.

Nous avons également eu l’occasion de visiter cette collection et de rencontrer une des personnes responsables, le Pr Simona Talu. Les conditions de conservation de cette collection sont encore pauvres et des conseils ont été prodigues pour les améliorer. Malheureusement il n’y a pas eu le temps de faire des travaux pratiques. Lors de futurs workshops nous espérons renouer avec nos anciennes habitudes et ętre plus attentifs ŕ cet aspect. Une question «qui sait quoi?» était organisée par la délégation lituanienne du musée d’histoire de la médecine et de la pharmacie de Kaunas. Cela concernait des instruments d’électro-physiothérapie de leurs collections pour lesquels ils avaient trčs peu d’informations. Les experts dans le public ont ainsi pu leur donner des informations précieuses et d’autres pistes. Dans le but de nous aérer l’esprit une visite au trčs joli jardin botanique de Cluj-Napoca était organisée. La cerise sur le gâteau était les deux excursions aprčs le workshop: une ŕ Sighisoara pour voir la petite collection de médecine et de pharmacie de musée de la Tour de l’Horloge et un bâtiment présenté comme le lieu de naissance de Dracula; la deuxičme ŕ la plus puissante station hydroélectrique de Roumanie.

Les participants venant d’autres pays que la Roumanie étaient au nombre de dix-sept (Estonie, Russie, Sučde, Lituanie, États-Unis, Pays-Bas) et les participants roumains douze. Nous regrettons qu’en raison de la crise financičre plusieurs collčgues aient dű annuler leur participation et nous espérons que cela changera ŕ l’avenir, puisque nous avons décidé de continuer ces workshops. Il n’est pas encore établi qui accueillera le prochain. Il était de toute façon utile et agréable de revoir d’anciens collčgues et de discuter de problčmes concrets et actuels que rencontrent aujourd’hui les musées en général. Tous les participants remercient l’AEMHSM pour son soutien. Naturellement nous souhaitons aussi remercier notre hôte Dr. Pompiliu Manea et TEMCO pour leur générosité et leur hospitalité.

Le 10 septembre 2009

Willem J. Mulder, coordinateur

Avec l’aimable participation de Ramunas Kondratas

September in Cluj, we did a workshop now professor Pompiliu

In Romania we’re singing loud professor Pompiliu

About medical

About technical

About historical

About pharmaceutical

About things most beautiful

And the honor we gave to you

In two days time we heard you speak professor Pompiliu

These two full day’s we learned a lot professor Pompiliu

About radiology

About dermatology

Electro-physiotherapy

And ophthalmology

About medical history

And it’s old technology

Also Romanian history

And the people of Transylvania

The workshop ends tonight, you know professor Pompiliu

Tomorrow we are in a turistical show professor Pompiliu

Thanks to Roxana

Thanks to Temco

Thanks to all your people

So kind and professional

Thanks for all we have got from you

The good wine and palinka too

Thanks for all we have got from you

The good wine and palinka too

William Mulder – together with all the Workshop participants

LE CENTENAIRE DE LA PREMIČRE PUBLICATION SUR LA

DIFRACTION DES RAYONS X

HORIA COLAN

Membre correspondent de l’ Académie Roumaine

La découverte de la diffraction des rayons X a travers les cristaux et son Application on cristallographie a fait époque pour la science des matériaux; elle est a la

Base de l’analyse diffractométrique, avec de multiples applications dans la caractérisation des matériaux: détermination des paramčtres cristallins, microanalyse chimique, détermination de la taille des grains, des textures et des tensions, etc. [1].

En 1912, Max von Laue a eu l’intuition de considérer que les équidistances Entre les plans réticulaires ont le męme ordre de grandeur que la longueur d’onde des Rayons X et a utilisé les cristaux comme des réseaux de diffraction en remplaçant les réseaux optique a paramčtre plus grand. Ensuite, en 1913, les deux Bragg ont démontré Que les spectres formes s’expliquent de maničre satisfaisante par l’hypothčse d’une réflexion sur les plans atomiques des cristaux, en établissant la loi qui porte leur nom.

W.Friedrich et P. Knipping ont réalisé expérimentalement l’idée de Laue et ont Obtenu sur plaque photographique l’image d’interférence des radiations. Les maximums d’interférence obtenus ressemblaient parfaitement ŕ ceux des radiations lumineuses, Confirmant de la sorte l’hypothčse de la nature ondulatoire des rayons X.

Pour cette découverte, il a été attribue a Laue le prix Nobel de physique en 1914. P.Debye et P.Scherrer ont développé la méthode (méthode des poudres) en utilisant un agrégat polycristallin a la place d’un monocristal.

MAX VON LAUE ET L’ISTOIRE DE LA DECOUVERTE

DE LA DIFFRACTION DES RAYONS X

Dans son livre Geschichte der Physique (1947), Max von Laue présente aussi les Principaux moments de la découverte et de l’application de la diffraction des rayon X. [2]. Les qualités du texte, la valeur et la profondeur des idées, le brillant exposé sont autant de raisons pour laisser en bonne partie parler Laue.

Francesco Maria Grimaldi (1618-1663) a fait les premičres observations dans le domaine de l’interférence et de la diffraction de la lumičre. Il a tenu a vérifier expérimentalement l’idée d’origine vaguement empirique que la lumičre se propage selon Toutes les rčgles de la géométrie et, a sa grande surprise, il découvre le phénomčne de la diffraction qui le conduit plus loin a l’hypothčse que la lumičre pourrait ętre de nature ondulatoire.

Au début du XIX sičcle (1821), Joseph v. Fraunhoffer (1784 – 1826) a découvert la diffraction ŕ travers les réseaux.

Friedrich Magnus Schwerd (1792 – 1871) a donne une interprétation ondulatoire du phénomčne (1835) dans son ouvrage Die Beugungserscheinungen aus den Fundamentalgesetzen der Ondulationstheorie analytisch entwickelt (Les phénomčnes de diffraction déduits analytiquement des lois fondamentales de la théorie ondulatoire). Laue montre que l’idée d’interférence « est des lors une des conquętes les plus précieuses de la physique. Toutes les fois que nous sommes en présence d’une radiation de nature inconnue, nous essayons de produire des interférences; si nous y parvenons, son caractčre ondulatoire est démonté» (p. 51)

En novembre 1859, «la connaissance du spectre de la lumičre s’est considérablement amplifiée par la découverte de Wilhelm Conrad Röntgen (1845 – 1923) qui a fait époque» et pour laquelle il lui a été décerné, en 1901, le premier prix Nobel de physique.

L’année suivante, des chercheurs comme E. Wiechert et G. Stokes ont considéré que les rayons X sont une radiation lumineuse ŕ trčs courte longueur d’onde, mais la plupart continuaient d’ętre convaincus que les rayons X sont corpusculaires. La confirmation complčte du point de vue des premiers n’est survenue qu’en 1912 par les expériences d’interférence réalisées par Walter Friedrich et Paul Knipping sur les réseaux atomiques spatiaux des cristaux. Les expériences ont constitue la victoire de l’hypothčse plus ancienne des réseaux spatiaux des cristaux et de l’hypothčse énoncée par Max von Laue (1879 – 1960), en prouvant l’interférence des rayons X passes a travers le réseau cristallin.

«Dans ces expériences il a été trouve aussi la premičre preuve décisive de la nature ondulatoire des rayons Röntgen, que jusqu'ŕ ce moment-la d’importants chercheurs avaient niée en raison des phénomčnes quantiques trčs prononcés qu’ils présentent. La théorie de ces phénomčnes, donnée par Laue des la premičre publication sur ce thčme et confirmée quantitativement, est une petite généralisation de celle obtenue en 1835 par Schwerd pour les réseaux optiques. Elle a été pour peu de temps seulement mise en doute par certains d’entre eux» (p. 168)

Puisque jusque lŕ les paramčtres du réseau pouvaient ętre estimes approximativement seulement comme ordre de grandeur, la détermination de la longueur d’onde était impossible. On ignorait combien d’atomes contient chaque cellule du réseau spatial. En 1913, William Henry Bragg (1862 – 1942) et son fils William Lawrence Bragg (1890 – 1971) utilisent l’hypothčse formulée par William Barlow (1845 – 1934) en 1898 sur la structure du NaCl, basée sur l’idée de l’entassement le plus dense des sphčres. Au moyen des intensités des maximums d’interférence, ils ont confirme cette structure, ont établi la constante du réseau et a partir de celle-ci la longueur d’onde des rayons X et ensuite ils ont pu déterminer grâce a cette derničre les constantes des réseaux des autres cristaux. De la sorte, un an aprčs Laue, il leur a également été décerne le prix Nobel en 1915.

Pour des métaux comme Al, Cu, Mg on a confirmé la disposition des atomes dans l’entassement le plus compact de sphčres (cellule cubique ŕ faces centrées ou cellule hexagonale compacte), conformément ŕ celui prévu en 1611 dans un écrit de Kepler.

La détermination des longueurs d’onde a constitue la base de la spectroscopie ŕ rayons X (les radiations caractéristiques K, L, M,…), crée ŕ partir des travaux des deux Bragg, de H.G.I. Moseley, etc.

A l’aide des rayons il a été mis en évidence que, le plus souvent l’état cristallin ne résulte pas en cristaux uniques ŕ faces géométriques mais par une structure microscopique formée de grains a surface irréguličre disposes de façon aléatoire. A juste raison, Laute dit : «C’est pourquoi toute la théorie atomique du corps solide, par exemple la théorie quantique de la conductivité électrique, a pour point de départ le réseau spatial» (p. 170)

Mais Max von Laue présente le mieux l’historique de sa grande découverte dans son ouvrage autobiographique «Mon chemin dans la physique», paru dans le livre de Hans Hartmann Schöpfer des neuen Weltbildes (Créateur de la nouvelle image du monde) [3].

Comme étudiant, arrivant de Göttingen, Laue a effectue ŕ l’Université de Munich des travaux pratiques diriges par Röntgen ; ensuite, ŕ Berlin, il a fréquente le cours d’optique théorique de Max Planck, a passe son doctorat en 1903 et est devenu ŕ partir de 1905 assistant de Planck.

En 1909 il est revenu ŕ l’Université de Munich, oů aux côtés de Röntgen travaillant Arnold Sommerfeld (1868 – 1951) qui avait occupé la chaire devenue vacante de Boltzmann. Sommerfeld soutenait la nature ondulatoire des rayons X, «en contredisant la théorie corpusculaire que W.H. Bragg soutenait énergiquement en Angleterre» (p. 217). En appliquant la théorie de la diffraction, il a réussi ŕ obtenir la valeur moyenne de la longueur d’onde (1912).

Męme Röntgen, «aprčs les expériences de Friedrich et Knipping, a longtemps refuse catégoriquement de reconnaître l’explication de l’interférence». (p. 218)

En février 1912, P. Ewald a demande ŕ Laue son opinion concernant le comportement des ondes lumineuses dans un réseau spatial d’atomes polarisés.

«Pendant la discussion du problčme, il m’est soudain venu l’idée qu’il fallait tenté de passer ŕ travers les cristaux des ondes plus courtes, ŕ savoir des rayons Röntgen. Si les atomes forment effectivement des réseaux spatiaux, alors il doit se produire des phénomčnes d’interférence similaires ŕ l’interférence de la lumičre dans les réseaux optiques. » (p. 220)

Friedrich, assistant de Sommerfeld, a décidé d’effectuer des recherches a se sujet bien que «Sommerfeld ne s’attendit a rien de la part de cette idée». Conjointement avec Knipping qui préparait son doctorat ŕ Röntgen, ils ont démarré les expérimentations au printemps de l’année 1912. Ils sont arrives au résultat que «le photogramme de la radiation d’un morceau de sulfate de cuivre présentait en dehors du rayon Röntgen initial, l’anneau du spectre de diffraction du réseau», confirmant l’idée de Laue et sa théorie de la diffraction dans les réseaux optiques.

«Le 8 juin 1912, j’ai communiqué cette découverte dans une réunion de la Société Allemande de Physique, a l’Institut de physique de l’Université de Berlin, au męme endroit oů, en décembre 1900, Planck avait parlé pour la premičre fois de la loi de la radiation et de la théorie des quanta» (p. 222).

Et, plus loin (p. 223)

«L’histoire de la découverte de l’interférence des rayons Röntgen illustre clairement la valeur de l’hypothčse dans la science…C’est exclusivement l’hypothčse du réseau spatial du cristal qui a suggčre l’idée de la nécessité d’entamer des recherches sur ces rayons».

Dans son discours d’ouverture du Congres des Physiciens, ŕ Würzburg, le 18 septembre 1933, Laue disait (p.231) :

«Si nous nous réunissons demain ŕ l’Institut de physique de l’Université actuelle, nous nous trouverons dans un lieu historique. A la fin de l’année 1895, Wilhelm Conrad Röntgen a découvert dans cet édifice les rayons qui portent son nom».

DUMITRU BUNGEŢIANU ET LA DIFFRACTION DES RAYONS X

Le nom de Dumitru Bungetianu (1860 – 1932), professeur de physique ŕ l’Université de Bucarest, est lié aussi ŕ cet événement décisif de l’histoire de la science des matériaux : la découverte de la diffraction des rayons X déjŕ en 1896, immédiatement aprčs leur découverte par Röntgen et 16 ans avant les travaux de Max von Laune.

La priorité concernant l’idée de l’interférence des radiations Röntgen, exprimée avec une conviction inébranlable, appartient ŕ Bungetianu. Les résultats des expériences et ses conclusions ont été publies dans le revue L’Eclairage électrique, tome VII du 25 avril 1896, no 17, pp. 165 – 167 [4], [5]. Le titre de l’article est sifnificatif : La diffraction des rayons X. Le Directeur scientifique de la revue J. Blondin présente ainsi la lettre de Bungetianu :

«Les nombreuses tentatives faites jusqu’ici pour rechercher si les rayons X peuvent interférer n’ont donne que des résultats négatifs. M. Bungetziano, Professeur de physique a l’Université de Bucarest, nous communique a ce sujet la lettre suivante. A cause de l’importance des résultats qu’elle relate, nous avons cru devoir publier immédiatement cette lettre, sans nous dissimuler toutefois que sec résultats sont sujets a critique et auraient besoin d’ętre confirmes avant d’ętre admis sans restriction».

Bungetianu commence sa lettre par une affirmation catégorique :

«Je vous adresse quelques photographies qui prouvent bien que les rayons X peuvent interférer par diffraction».

Ensuite sont présentées les expériences effectuées, les résultats obtenus concrétises dans trois photographies du phénomčne ainsi que leur interprétation et les conclusions. Quelques citations :

«…cette ombre est entourée de deux franges circulaires dues ŕ la diffraction des rayons invisibles».

«Les franges d’interférence, que montre la photographie n° 3, sont produites avec une régularité qui rappelle les phénomčnes analogues de la lumičre ordinaire

«De tout ceci, il ressort clairement que les rayons X, ou du moins une catégorie de ces rayons, possčdent la propriété d’interférer par diffraction.

Ce fait a, comme on le devine, une importance scientifique indiscutable ; d’abord l’hypothčse de la propagation de ces rayons par deux ou bombardement moléculaire se trouve réduite a néant ; ensuite la périodicité de la vibration de cette radiation s’affirme sans conteste ; finalement la possibilité de mesurer la longueur d’onde de ce mouvement vibratoire apparaît plus proche. Je regrette pour ma part que l’insuffisance de mes moyens de recherches ne m’aient pas permis d’entreprendre cette mesure de longueur d’onde, bien que je fusse en possession du phénomčne depuis quelques semaines».

Sans tenir compte de la valeur des résultats expérimentaux, le fait important est que Bungetianu a été un des premiers chercheurs qui a soutenu l’idée de la nature ondulatoire des rayons X.

Bungetianu a publié aussi un autre ouvrage sur les rayons X [6] présenté ŕ Bucarest le 14 mars 1896, ŕ plus d’un mois avant celui de Paris. Il est intitulé Razele lui Röntgen (Les rayons de Röntgen) et comprend dans 15 pages une ample présentation des rayons X, ou, tel que dit l’auteur «en quoi résident ces rayons, quelles sont leurs propriétés établies jusqu'ŕ présent par les recherches, quelles sont les opinions des savants sur leur nature» (p. 4). Parmi ces derničres : «flux moléculaire», «propagation par vibrations longitudinales ou transversales de l’éther», etc.

C’est tout ŕ fait surprenant que dans cet ouvrage, n’ayant paru que trois mois aprčs l’historique communication de Röntgen sur la découverte des rayons X, le physicien roumain a eu l’intuition de prévoir que la longueur d’onde de ces rayons est du męme ordre de grandeur que celui des distances entre les atomes (les paramčtres du réseau). C’est ainsi qu’ŕ propos de l’explication de la pénétration des métaux par les rayons X, métaux qui dans la théorie de Maxwell étaient considérés opaques, Bungetianu dit (p. 14) :

«Cependant on pourrait résoudre enfin cette difficulté d’interprétation si on supposait que la vibration de l’éther serait trčs rapide, c’est-ŕ-dire qu’elle aurait une période de męme petitesse que la distance entre les molécules de la matičre ; en ce cas la longueur d’onde correspondante serait trčs petite et la propagation parmi les molécules des corps, admissible».

Dans l’histoire des sciences et des techniques, bien des fois une grande découverte est le résultat de l’accumulation d’une longue suite d’observations et de recherches qui permettent plus tard, par leur systématisation et généralisation, de pénétrer la nature du phénomčne et établir ses lois.

Le mérite de Bungetianu, ainsi qu’il résulte de ce qui a été dit ci-dessus, malgré les expériences non rigoureuses effectuées, est qu’il a eu la conviction ferme de la réalité de l’interférence des rayons X, de leur nature ondulatoire et qu’il a prévu l’ordre de grandeur, le męme pour leur longueur d’onde et pour la distance interatomique. Il n’a pas utilise de cristaux et a mis l’apparition des franges d’interférence au compte de l’hypothčse de la création de plusieurs centres secondaires d’émission de rayons X (phénomčne observe aussi par V.P. Linnik en 1930).

Dumitru Bungetianu était licencié en mathématiques de l’Université de Iasi, puis de la Faculté de sciences de Paris, également en sciences physico-chimiques. Il a suivi des cours ŕ la Sorbonne et au Collčge de France et a fait des études de météorologie ŕ Paris, Berlin, Hamburg et Petersburg.

Relativement ŕ la recherche réalisée sur les rayons X ŕ peine découvertes et leur utilisation, il convient de citer le nom du physicien Dumitru Hurmuzescu (1865 – 1954) qui a passé son doctorat avec Gabriel Lippmann en 1896 et découvre la męme année, en collaboration avec le physicien français René Benoit (1844 – 1922), le fait que les rayons X rendent l’air ŕ travers lequel ils passent, bon conducteur d’électricité.

Le médecin Constantin Dumitrescu – Severeanu effectue ŕ l’hôpital Coltea de Bucarest les premičres radiographies du pays. Et toujours en 1896, le neurologiste Gheorghe Marinescu, en utilisant l’appareil Röntgen construit par D. Hurmuzescu et R. Benoit, réalise les premičres radiographies au monde pour établir le diagnostic différentiel entre l’acromégalie et l’érythromégalie.

BIBLIOGRAPHIE

H. Colan, Histoire de la science des matériaux – Périodes et contributions roumaines, Académie Roumaine, NOESIS, Travaux du Comite Roumain d’Histoire et de Philosophie des Sciences XX (1995), pp. 115-122.

M. v. Laue, Istoria fizicii, Editura stiintifica, Bucuresti, 1963 (Geschichte der Physik, Ullstein Bücher, Berlin 1958).

M. V. Laue , Drumul meu în fizica. Dans: Istoria fizicii [2] (Dans: Hans Hartmann, Schöpfer des neuen Weltbildes, 1952)

I. Ivanov, A. Negoescu, Contributia stiintei românesti la descoperirea difractiei radiatiilor Roentgen, Revista Învatamântului Superior 9 (1967), Nr. 4, pp. 71-76.

D. Bungetianu, La diffraction des rayons X. L’Eclairage Electrique, Revue hebdomadaire d’électricité, Paris, Tome VII, 3 (1896), No. 17 (25 avril), pp. 165-167

D. Bungetianu, Razele lui Röntgen, Conférence donnée devant la société des Amis des Sciences Mathématiques (Séance du 14 mars 1896), Bucuresti, Tipografia Gutenberg, Joseph Göbl, 1896.

H. Colan, A century since the first publication regarding the X-ray diffraction, 23rd Symposium of the International Committee for the History of Technology, Abstract of Papers ICOHTEC 96, Budapest 7-11.08.1996, p. 211.

Comparison between 4 panoramic X-ray retrofit options

Dipl. ing. Alexandru Cetateanu

	DXIS	AJAT	SCHICK	PSP–All Companies
Technology used1 (see explanations under)	CCD (Charge-Coupled Devices)	Cadmium Tellurium	CMOS (Complementary Metal Oxide Semiconductor)	Memory Phosphor plates
Picture quality2	Good	Better	Acceptable	Good
Radiation reduction3	30 to 70% less radiation	No reduction at all	No reduction at all	No reduction
Sensor size4	10 x 2 x 2.5 inch	12x10x5 inch	10x 2 x 0.5 inch, fixed on the film drum or cassette	N/A 5
Computer connection6	Single coaxial cable up to 100m	Thick, multiple wires cable	Thick, multiple wires cable	N/A
Power supply7	Self-powered from the computer connection	AC/DC Power Supply	AC/DC power supply	N/A
Compatibility8	21 different models and manufacturers	8 different models and manufacturers	12 different models and manufacturers	ALL, including Cephs
Pixel size9				unknown
Product available since10
Real Time11	YES, the picture is seen during the rotation	YES, the picture is seen during the rotation	NO, the picture will be seen after the end of Pan rotation	NO, requires Scanner – the picture becomes available in a few minutes; similar to film
Lines pairs12
Removal of the old film mechanism13	YES	YES	NO	NO
Ceph option available14	NO	NO	NO	YES
Full control of the X-ray Pan15	YES	NO	NO	N/A
Different layers on focus16	NO	YES	NO	NO
Visibility for positioning the patient17	More visibility than before the conversion to digital	Less visibility than before the conversion	Same visibility as before the conversion	Same visibility as before the conversion
Time required to see the image18	Rotation time plus 2 seconds	Rotation time plus 2 seconds	Rotation time plus approximately 10 seconds	2 to 10 minutes; varies according to the chosen quality level for the image
Picture size19	12.7x 30 cm	15x30 cm	15x30 cm	Same as films
Time to Install 20	4-6 h (depends on the model of the Pan)	About 5 h	About 2 h	About 2 h
Price 21	About $16,000	About $16,000	About $14,000	About $20.000

Notes:

a. CCD (Charge-Coupled Devices) technology, same as the one used in digital photo cameras, but requiring a lot larger sensors. It is expensive, but very stable and reliable. The two inventors of the CCD, among which one is Canadian, were awarded the Nobel Prize for Physics in 2009. Using this technology for taking X-rays requires a scintillation plate inside the sensor, which reduces slightly the quality of the image.

b. Cadmium - Tellurium technology is new and reliable but rather expensive. It does not require a scintillation plate, but requires instead many electronics, resulting in a larger sensor.

c. CMOS technology - less expensive, but also delivers lower quality pictures. It also requires a scintillation plate inside the sensor.

d. PSP technology - film like (a lot thicker) phosphor plates. Unlike films, will not require chemicals for processing, but will require a special, expensive scanner to read the image from the plates. Time to read the plate depends on the size and the resolution and may go up to tens of minutes for highest quality images. Also, there is a recurring cost for changing the phosphor plates and the sleeves after a certain number of exposures.

The picture quality looks better with Tl-Cd Sensors, and good with CCD and PSP. Both the choice of CMOS technology and the design employed in the retrofit kit from Schick lead to the result that that the quality and the geometry of its X-ray images is not as good and stable as with the other systems.

Only DXIS will reduce the radiation, by replacing the primary slot surface with a new slot. Depends on the Pan model to be retrofitted to Digital, the reduction is between 30 to 70%). All the others will use the same device as the one used for films, meaning the same radiation level for the patients. The rotation time cannot be reduced and the KVp also (the KVp level is dependent of the size of the patient head – bigger head – more kVp is required).

Sensor size is important for the visibility required to position the patient properly, which is very important in order to obtain good pictures.

As this technology uses a scanner, the size of the phosphor plates used for taking X-rays is the same as for films. Consumables still required (phosphorus plates, sleeves etc ) .

It is preferable to have less wires and connectors, as this means a more reliable system.

The presence of an AC/DC adaptor may lead to possible electrical noise interference with the picture. A battery is the best solution as it does not produce interference, it is not expensive, but will have to be replaced each 4-5 years. Among the systems tested, only DXIS uses a battery.

See the retrofit systems available for different models of Panoramic X-ray machines in the annex.

A smaller pixel size is the preferable.

Date when the system was first available on the market.

Desirable feature. Seeing the picture during the rotation of the arm will prevent an all-too often seen and very unpleasant situation – a patient is fully exposed to X-ray (12 to 18 seconds), but no picture is produced at the end, due to wrong settings being used, or no film being loaded. With the “real time” feature, should any error occur, the operator can stop the exposure after only 2-3 second, and do the necessary correction. This feature prevents patient frustration over being doubly exposed to radiation.

More lines pairs of the image, better picture quality.

By removing the old film mechanism (Cassette or film drum, plus all the belts, motors, sensors etc) a lot of sources of malfunctions will be prevented, and consequently the usable life of the machine is increased. The conversion from film to digital will be permanent with AJAT and DXIS systems (or very time consuming to reverse back to film), and very easy with the Schick system. With PSP there is not any change at all – the machines will operate exactly in the same ways as with film.

The biggest (and only) advantage of PSP systems over the direct digital systems is the availability of the CEPH option. For the Pan - Ceph machines, the Ceph part cannot be converted to digital as of now because of the high cost of the sensors, and in the case of the DXIS and AJAT systems, the Ceph will not be usable after the conversion, not even with films.

It is an extra safety features. In some US states it is forbidden for an equipment to emit radiations to the patients if there is no (for different reasons) acquisition of the picture.

Only AJAT has this feature – if a part of the x-ray is not on focus (blurry part of the picture) the software has the possibility to move back or forward between the layers, so that the blurry part of the picture becomes useable.

The DXIS is the best with this respect. The AJAT the worst.

Real time speed does not exist per see, as a delay of 2 seconds exists even with the DXIS and AJAT systems. The 2-seconds delay appears when transferring the large panoramic image to the computer. With the Schick system the picture will be seen after the end of the arm rotation. With the PSP the time it is almost the same as with films.

It was the European Medical Society belief that the Tyroid Gland and the Optic Nerve should not be exposed to X-ray radiation. That’s why the DXIS sensor is 12,7 cm and the others (USA manufactured or for USA use) are 15.00 cm width. A lot of European Pan models are using 12,7 cm films. By proper positioning (head up or down on the chin rest) the TMJ or the complete chin will be seen on the picture.

Depends on the Pan Model.

The price depends on the complexity of the retrofit system. This are approximate figures.

Note: This is an attempt to present the differences between the different systems at the best of our knowledge. Any observations and additions to this comparison are very well welcome. Please send your observations to [email protected]

Thank you!

Annex: the models compatible with the retrofit kits

The DXIS System is compatible with the following 21 machines:

The AJAT System (SCAN 300 FP) is compatible with the following 7 machines:

The Schick System (iPan) is compatible with the following 10 machines:

MITUL CONDUCĂTORULUI OMNISCIENT

Prof.dr. Ozana Kalmuski – Zarea

Director artistic al Filarmonicii “Mihail Jora” Bacau

Abstract: A leader should be endowed with/hould prove/skills that confer him on the position as a leader. A leader is the one endowed with charisma, influence,the ability to analyse and with a high ability to use knowledge and people, the one that can impose himself and so he /she justifies his /her position as a leader. The opposite of a leader is the one that hides his weaknesses through authoritarianism /by being authoritarian.

Keywords: leader,omniscient, power, knowledge

Ne desparte prea putin timp de perioada în care partidul unic “pregatea” în scolile sale oameni buni la toate si la nimic. Academia “stefan Gheorghiu” era instrumentul specializat în fabricarea acestor produsi rezultati din combinarea “E”-urilor marxiste. Prefabricatul obtinut putea fi utilizat, asemeni unui veritabil jolly – jocker atât în cultura cât si în agricultura, atât în conducerea unui spital cât si unei ferme de pasari. Curând aceste procedee ar putea fi uitate. Nu au uitat însa si cei care înca mai conduc dupa preceptele de tip stefangheorghist.

Cei mai multi au pastrat înca mentalitatea ca esenta conducerii este puterea, desi cu niste secole mai înainte Francis Bacon, afirmase ca puterea înseamna cunoastere. Deasemenea multi dintre ei cred ca a conduce înseamna a administra; ceea ce e o mare eroare întrucât a conduce înseamna a influenta oamenii potrivit unui scop si unei viziuni pe care o are conducatorul. Daca o are.

Ca director adjunct al unei institutii de cultura m-am confruntat cu diferite situatii si am avut adeseori posibilitatea sa constat ca, în cel mai bun caz, un manager poate mentine o anume directie, dar lipsa însusirilor de conducator nu-l poate aduce în pozitia de lider, de a impune o anume directie, adica de a face din el un veritabil conducator.

Desigur, un coeficient important în reglarea mecanismului directionarii oamenilor si proceselor îl joaca inteligenta. Dar inteligenta nu e întotdeauna un factor favorizant al managementului; se întâmpla sa întâlnim persoane, personalitati a caror capacitate de sinteza si de viziune depaseste cu mult nivelul mediu, dar a caror abilitate în a conduce lipseste cu desavârsire.

O alta parere gresita privind mitul conducatarului este chiar faptul de a se afla, la un moment dat în postura de conducator. Aceasta îl asimileaza îndeobste în ochii celor din jur, persoanei cu anume calitati, cu anume abilitati si anume înzestrari naturale sau dobândite care, l-ar îndreptati sa ocupe aceasta pozitie în societate, deasupra altora ca el dar lipsiti de însusirile respective.

De regula, cel aflat în aceasta pozitie este convins ca o merita pe deplin. Ca întruneste toate cerintele necesare ocuparii ei. Ca nimeni altcineva din cei aflati mai jos pe scara ierarhica nu dispune de abilitati si potential asemanator, ceea ce conduce mai întotdeauna la instaurarea unui regim de management autocratic, în care, treptat, psihoza detinerii adevarului unic îl va cuprinde pe personajul descris aici si are toate sansele sa se instaleze temeinic.

Simultan, managerul omniscient si autocrat va pretinde ca omniscienta sa-i fie recunoscuta la tot pasul si în toate actele, deciziile, hotarârile, chiar daca sunt sau devin contradictorii, confuze, absurde, aberante sau ilogice. Aceste masuri vor fi cu atât mai imperioase si mai inflexibile cu cât persoana în cauza va deveni constienta de statutul sau de inferioritate manageriala fata de alta persoana, sau persoane, capabile sa dea un impuls nou societatii respective, firmei sau institutiei.

El va deveni constient ca nu pozitia îl face lider, caci liderul este acela care, prin carisma, influenta, capacitate de analiza si o buna utilizare a cunostintelor în domeniu îl poate impune si în acest fel poate pretinde pozitia. Pe de alta parte asa cum cunoastem si observam din practica româneasca de zi cu zi, nu ne-am departat prea mult de modelul gregar inventat de socialism în materie de management, asa încât nu putem vorbi în momentul de fata de o societate a meritocratiei în care conducatorului de jure sa i se recunoasca valoarea si, implicit sa fie asezat de societate la locul cuvenit. Cine sunt cei care decid pentru cei care urmeaza sa decida?

Aici ne aflam în plin aleatoriu întrucât, în cele mai fericite cazuri, pentru alegerea, sa spunem, a unui manager de teatru, vor hotarî si alti trei – patru oameni de teatru. Dar aici trebuie sa mai vorbim de ingerinte a caror influenta se afla, din pacate, în cele mai multe cazuri, deasupra stampilei pe care o vor pune cei trei – patru papusari. Fiindca chestiunea, pusa în termenii ei reali, românesti, caci despre asta vorbim, este: pe cine vrem în locul cutare? Sau: avem nevoie de cutare? Pentru ca acei ce decid cine urmeaza sa decida au, întotdeauna nevoie de navigare lina, lipsita de probleme si, doamne fereste, convulsii.

Managerul ales, atunci când e rezultatul acestui gen de târguieli, ramâne, în buna masura, dator celor care l-au propulsat în pozitia respectiva. Altfel spus el nu va putea – chiar daca prin absurd am admite ca vrea – sa impuna o anume linie personala, o anume directie colectivului a carui conducere i s-a încredintat.

Deciziile sale, dispozitiile cu oarecare anvergura vor fi întotdeauna dependente, marcate de teama de a nu gresi fata de optica, de conceptia protectorilor sai, ramânând, astfel, un executant docil, chiar involuntar al vointei altora. În atare situatie aliatii pe care îi va lua – pârghiile de care se va servi vor fi dintre subalternii cei mai neînsemnati si lipsiti de personalitate. Impresia sa va fi ca oamenii pot fi cumparati prin favoruri mai mari sau mai mici, în vreme ce aceia care primesc respectivele favoruri vor sti ca acestea nu vin ca urmare a meritelor ci a slabiciunii sefului care doreste sa le cumpere acceptarea.

Opusul acestui model este, se poate banui cu usurinta, liderul care-si camufleaza slabiciunea prin autoritarism. Acesta e constient de ignoranta sa în materie de conducere, dar crede ca, oricum, poate compensa aceasta lacuna prin comportament autoritar, actionând potrivit principiului prelucrat: “biciul stapânului îngrasa vita”.

Managementul acestui tip de conducator va fi unul de tip contrainformativ; cu spioni în toate compartimentele, cu masuri de stimulare a celor fideli si, reciproc, de intimidare a celor indezirabili. Managerul de aceasta factura va fi în proportie de 100% tipul cu pretentie de conducator omniscient, adica cel mai periculos exemplar din toate posibile. Mai întâi pentru ca a forma un conducator bun e nevoie de un model bun. Iar de mai bine de jumatate de secol noua ne-au lipsit modelele bune. Am avut însa, din belsug din cele rele. Apoi, pentru ca aceia care vor sa conduca, nu sunt animati de dorinta de a schimba în mai bine ci pur si simplu de a pastra cât mai bine ceea ce li s-a pus la dispozitie. Adica puterea asupra celorlalti.

În al treilea rând, pentru faptul ca, ajuns în pozitia respectiva el nu doreste sa se înconjoare de oameni capabili carora sa le delege anumite sarcini si nici ca altcineva sa se amestece în deciziile pe care le ia, instinctul de conservare si viclenia, teama de concurenta si de stirbire a autoritatii fiind tot timpul prezente. Or, se stie, potentialul fiecarui lider e determinat de cei care-l ajuta si pe care se bazeaza iar oamenii îl urmeaza. În mod natural ei urmeaza pe cel mai puternic decât ei însisi, îl dispretuiesc pe cel mai slab si îl accepta pe cel asemeni lor – dar nu-i acorda nici un respect.

Ar mai fi poate necesar, în economia acestor succinte notatii sa adaug si un aspect pe care multa lume îl cunoaste din experienta relatiilor interumane stabilite în cadrul unui grup de lucru. Este necesar sa amintesc ideea ca autoritatea si exercitarea puterii de decizie sunt fundamentale în materie de conducere a unui colectiv. Când seful acestuia nu detine însa însusirile de lider si aptitudinile de conducator atunci, din cadrul grupului, a colectivului vor aparea cu necesitate persoane care sa-i suplineasca inabilitatile.

Acestia sunt manipulatorii de conducatori, cei care, aflati în umbra se substituie autoritatii sefului, îi insufla deciziile, îi sugereaza actiunile, adesea nu în interesul grupului ci potrivit propriilor lor interese si prioritati partizane. În managementul cultural situatia descrisa, care din nefericire, nu se rezuma la aspectul teoretic, conduce la degradarea si scaderea accentuata a nivelului artistic, la provincializare si la dezbinarea întregului colectiv, care nu mai resimte sentimentul de apartenenta nici la grup nici la actul de cultura pe care, prin natura profesiei, trebuie sa-l presteze în fata publicului.

Confruntându-ma cu probleme din cele mai diverse, de la acelea de personal pâna la cele legate de resurse am ajuns la concluzia ca una dintre cauzele degringoladei în care ne aflam de mai multa vreme nu este doar reformarea mult discutata a clasei politice. Mai important, consider, în momentul de fata s-ar impune reformarea modelelor perimate de promovare potrivit meritelor reale, nu închipuite. Nu candidatul trebuie sa dovedeasca faptul ca doreste un post, ci societatea sa decida daca are nevoie de el sau nu. si nu ma gândesc doar la CV-uri, fiindca nu CV-urile fac manageri si lideri, ci la necesitatea societatii în folosirea unor anume aptitudini si nu a altora. Deseori se construiesc CV-uri tocmai pentru a camufla lipsa competentei.

Concursurile de CV-uri pentru ocuparea unei pozitii de lider nu tin cont de faptul ca însiruirea unor certificate, diplome, atestate ori abilitati mai sunt sau nu valabile, necesare sau oportune functiei pusa în joc.

Nu se pune niciodata în fata candidatului o problema reala care sa-i evalueze intuitia, viteza de gândire si calitatea deciziei, originalitatea în abordarea situatiei sau problemei, oportunitatea sau neoportunitatea deciziei respective.

În atare situatie concursul de CV-uri ramâne litera moarta si nu examen de competente. Îmbunatatirea care se asteapta în conducere va ramâne mai departe un deziderat câta vreme în loc de un concurs al meritelor avem o eterna birocratie repetitiva. Caci valoarea durabila a unei bune conduceri se masoara prin valoarea succesiunii, nu prin simpla ei înlocuire.

Pentru ca, daca un presupus conducator da dovada repetat de decizii eronate sau blamabile, fie si în actiuni marunte, atunci subalternii vor sti ca adevarata problema e faptul ca îl au pe el ca lider. Iar în managementul cultural o astfel de situatie duce la mistificarea actului de cultura.

Mitul conducatorului omniscient consta în faptul ca el crede despre el ca are întotdeauna dreptate, ca întelege mai bine decât altii, vede mai bine decât altii, mai departe decât ceilalti. Adevaratul conducator stie însa ca are nevoie doar de o calitate pentru a fi lider: aceea de a întelege ori a vedea înainte ca altii sa vada sau sa înteleaga.

BIBLIOGRAFIE

1. Bacon, F. – Eseuri, Ed.Stiintifica, Bucuresti, 1969, (în traducerea lui Armand Rosu)

2. Tannenbaum, R. si Schidt, W. – „How to choose a leadership pattern”, Harvard Business Review, 1958

3. Thompson, R. – The Effective Manager, Book 7 „Leadership and Power”, The Open University, Marea Britanie, 1996

UNIC DISTRIBUITOR   

TIBOR PORACZKY

0744606944

O SINGURĂ CERTITUDINE

Prof. dr.Constantin Calin, Universitatea Bacau

Abstract: the paper addresses some causes of our education non-reformation

Keywords: corruption, education, interest

Se pare ca nici pedagogii nu-i mai citesc pe clasicii lor. Daca i-ar citi, nu s-ar limita la jargonul sindicalist cînd abordeaza problemele învatamîntului: bani, investitii, infrastructura etc. Ar situa în centrul dezbaterilor profesorul.

Într-o epoca asemanatoare în multe privinte cu a noastra s-a spus apasat, cu deplina dreptate: “Atît pretuieste scoala, cît pretuieste profesorul”. si: “Cum e nivelul profesorilor, asa este nivelul oricarui popor modern”, (S. Mehedinti, Profesorul temelia tuturor reformelor scolare, Ed. Socec & Co., 1929, p. 6, 8). Autorul întelegea prin profesor, omul capabil sa-i educe pe tineri, sa-i formeze, sa le dea „cresterea” potrivita. Omul care, pe lînga stiinta, are metoda, tact, autoritate. Cîti din acestia sînt azi? Din solidaritate de corp, din ipocrizie, din lasitate, întrebarea e mereu ocolita. Or, adevarul dureros e ca în învatamîntul actual, mai mult decît în trecutul apropiat, exista o mare promiscuitate; insi calificati si insi de strînsura; cu însusirile necesare si fara; care-si gîndesc activitatea în termeni de misiune si care si-o gîndesc în termeni de „serviciu”; devotati si superficiali; seriosi si rigolarzi; exigenti si indulgenti sans rivage; drepti si clientelari etc.

Din pacate, la toate nivelurile, cei din a doua categorie au devenit numerosi. Aceasta promiscuitate produce în multe locuri o atmosfera deletera, de bîrfe si complicitati, deceptionanta pentru firile oneste, pentru cei ce urasc mediocritatea si vulgaritatea.

Curios, însa, despre asemenea aspecte si despre altele, care frîneaza încercarile de reforma, nu se prea discuta. Nu se discuta, de pilda, despre lipsa de consideratie la care profesorii au ajuns în mediile unde functioneaza, despre suspiciunile de incompetenta si de coruptie cu care, adesea pe nedrept, sînt priviti, despre irespectul aratat de proprii lor elevi si studenti. E drept, nu odata, aceste atitudini ofensatoare pentru întreaga tagma pornesc de la situatia materiala, inferioara celei a jandarmilor si administratorilor de bloc, sa zicem. Dar, daca ar fi absolut sinceri, profesorii ar trebui sa recunoasca faptul ca sînt între ei destui avizi de avantaje, versati în compromis, interesati de relatii cu „lumea buna”, slugarnici fata de sefii lor (inspectori, directori), „negustori în Templu”, care ignora ca, etimologic, examen înseamna cumpana; acul, limba cîntarului, iar cumpana celui de la catedra, ca si a judecatorului, trebuie sa fie întotdeauna exacta. Sau ca unii nu citesc, nu se straduiesc sa aiba o opinie personala, nici în materia lor, nici în plan cetatenesc. Sau ca, vai, plagiaza! Pe lînga lamentari, e nevoie si de vituperari. Asa stînd lucrurile, nu pot sa nu ma întreb de unde începe raul. Începe, cred, de sus, de la universitati (nu putine înfiintate ca sa aiba unii unde sa predea), care, speculînd pofta de diplome ivita dupa 1990, au primit studenti pe toate usile, tineri eminenti, dar si multi mediocri, multe „loaze”, pentru bani. Între timp, cum-necum, „loazele” au ajuns medici, juristi, economisti, ziaristi, politicieni si, desigur, în lipsa de ceva mai lucrativ, profesori. Apoi si-au luat, pentru eticheta, masterate si alte titluri.

Cine ar vrea sa-i descopere îi gaseste cu greu, caci neghina s-a amestecat cu grîul bun, mai vechi sau mai nou. Majoritari acum, ei ar trebui sa constituie -ironie a vremii noastre!- „temei tuturor reformelor scolare”! Parveniti pe cai laturalnice, pot avea, oare, nu numai pregatirea necesara, dar si mentalitatea corecta de educatori, de îndrumatori sufletesti ai celor pe care-i învata?

Binenteles, întrebarea mea e o întrebare de sceptic, unul care, totusi, e în stare sa parieze ca nici dupa proxima majorare de salarii în învatamînt, sanatate etc, ba nici dupa cele viitoare, nu se vor vinde mai multe carti si mai multe reviste de cultura!

Progressive pigmented purpura-Schamberg’s disease. Case presentation

Authors: Sorana Mariana Staticescu*, Alin Ionut Otel*, MV Nanulescu**

* The Emergency Hospital for Children, Third Clinic of Pediatrics, Cluj Napoca

**University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca

Abstract

Introduction. Progressive pigmented purpura includes four entities whose etiology is not known but who share the same pathology characterized by vascular inflammation. Often the clinical picture may be intricate, thing that makes difficult, at first, the inclusion in one of the subclasses. In terms of evolution it is a chronic disease and the clinical skin manifestations can persist up to 7 years. Therapy is until now variable, and the results are relatively favorable both with corticosteroid administration, but also with a therapy that includes cyclosporin, griseofulvin or PUVA therapy (psoralen and ultraviolet type A).

Case report. We illustrate the clinical observation of a patient that is hospitalized for the appearance of a purple rash located on the legs that is not accompanied by other clinical or laboratory manifestations. The clinical and dermatological evaluation formulates the diagnosis of progressive pigmented purpura-Schamberg's disease, with exclusion of possible Henoch-Schonlein purpura. In conclusion, purple rash is a clinical manifestation that needs to be well documented even in the presence of a familial history that would lead us to an autoimmune etiology.

Key words: Progressive pigmented purpura, vasculitis.

Introduction

Bleeding in the skin (purpura) may be due to any disorder in one of the three components of the hemostasis: platelets, plasma factors of coagulation, blood vessels. Usually impaired platelets lead to petechiae, disturbances in coagulation in bruising and vasculopathies in palpable purpura [1].

Case report

This paper presents the case of a 17-year-old girl hospitalized in our department to investigate a purple rash located in the legs. (Fig. 1) The rash appeared 2 months before the admission and she was hospitalized in another unit, in the territory. Laboratory investigations have revealed proteinuria and microhematurie which have led to the suspicion of Henoch-Schonlein purpura with renal determination (a diagnose also supported because of family history load-maternal grandmother with lupus erythematosus and paternal aunt with dermatomyositis). From the onset of disease until hospitalization in our clinic, the skin lesions have retained the same character. The admission exam revealed erythematous placards with point brown lesions, mainly on the periphery of the placards. The placards were tended to conluence and were not pruritic.

Figure 1: Schamberg’s disease - brown-orange erythematosus placard in the lower limbs

Laboratory investigations performed during hospitalization did not reveal changes in urinalisys. The dermatological consultation described a suggestive aspect of Progressive Pigmented Purpura (Schamberg’s disease) and recommended a therapy with vitamin C for 3 weeks, in order to increase vascular resistance in combination with Advantan for 10 days a month.

Discussion

Progressive Pigmented Purpura is a group of diseases of unknown etiology in terms of pathology characterized by the presence of capillary inflammation. Clinically, this group contains four entities: progressive pigmented purpura of Schamberg, purpura annularis telangiectodes of Majocchi, lichenoid dermatitis of Gougerot and Blum, and eczematoid-like purpura of Doucas and Kapetanakis [2]. A differential diagnosis between the four entities is sometimes difficult because in many cases the clinical appearance may be one which combines several elements in each class. The most characteristic aspect is seen in Schamberg's disease where the primary lesion is represented by a brown-orange erythematosus placard, with erythematous point lesions, impalpable, in the peripheral [1].

Most often purpura, which is impalpable, appears in the legs and is easily recognized because of the brown-orange pigmentation caused by deposits of haemosiderin. Purpura is often associated with the development of so-called point lession "cayenne-pepper spots", but sometimes one can see just placards and lichenoid papules. (Fig. 2)

Figure 2: “Cayenne pepper spots” - typical eruption in Schamberg’s disease

Although in most cases purpura is located in the legs, occasionally there have been reported cases of Progressive Pigmented Purpura located on the face, this being often associating with itching [1].

All four subclasses are histologically characterized by perivascular and interstitial inflammatory infiltrate, accompanied by extravasation of erythrocytes and deposits of haemosiderin. The inflammatory infiltrate is largely composed of T-lymphocytes, Langerhans cells and macrophages. Although the pathogenic mechanism involved in Progressive Pigmented Purpura is unknown, the nature of inflammatory infiltrate and the increased expression of adhesion molecules in endothelial cells suggests an immune response mediated by T-cells and delayed hypersensitivity reaction type IV

Positive diagnosis of Progressive Pigmented Purpura is a clinical one and skin biopsy is rarely necessary to confirm it.

A similar rash to that of Progressive Pigmented Purpura may appear in fungoid mycosis, occurring either before or after the typical lesions of cutaneous lymphoma [4]. There are some medicines that can cause hyperpigmentation by increasing melanin production or by injuring the keratinocytes or melanocytes in epidermal basal layer. In this category we have medicines used in malaria, antipsychotics (phenothiazines, imipramine, desipramine), tetracycline and its derivatives, amiodarone, antineoplastic agents, amitriptyline. Cutaneous vasculitis manifested clinically as purpura or purple maculopapular rash may sometimes occur as side effects from use of bromhexin or captopril, sedatives, antibacterial and antifungal agents such as itraconazole. The pathophysiological mechanism involved is a vasculitis mediated by lymphocites [3].

Most patients with this chronic disease are disturbed due to cosmetic effects of the disease. The disease, most often, is resistant to any form of therapy and rash may persist months or years. The most frequent therapy recommended is those that include oral corticosteroids, PUVA (psoralen ant type A ultraviolet), cyclosporin or Griseofulvin. However the consequence of such therapies should be well-conceived because a chronic administration may lead to a series of unpleasant adverse effects [2].

If skin lesions are accompanied by itching, most times it is recommended to use topical steroids and PUVA combination, therapy that had some success in Schamberg's disease and Gougerot and Blum disease

Bioflavonoids are a class of drugs that reduce capillary permeability and fragility, used successfully in the symptomatic therapy of localized venous insufficiency of the lower limbs. They cause increase capillary resistance and inhibition of specific enzymes that are activated in inflammation. Moreover, bioflavonoids and ascorbic acid showed an antioxidant and protective effect, and the combination effect is adder. Ascorbic acid reduces the permeability of endothelial cells, its effects being based on the antioxidative properties [2].

Pentoxifylline is another compound used frequently in these conditions because of its capacity to inhibit the production of cytokines and the accession of inflammatory cells to the endothelium. (5) In a multicenter randomized trial, Panda S. tried to compare the effects of oral pentoxifylline (1200 mg per day in three divided doses) versus local application of 0.05% betamethasone diproprionat twice daily. This therapy was administrated for 8 weeks and after, the patients followed an additional 24 weeks. The study showed that pentoxifylline had superior results compared with topical betamethasone, but the therapy should be administrated more than 8 weeks [6].

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Reinhold U., Seiter S., Ugurel S., Tilgen W. Treatment of progressive pigmented purpura with oral bioflavonoids and ascorbic acid:An open pilot study in 3 patients. J Am Acad Dermatol 1999;41:207-8

Crowson N.A., Magro C.M. The dermatopathology of drug eruptions. Curr Probl Dermatol 2002;14:117-146

Mar A., Fergin P., Hogan P. Unilateral pigmented purpuric eruption. Australian Journal of Dermatology 1999;40:211-214

Pinar Y. Basak, Seniz Ergin Should pentoxifylline be regarded as an effective treatment for Schamberg’s disease? J Am Acad Dermatol 2001;44-Letters

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