Archive issue

1. Statins Therapy, C-Reactive Protein (CRP) Levels and Type 2 Diabetes

Floriana Elvira Ionica(1), Maria Mota(2), Catalina Pisoschi(1), Florica Popescu(1), Eliza Gofita(1)

Purpose: The effectiveness of therapy with hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, for reducing elevated C-reactive protein (CRP) levels and cardiovascular risk at patient with type 2 diabetes. Atherosclerotic plaque growth may be attenuated with therapy aimed at minimizing inflammation. CRP is considered to be a major inflammatory cytokine that functions as a non-specific defense mechanism in response to tissue injury or infection. Synthesized mainly in the liver, CRP activity is stimulated by other cytokines, especially interleukin (IL)-6, IL-1b, and tumor necrosis factor-a (TNF-a). CRP binds to a variety of molecules, particularly liposomes and lipoproteins, such as LDL and VLDL cholesterol, and is a powerful activator of the classic complement way. Accumulating evidence suggests that CRP, which is also found within macrophages of atherosclerotic plaques, is causally or mechanistically related to atherothrombosis. Inflammation plays an important role in the pathogenesis of type 2 diabetes. Because increased levels of CRP have been associated with arterial-wall inflammation, statins can prevent ischemia by both inhibiting deposition of lipids and decreasing inflammation. Conclusions: Inflammation underlies diabetes and may predict it. The role of lowering CRP in reducing the risk for and improving the prognosis of diabetes is undergoing assessment. The lowering of elevated CRP levels by statins may reduce the risk of cardiovascular events independently of the effect of statins on lipid levels. The results of ongoing clinical trials will continue to provide data on the additive value of testing levels of CRP and other inflammatory markers for cardiovascular risk assessment and should delineate the clinical utility of such testing in various disease states.

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2. Endoscopic Papillectomy into the Treatment of Neoplastic Lesions of Vater Papilla

G. Ghidirim(1), I. Misin(1), V. Istrate(1), S. Cazacu(2)

Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy. Aim: Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas. Material and method: 12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases. Results: En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence. Conclusion: Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.

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3. The Influence of Risk Factors to the Prevalence of Gastric Mucosal Atrophy, Intestinal Metaplasia and Dysplasia in Oltenia Region

S. M. Cazacu(1), C.C. Vere(1), N. Bodrug(2), D.I. Gheonea(1), Violeta Comanescu(3), T. Ciurea(1)

Background &aims Gastric atrophy and intestinal metaplasia represent the most important premalignant lesions in gastric carcinogenesis (risk 1.1% / year). Although H. pylori infection has a major role, the prevalence and severity of mucosal atrophy and intestinal metaplasia at Helicobacter positive patients is variable, which suggest other factors except H. pylori infection may play an important role. Method. We performed a prospective, case-control study at patient admitted in a tertiary care unit (Ist Medical Clinic, Emergency Hospital Craiova) and examined by endoscopy during 3 years. We selected 1432 patients with chronic gastrites or gastropathies by endoscopic examination; atrophy and intestinal metaplasia were confirmed by pathologic exam. We analyzed the prevalence of risk factors by comparing patients with atrophy and intestinal metaplasia with patients without these abnormalities. ResultsThe presence of IgG anti-HP antibodies was associated with increased risk of superficial (OR=1.711) and atrophic gastritis (OR=1.744). At patients with gastric atrophy diagnosed by endoscopy, OR has statistical significant risk for age above 50 years (OR=8.54, CI 95% 2.95-14.42), for rural residence (OR=2.47), smoking habit (8,821) and alcohol consumption, whereas NSAID use was associated with some protective effect. For intestinal metaplasia, a statistically significant risk was noted above 60 years, rural residence (OR=3.25), smoking habit (2, 8947) and alcohol consumption. Endoscopic-diagnosed atrophy has proved a mild to moderate sensibility for the detection of atrophy at pathological examination. Conclusions Helicobacter pylori infection, age, rural residence, smoking habit and alcohol consumption were associated with increased risk of gastric atrophy and intestinal metaplasia.

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4. Central Vein Catheters Complications at Hemodialysed Patients

Natalia Istrate(1), E. Mota(2), Daniela Cana-Ruiu(2)

Venous catheters are used for patients with chronic renal failure who need urgent haemodialysis (HD), but without available mature access ,and patients on maintenance HD who have lost their permanent access function. The aim of this retrospective clinical study was to determine the incidence of venous catheter complications in chronic HD patients. We analyzed 80 patients, 47 men and 33 women, with median age 49 years, who underwent chronic hemodialysis in Hemodialysis Center Craiova. 80 patients used 100 venous double lumen catheters giving a total experience of 13.749 catheters days. 40 catheters required at start of HD and 60 catheters used during entire timp on HD. 60 catheters was in internal jugular vein, 25 of catheters was in femoral vein and 15 of catheters was in sunclavian vein. Complications in the femoral approach were: infection and removal 40%, catheters thrombosis 30%, bleeding from a punctured femoral artery in 5%, groin hematoma 3,5%, poor flow 3,5%.In the jugular vein approach , infection occurred in 30% patients, thrombosis in 20% patients and accidental withdrawal in 3,36%. Blood- culture-proven sepsis severe enough to require hospitalization occurred in 10 patients(17%), 3 patients development infectious endocarditis and 2 patients died.One misplacement into the carotid artery were noted and another complication was punctured carotid artery with development an arterio-venous fistula.In the subclavian vein approach , catheters disfunction was found in 20% patients, infectious in 33% patients and deep vein thrombosis in 6,66% patients.Central venous catheters are still associated with a high rate of complications and may be a regular access choice only no other option available for haemodialysis.

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5. Clinical-Imagistic Correlations in the Prolactinomas Evolution

Simona Bondari(1), Dana-Maria Albulescu(2), Adriana Iliescu(1)

Pituitary pathology of prolactinoma type was studied under the clinic and imagistic aspect. In the present, clinic and paraclinic diagnosis colligation to the imagistic one, may constitute the base for a prolactin secreting macro-or microadenoma correct diagnosis. Evolutivity aspects of those post therapeutic lesions are different meaning the rapid favorable evolution of the serous prolactine values, of a slower sometimes insignificant evolution of imagistic quantified lesions. Clinical, paraclinical but also imagistic monitoring of that pathology leads to optimizing the drug therapy applying.

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6. Clinical and Morphological Aspects of Warthin’s Tumor

Luminita Daguci(1), Cristiana Simionescu(2), C. Daguci(1), Marilena Bataiosu(3), L. P. Dragomir(1)

The study includes 16 cases of Warthin’s tumor in a period of 4 years (2004-2008). The tumors were diagnosed at patients of VII decade, most of them smoker. The studies of Warthin’s tumor macroscopic morphological parameters allow us to establish the localization exclusive at parotid glands like solitary tumor and the tumoral volume oscillate mostly between 2-4 cm in diameter. Histopathologically we notice the prevalence of typical tumor forms ,with balanced raport epithelium / stroma. In this study we have found in 10 cases typical forms ,in 4 cases the prevalence of epithelium component and in 2 cases the prevalence of stroma component.

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7. Histopathological Study of Basal Cell Carcinomas

Claudia Mateoiu(1), Claudia-Valentina Georgescu(1), Georgiana Fota(1), Cristiana Simionescu(2)

In this study I have analyzed the most important parameters necessary for diagnostics of histopathological of basal cell carcinomas with the purpose of establishment of correlations between histopathological aspect, tumor localization, clinical data about patients and their ulterior evolution, for identifying new elements with prognostic level for BCC, also in reducing the number of recidivisms. Materials and methods: The study evolves a number of 703 cases of basal cell carcinomas diagnostics in the Pathological and Cytological Anatomy Lab of the Clinical County Hospital of Emergency of Craiova, during a 5 year period (1 January 2003 – 1 January 2008), worked by the standard paraffin inclusion and colorants with standard hematoxyline-eosin stain. Results and discussions: The report F/M was of 1.06 in favor of women. The most affected group age was between 51-70 years old, with 351 patients (49.92%). Localization of the most frequent BCC was at a cephalic extremity level (89.90%). The histopathological analysis of lesions of BCC has revealed a polymorphism extremely various. The histological type most frequently met was of BCC solid. Majority of lesions, yet have presented in one or more different regions. Majority of lesions have invaded hypodermic level – 20 cases (48.78%) and only 24 cases were recurrences (3.41%).Conclusions: The study has underlined the importance of pathological tumor dermatological malign both by a greater number of cases studied also through incidence of growth of basal cell carcinomas.

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8. Histopathological Prognostic Factors Evaluation in Invasive Mammary Carcinoma

Nicoleta Patrana(1), Cristiana Simionescu(2), Claudia Georgescu(1), Georgiana Fota(1), Mihaela Muntean(3)

The most frequent tumor on women is mammary carcinoma. The present study included 182 cases of invasive mammary carcinoma. We analyzed the clinical and morphological factors with prognostic value in the specialty literature. The surgical resection pieces were analyzed using the usual histopathologic technique by paraffin embedding and staining HE. One of the most important prognostic factors analyzed in this study was the axillary lymph node status. Half of the patients presented negative lymph nodes. The tumor size is one of the recognized prognostic factors, the most frequent tumors having 2-5 cm. The histopathological examination revealed that the most frequente invasive mammary carcinoma was infiltrative ductal tumours. Usin the Nottingham grading system we found that the most frequent types of tumor was GIII.

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9. The QSPR Study of Water - Octanol Partition Coefficients for a Series of 24 Benzene Derivatives

P.G. Anoaica(1), Emilia Amzoiu(1), L. Giubelan(2)

A series of 24 benzene derivatives are commonly used as solvents or reactants in the chemical process of synthesis. For this reason, a circumstantial study of skin permeability (or biologic membranes) to such classes of substances is enforced. This paper presents a correlation between the log P partition coefficients for these compounds and the descriptors characterizing the molecular structures. These descriptors were calculated using quantum ab initio molecular methods as Polarizable Continuum Model (PCM) for water and 1-octanol solvents which feign biological phase (the interface between water medium and cellular membrane). The partition coefficients analysis depends on the energies of solvation, molecular shape descriptors (area / volume of molecular cavity and Connolly area).

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10. Subdeltoideus Bursitis Manifested as Gigantic Cystic Supraclavicular and Lateralcervical Tumour

A. Demetrian(1), R. Melinte(2), I. MAndrila(1), Rodica Dilof(1)

The authors present a case of a left gigantic supraclavicular and lateralcervical tumor with rapid growth, which has turned out to be a subdeltoideus bursitis.

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11. Complex Congenital Urinary Tract Malformation with Secondary Urinary Stone Disease – Therapeutic Multimodal Solution

Stoica L., Tomescu P., Dragoescu O., Vilcea I., Enache M.

Objective. This presentation emphasizes the continuous development of surgical treatment applied for urological diseases by solving a complex case of urinary stone disease developed on a congenital abnormal urinary tract (bilateral ureterocele and right pelviureteral duplication) through combined therapeutic measures which would have been treated by open surgery not long ago. Case presentation. This is a description of the retrograde ureteroscopy made under spinal anesthesia using Ho:YAG laser lithotripsy, extraction of resulting stone fragments, ureterocele incision with the introduction of a left ureteral catheter at the end of the procedure. Results. Postoperative recovery was short and simple and followed by a session of extracorporeal shock wave lithotripsy for the remaining right kidney stones as well as endoscopic removal of the left double J catheter at 30 days. Conclusions. Stone kidney treatment is continuously changing along with the technological development. Use of minimally invasive (a singular surgical session of Ho:YAG - retrograde ureteroscopy) as well as noninvasive techniques (ESWL) allowed complete treatment of this complex case and decreased associated morbidity and hospital stay.

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12. The Mechanic Canal Treatment Using the Protaper Manual System

Oana Diaconu , Marilena Bataiosu, Mihaela Tuculina, Iren Moraru , Lelia Gheorghita, Victoria Andrei

Modern endodontic treatment aims toward the modification and adjustment of the root canal shape according to the need to correctly debride and fill the endo-canalicular system. The preparation of root canals using the Ni-Ti needle system approaches perfection in accuracy as well as in respecting canal anatomy, at the same time reducing the risk of potential preparation errors. This article tries to show in detail the succession of steps in root canal preparation with the help of the manual ProTaper system.

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