Archive issue

Current Health Sciences Journal

vol. 35 no. 4, 2009

1. Cellular Responses to Cerebral Ischemia during Aging

T.A. Balseanu, Ana-Maria Buga, A. Popa-Wagner

Old age is associated with an enhanced susceptibility to stroke and poor recovery from brain injury, but the cellular processes underlying these phenomena are uncertain. Therefore studying the basic mechanism underlying functional recovery after brain ischemia in aged subjects is of considerable clinical interest. The available evidence indicates that (i) compared to young rats, middle aged rats develop a larger infarct area, as well as a necrotic zone characterized by a higher rate of cellular degeneration, and a larger number of apoptotic cells; (ii) in both old and young rats, the early intense proliferative activity following stroke leads to a precipitous formation of growth-inhibiting scar tissue, a phenomenon amplified by the persistent expression of neurotoxic factors; and (iii) the regenerative potential of the rat brain is largely preserved up to 20 months of age but gene expression temporally displaced, has a lower amplitude, and is sometimes of relatively short duration. Whether endogenous neurogenesis contributes to spontaneous recovery after stroke has not yet been established. If the neurogenesis from endogenous NSCs will be used as therapeutic approach, it will require individual approach to assess the possible extent of neurogenic response and possibilities to alter this response for functional improvement or prevention of further progression of the disease.

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2. Mandibular Panoramic Indexes Predictors of Skeletal Osteoporosis for Implant Therapy

Marina Melescanu-Imre, Elena Preoteasa

The aim of this study is to evaluate the relationship between osteoporosis and mandibular panoramic indexes in order to assess the possibility of using these parameters as an indicator of osteoporosis. Bone quality relates to bone turnover rate, architecture, damage accumulation, and degree of matrix mineralization. Risk factors for osteoporosis can be categorized as no modifiable (sex, age, early menopause, body frame, race, heredity) or modifiable (lack of calcium, exercise, smoking, alcohol, systemic diseases etc). Various studies have demonstrated that individuals with osteoporosis have altered morphology of the mandible and various investigators reported different aspects:  mandibular bone mineral density and cortical index (MCI), mandibular alveolar bone mass, inferior Cortex of the Mandible, alveolar bone resorption, the number of teeth present and special considerations for implant therapy in osteoporotic patients. In conclusion, this paper is a review of the literature on the possible association between osteoporosis and oral bone loss, with an emphasis on radiological studies and dentists are a potentially valuable resource for initial patient screening for signs of osteoporosis, as individuals with osteoporosis have altered architecture of the inferior border of the mandible as seen on panoramic radiographs.

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3. EUS Elastography in Evaluating Chronic Liver Disease. Why not from Inside?

M. Rimbas, D. I. Gheonea, Larisa Sandulescu, A.Saftoiu, P. Vilmann, T. Ciurea

Fibrosis is the liver’s scarring response to injury, culminating in cirrhosis and its complications. Percutaneous liver biopsy with connective tissue stain is considered more likely a ‘‘silver’’, rather than a ‘‘gold standard’’ for assessing the degree of hepatic fibrosis. That’s why new modalities were recently developed to accurately assess the stage of the liver disease. The term ‘‘elastography’’ describes an imaging technique that conveys information about a tissue’s relative firmness in response to compression, meaning it is more akin to palpation than inspection. Real-time transabdominal elastography represents a new technology for measurement of tissue elasticity integrated in ultrasound systems and can be performed with conventional ultrasound probes during a routine sonography examination. Some of its limitations are that it cannot explore neither all the patients, nor a sufficient size of the liver. In order to overcome these, now that the technology exists, we propose an endoscopic approach from the “inside”.

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4. Basal Cell Carcinomas – Clinical-Evolutional and Histopahotologic Aspects

Loredana Elena Stoica, Claudia Valentina Georgescu, V. Patrascu, C.C. Radu, I.Tolea, L. Mogoanta

Basal cell carcinoma (BCC) is the most frequent cutaneous tumour. Having as aim the identification of the clinical-evolutional and histopathologic aspects of the basal cell carcinomas, we have undertaken a retrospective study for a period of 5 years, from 1st January 2004 to 31st December 2008, on 706 patients interned in the Dermatology Clinic of Craiova, whom indicated 738 tumours. A clinical data was drawn for the patients, containing the identification data, environment, profession, cancer localisation and history of the disease, clinical and histopathologic diagnosis. Results. In our lot, the most numerous cases were of pearly BCC (33.6%), nodular BCC (22.2%), respectively scar plane BCC (13.1%).Regarding the histopathologic type, the repartition was as it follows: solid BCC (33.7%), polymorph (19.2%), adenoid (13.1%), keratinised (11.8%), superficial (7.0%), cystic (3.8%), pigmented (3.8%), scleroderma form (2.2%), in situ (1.4%).

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5. Epidemiological-Clinical Study on the Acute Ethylic Alcohol Intoxications in Children

Singer Cristina, Stancu Polixenia, Cosoveanu Simona, Osiac Loredana, Apostu Elena, Nica Lavinia, Botu Alina

Methodology. An epidemiological-clinical study was carried out on the acute ethylic alcohol intoxications (AEAI) in the children, aged 0-16 years, admitted to the 2nd Pediatric Clinic of the Emergency County Hospital in Craiova, between 1.01.2000 and 31.12.2007. Results. During the 8 years of study, there were admitted 119 children with AEAI; 98 (82.4%) were voluntary and 21 (17.6%) accidental (in children under 7 years). The group structure – in children with accidental intoxications: M/F= 12/9, U/R= 9/12; in children with voluntary intoxications: M/F= 69/29, U/R= 67/31, age group (years): 1-7= 21, 7-10= 13, 10-14= 46, >14= 39 cases. The type of ingested alcohol: wine 32 cases, plum brandy 20, beer 16, liquor/ cognac/ cherry brandy each in 7 cases, whisky 3, gin 2, cocktail 21, combinations with other toxic products: alcohol + glues/ varnish/ diazepam in 4 cases. The clinical manifestations in children with accidental intoxications: sleepiness in 11 cases, vomiting in 10, alcohol smell in 8, walking and speaking disorders in 4, unrest in 3, hypothermia in 3, coma in 5 cases; in children with voluntary intoxications: vomiting in 47, alcohol smell in 40, sleepiness in 33, walking and speaking disorders in 34, unrest in 15, euphoria in 2, aggressiveness in 1, Mallory-Weiss syndrome in 1 case, coma in 39. Conclusions. More than 2/3 of the AEAI were voluntary. The accidental intoxications prevailed in M (61.1%), in R (61.1%) and they belonged to the age group 1-7 years. The most frequent clinical manifestations were: sleepiness, vomiting, alcohol smell. The voluntary acute intoxications were more frequent in M (71%), in U (68%) and in the age group 10-14 years (46%). The most frequent clinical manifestations were: vomiting, alcohol smell, and coma. The alcoholic coma was present in 23.8% in accidental intoxications and in 39.8% of the voluntary intoxications.

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6. Screening for Cardiac Anomalies During the Early Second Trimester (as part of the Triple/combined Test Ultrasound) – Accomplishments and Limits

A. Comanescu, N. Cernea, Stefania Tudorache, D. Iliescu, R. Capitanescu, Claudia Oprea

Part of the SONOSEROSCREEN PROJECT , we study at the beginning of the first trimester a group of biochemical and ultrasound variables. Regardless the results obtained, all the patients enrolled in this cohort is subject to a second study in the early second trimester that encompasses the dosage of AFP, iA, β-hCG, uE3 an an ultrasound exam targeted at precise biometry and fetal morphology. We tried to evaluate the achievable accomplishments and limits of fetal heart evaluation at 16-20 weeks ultrasound. We evaluated the heart ( four chambers and great vessels) at all patients that came for the early second trimester evaluation (stage II of our study). All patients were reassessed at 24 weeks. Correct heart scanning is possible at the triple test ultrasound (16 – 20 weeks), but needs an experienced sonographer, who masters the Color Doppler, patients and a high end ultrasound machine.

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7. Correlations Between Chorial Villositary Vasculogenesis and Ultrasound Morpho-Functional Markers of The Trofoblast In The Normal Pregnancy

Liliana Novac, Mihaela Niculescu, D. Iliescu, Maria Manolea, Stefania Tudorache, R. Capitanescu , N. Cernea

Introduction. The placental vasculogenesis process appears only in the time of the embryo developement and forms the primar vasculary substratum, the first capillary vessels developing in the days 18 – 20 from the fecundation, phenomena that are necessary for the normal evolution of the pregnancy. At the same time, at the level of the implantation site, the ultrasonographic investigation of the trofoblast has shown specifical changes correlated with the gestational age. Matherial and method. We have investigated 47 pregnant women with the gestational age between 5 and 12 weeks, which had legal abortion on request. The patients were echographically monitored until the time of the curettage, particulary by the trofoblastic thickness at the implantation site. The material resulted after the curettage has been histologically studied, the histological and echographical evaluation of the cases being made according to the gestational age. Results and discutions. It has been accomplished a gestational histological grading by establishing some specific elements of the villositary developement related to the gestational age, that has been correlated with the dates from the ultrasonographical evaluation. Conclusions. The trofoblastic vasculogenesis undergoes stadial phenomena specific to the first trimester chronology and the trofoblastic thickness at the implantation site level may be correlated with the gestational age. The correlations between those histologic and imagistic characteristics of the placentation at the implantation site may allow a better understanding of the phenomena that have their roots at this level, and it is necessary to have additional studies for determining if the changes of this phenomena are associated with the spontaneous abortion.

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8. Stress in cholecyst pathology

Ileana Viorica Dinca

Chronic or acute daily stress, postoperatory or food one represents a risk factor causing the appearance of the cholecystis or acute or chronic cholecyst-pancreatic pathology. The present study focused on the extracell matrix microanatomy from the cholecyst wall, correlated to the storing function of the gallbladder. ”Neuromuscle units” revealed into the cholecyst wall structure, spacial distribution of the microanatomic elements from the vesicular wall and the relationships they have with the extracell matrix structure determine that the cholecyst wall should react as a unitary whole in case of an excessive neurotransmission.

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9. Histopathological Study of the precursor Lesions of the Ductal Invasive Breast Carcinoma

Georgiana Luminita Fota, Cristiana Simionescu, Claudia Valentina Georgescu , Nicoleta Patrana , Mihaela Muntean , A. Stepan

The precursor lesions of the ductal invasive breast carcinoma are a heterogeneous group of lesions that raise problems in defining, classifying and diagnosing them. These lesions include the usual ductal hyperplasia, flat epithelial hyperplasia (Ductal Intraepithelial Neoplasia grade 1A), atypical ductal hyperplasia (Ductal Intraepithelial Neoplasia grade 1B), and ductal carcinoma in situ (13, 16). There are three histopathological grades of the ductal carcinoma in situ: low grade (Ductal Intraepithelial Neoplasia grade 1C), intermediate grade (Ductal Intraepithelial Neoplasia grade 2) and high grade (Ductal Intraepithelial Neoplasia grade 3) of malignity (13). We focused on the distribution of the precursor lesions of the ductal invasive breast carcinoma within the pathology of mammary gland, their association with ductal invasive breast carcinoma, the shares of the age categories and sexes, as well as their histopathological study. The predominant lesion of the ductal invasive breast carcinoma was the usual ductal hyperplasia. We found the usual ductal hyperplasia as being the only precursor lesion also microscopically diagnosed at men. In the studied period, we have not found flat epithelial hyperplasia cases. The least frequent precursor lesion was the atypical hyperplasia. Comedocarcinoma was the most frequent in association with the ductal invasive carcinoma. This study aims to bring new references to those existing or to confirm the data from the pathology literature.

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10. Morphological Features of Fetal Appendages in Fetal Distress Induced by Placental Pathology

I.E. Plesea, I. Ivanus, O.T. Pop, Mirela Ghilusi, Claudia Valentina Georgescu, Carmen Popescu, V. Gheorman

Fetal growth is depending on integrity of fetal appendages. The aim of the study was reveal if morphological changes of fetal appendages could be related with the presence of fetal distress (either acute or chronic). Several quantitative parameters, such as placental weight, type of placental pathological process; vascular densities in the placental villi, thickness of umbilical cord vessels’ wall and amniotic membrane thickness were assessed on 20 pacients whose new borns had fetal distress. The results of statistic correlations between those parameters allow us to conclude that umbilical vein wall thickness can affect the vascular density in central placental areas and consequently fetal-placental exchange, resulting in fetal distress.

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11. Morphopathologic Features of Fetal Appendages in Fetal Distress

I. Ivanus, I.E. Plesea, V. Gheorman, Anca Ancuta, Corina Cotoi, Fl. Cornitescu, N. Rica

Fetal growth depends on the integrity of fetal appendages. The aim of the study was to reveal the possible correlations between different morphological changes of each of the three fetal appendages (placenta, umbilical cord and amnios) and the presence of one of the two aspects of fetal distress (FD) (acute or chronic). Placental weight and type of fetal appendage pathological process were assessed on 116 patients whose newborns had fetal distress. The results of our analysis allowed us to conclude that umbilical cord pathology was not the main cause of FD as one might think at first sight but placental pathology, which was the main factor in both the intrauterine growth retardation (IUGR) subgroup as placental insufficiency as well as the acute fetal distress (AFD) group as premature detachment of normally inserted placenta (PDNIP). Associations of several pathological processes of fetal appendages were rare, usually leading to the onset of IUGR.

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12. Influences Exercised By The Intensity Of The Oxidative Stress Over Wounds Healing In Surgical Therapy Of Breast Cancer

Tudorascu Brujan Iulia, C. Margaritescu, M. Novac, Cristina Simionescu, Camelia Foarfa, Maria Vrabete

The objectives of our study were: Determination of the plasmatic oxidative status over the patients with operated breast cancer (CS). Assessment of the ratio between the intensity of the induced S.Ox (tumour + surgical act) and the plasma antioxidant potential. Evidencing of parameters, allowing elaboration of a prediction with regard the quality of the post-operation wound cure. Methods: We investigated 32 patients with breast cancer (CS) and 37 healthy patients (witness lot), 69 cases, in total. We have calculated the total anti/oxidant potential, of plasma (TAOP), measured the concentration of total peroxides from plasma and calculated the ratio between the two values, which is expressed as an index of oxidative stress (ISO). These values are used in order to appreciate the oxidative status of plasma. We achieved four groups of study, considering the morphopathological aspect of tumours and the prognosis over the quality of wound healing, post-surgery. In order to explain the psychopathological mechanisms involved in healing the surgery wounds done on the neoplastic field, we checked the evolution of clinical parameters: clinical: wounds appearance, umorals interactions between the residing cells and those migrating from the blood vessels into the wound tissues. We associated to the conventional therapy, post-surgery a diet with exogenous oxidants (C vitamin, selenium, and beta carotene) and we noted down the features of wound healing, after 3/6 weeks post/operation, up to 2-4 years of life, as appropriate. Outcomes: TAOP has been reduced, the index of the oxidative stress significantly increased at the patients with operated CS, who had a faulty wound healing. The additional exogenous anti/oxidants have different effects, from none effect, to the patients with a lipids and glucides rich diet up to defaultless healing and improvement of the general clinical condition. Conclusions: Reduction of the oxidative stress intensity has a positive role in wound healing and for this reason the administration of some exogenous anti/oxidants could influence the evolution of the general condition of the patients operated for breast cancer (CS), with a favourable sense , for life.

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13. Dissolution of Pentoxifylline from Extended Release Formulations. Researches Concerning Development of a Biorelevant Test

Georgeta Ionica, F. Radulescu, Dalia Miron, ValentinaAnuta, C. Mircioiu, Ionela Belu

Paper presents results of a pharmacokinetics study concerning pentoxifylline and its main metabolites after administration of extended release formulation of Trental 400 mg and correlation of this pharmacokinetics with in vitro dissolution test results of parent drug. In order to establish most relevant in vitro test, dissolution was performed in different experimental conditions (stirring rate and dissolution medium). Correlation was linear and very good. Generalization of correlation to rate of appearance of metabolites in plasma proved that this process could be well correlated with dissolution. Most relevant test was finally found to be the release in water medium, in conditions of a high stirring rate – 100 rpm.

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14. Using the open window thoracostomy (Eloesser window) in chronic pleural empyema

A. Dobrinescu, A. Demetrian

The authors present a case of chronic pleural empyema solved by open window thoracostomy (Eloesser window).

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15. Particularities of Real-Time Polymerase Chain Reaction Technique (RT-PCR) in the Monitoring of Chronic Myeloid Leukemia Patients – A Brief Overview

Kinga Tatar, Hortensia Ionita

Chronic myeloid leukemia (CML) is a myeloproliferative disorder, characterized by a specific chromosomal aberration, the Philadelphia [Ph] chromosome. The Ph chromosome is the result of a reciprocal translocation between the long arms of chromosomes 9 and 22, t (9;22)(q34;q11). The molecular consequence of this translocation is a novel fusion gene, BCR-ABL, which encodes a constitutively active tyrosine kinase, implicated in pathophysiology and development of CML [1,2]. Imatinib mesylate currently the golden standard for front line treatment of CML, is a selective inhibitor of the BCR-ABL tyrosine kinase activity. Responses to imatinib occur at hematologic, cytogenetic and molecular levels. IM therapy now allows the majority of patients with CML to reach CCyR - a confirmed good prognostic indicator [3]. In different studies, 87% of patients in chronic, 17% of patients in accelerated, and 7% of patients in blast phases reached the important clinical aim of Ph negativity [3-5]. Ph chromosome status is usually assessed by classical bone marrow cytogenetics and this method has the limitation of poor sensitivity. Patients who reveal 1012 leukemic cells at the time of diagnosis, in CCyR may still have as many as 1010 leukemic cells in their body. Once a patient has achieved CCyR, monitoring of residual cells is usually performed by estimating the BCR-ABL transcripts on a molecular level using quantitative real-time polymerase chain reaction (QRT-PCR). A 2-log reduction in BCR-ABL transcripts correlates with Ph negativity in CCyR. Patients achieving a 3-log reduction in BCR-ABL transcripts are defined as having a major molecular response (MMR), a surrogate marker closely correlating with the probability of disease free survival [8]. Patients failing to achieve this 3-log response, at any time during therapy, had significantly shorter progression-free survival [6]. After a 5 to 6 log reduction, BCR-ABL transcripts can no longer be detected by QRT-PCR and patients are designated as having complete molecular response (CMR). But even with the most sensitive QRT-PCR assay, CMR is consistent with the persistence in the patient’s body of up to 106 or 107 leukemic cells [7]. Due to the proliferation of such residual cells a significant fraction of those patients who have responded on a deep molecular level, lose this response and progress to advanced phase disease. The clinical advantage of the extremely sensitive method of QRT-PCR is to be alerted by rising transcript levels at a very early time point, usually weeks or even months before the onset of clinical symptoms, allowing early terapeutic intervention with a beneficial impact on survival.

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16. More Performing Techniques for Identification of Comitial Focus and their Spreading

D. Faget, D. Georgescu, A. Nestianu, V. Nestianu

By measuring EEG frequencies by Burch method (analysis of periods), determining the exact times of various EEG frequencies, which the specialist sees by visual inspection, we can obtain more precise and certain information regarding the comitial focus than by FFT, as this technique provides wave indexes for each frequency. Frequency analysis by FFT also finds inexistent frequencies on the route, resulted by decomposing in Fourier sequences, and therefore sometimes the result is false. In order to observe the spreading of ample, super-voltage comitial-type discharges on the cerebral cortex, an original technique was implemented, which determines graphically by maps the time measured in milliseconds in which the comitial wave spreads on the cerebral cortex (time mapping).

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