Archive issue

1. Updates on the Treatment of Chronical Hepatitis B

Adina Lican, I.Rogoveanu,, T. Ciurea,, Larisa Sandulescu, D.Coldusu, Cristina Miscu, Natalia Braia

Chronic infection with hepatitis B (HBV) is a major public health problem worldwide, with important socio-economic implications. It is estimated that over 2 billion people have been infected with HBV, of which 350-400 million chronic HBV carriers remain. Chronic HBV infection can lead to the development of liver cirrhosis and liver failure. Moreover, HBV is the most common cause of CHC and it is considered an oncogen virus. The goal of therapy in chronic viral hepatitis B is to improve patients` quality of life and increase survival by preventing progression to cirrhosis, liver cancer and death. Achieving the desired goal can be done through sustained serum HBV DNA suppression, which is accompanied by reducing the histological activity of chronic hepatitis and cirrhosis, leading to the decrease of risk of cancer. HBV infection can not be completely eradicated because of persistence of covalently circular DNA (cccDNA) in the nucleus of infected hepatocytes. But reducing viral load by treatment (studies with interferon or nucleoside analogues) have shown to reduce the risk of liver cancer. Treatment of chronic hepatitis B virus (HBV) is currently an exciting topic because of the progress in this direction. Controversy is tied primarily to the choice of first line treatment - pegylated interferon vs. nucleoside analogues / nucleotide, but also the best way to approach therapy of viral resistance development. There are data that argue the choice of pegylated interferon as initial therapy in patients with chronic viral hepatitis B, both in patients with HBe Ag positive and those with negative HBe Ag. On the other hand, nucleoside analogues (Lamivudine, Entecavir) and the nucleotide (Adefovir, tenofovir) have advantages that make them preferred in certain situations as initial treatment of chronic hepatitis patients with HBV.

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2. Pathogenesis of esogastric junction cancer

Corina Maria Dochit(1), Cristiana Simionescu(2), Corina Gruia(1), Rodica TaslAca(3), Diana Stanculescu(4)

Introduction: Adenocarcinomas of esogastric junction are divided in three subgroups according to their relation with proximal extremity and gastric folds: AEG I – cancers of distal oesophagus; AEG II – cancers of true cardio; AEG III – sub-cardiac cancers. AEG I and AEG II are considered the same descriptive entity, being similar from the point of view of the patients’characteristics (fatness, medium-aged white men suffering from reflux illness without gastritis with Helicobacter Pylori), of the incidental tendencies and of molecular profile. Predisposing factors: genetic predisposition for the development of carcinomas on the bottom of Barrett oesophagus is supported by the fact that these ones affect almost exclusively the white men. There are familiar forms of the illness, where there were indentified polymorphisms and genetic alterations associated to adenocarcinomas of esogastric junction. As risky factors, there have been incriminated: gastro-oesophageal reflux illness, fatness, hiatal hernia, prematurity, smocking, alcohol consumption. Pathogenesis of esogastric junction cancers developed on the bottom of Barrett oesophagus which represents a premalignant condition that arises on the bottom of the long term gastro-oesophageal reflux illness, its formation implying at least three different phases. The progression towards malignity inside Barrett oesophagus is a multistep process, implying the transition from metaplasia to low degree dysplasia, to high degree dysplasia and invasive carcinoma. Conclusions: as the formation of the adenocarcinoma on the bottom of Barrett oesophagus represents a multiphase process, implying the transition from metaplasia to low degree dysplasia, to high degree dysplasia and invasive carcinoma, it is important that the patients with Barrett oesophagus should be carefully supervised, in order to diagnose the carcinoma from an early phase.

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3. The Dynamic Of Plasma Lipid Indices In Short Term Treatment With Statins

Camelia Capuci(1), Corina Stefan(1), D. Alexandru(1), R.Capuci(2), Maria Iancau(1)

Statins are a class of drugs and cholesterol-lowering effect demonstrated in reducing cardiovascular mortality. Thus, an increasing number of people with increased levels of serum cholesterol achieved with statin therapy indications. The higher level of current records showing that statins prevent cardiovascular disease may be greater in patients with more pronounced vascular inflammatory process. The study included 102 hypertensive patients, with values of total cholesterol (TC) of ? 4.5 mmol / L (> 200 mg / dL) and LDL-C (low molecular density lipoprotein fraction) ? 2.6 mmol / l ( > 135 mg / dL), which were administered simvastatin, lovastatin and pravastatin in doses of 20 mg / day and 40 mg / day for 12 weeks. He was comparing their effect on lipid indices . The dose of 20 mg / day and 40 mg / day the greatest influence on total cholesterol had a simvastatin (reduction of 21.20% and 28.10% respectively). On triglycerides, the effect varied more, the maximum decrease was caused by simvastatin (16.30%) to 20 mg / day and pravastatin (18.30%) at dose of 40 mg / day. Regarding lowering LDL-C and HDL-C (high molecular density lipoprotein fraction), three remedies have similar effects. The largest increase in HDL-C occurred under treatment with 40 mg / day of lovastatin (10.20%). The study aims to assess the effect of administration of statins is to choose a customized treatment according to individual patient characteristics.

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4. Difficulties in Diagnosis of Primitive Retroperitoneal Tumors

C.E. GAtita(1), I. Georgescu(2), R. Nemes(2)

Primitive retroperitoneal tumors (PRT) are relatively rare, without having specific signs that will lead to their early recognition and can not be include in the therapeutic schemes. They are diagnosed late, when they have been abdominalized through volume, invading the intra-peritoneal organs. Therefore, we did not hesitate to identify the difficulties in the diagnosis of PRT, where much confusion persists today as everything depends on the precocity of diagnosis.

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5. The Role Of Urinary Tract Obstruction In Occurrence Of Renal Failure

Alina-Gabriela Pauna

Urinary lithiasis is a condition characterized by the formation of concretions or calculi inside the urinary tract, after precipitation of substances, which normally are dissolved in urine. Obstructive renal failure occurs because of urinary flow obstruction under a normal renal perfusion and the absence of renal parenchymal lesions. Usually, prompt correction of the cause lead to restoration of renal function. Were followed 75 patients with urinary tract obstruction and obstructive renal failure (38 men and 27 women) hospitalized in the Nephrology Clinic, “St. John” Emergency Hospital, Bucharest, in 2006–2009. Of these, 61 had ureteral obstruction and 14 had obstruction by compression or tumor invasion. The following tests were performed: simple renal radiography revealed radiopaque calculi in 12 cases; ultrasonography was performed in all patients and showed parenchymatous index reduced below 5 mm in eight patients and pyelocaliceal grade II–III expansion in 48 cases and grade IV–V in 25 cases. Doppler ultrasound: could not calculate the resistance index in the eight cases with parenchymatous index decreased (under 5 mm) and the 65/75 cases had resistance index (RI) >0.70. Only 23 of 61 patients had spontaneous kidney stone removed, in three patients with calculi between 0.8–1.5 cm located in upper ureteric was performed ESWL (extracorporeal shock wave lithotrypsy) and 35 cases requiring calculus fragmentation by ureteroscopy procedure and mounting Cook probes.

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6. Histological Variants of Urothelial Bladder Carcinoma

A. Stepan, Alma Florescu, Anca Mitrut, Cl.Margaritescu, Cristiana Simionescu

The purpose of this study was to identify and histopathological analysis of cases of urothelial carcinoma with mixed differentiation. The study included a total of 260 cases witch were classic processed and histopathologically analyzed, appreciating the presence and type of differentiation and also the degree and tumor stage. In 68.8% of cases, urothelial carcinoma showed different histological differentiation, most commonly was observed areas with squamous, clear type and glandular cells,. These tumors had low degrees of differentiation and invasion was more advanced. The prognosis of patients can be improved by recognizing and properly quantify the tumor differentiation areas.

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7. Simoultaneuos Occurence Of Other Diseases Among Prison Inmates With Tuberculosis

Tanta Cernat(1), Maria Comanescu(2), D. Alexandru(3), V.Carlig(3)

Prison populations are considered to be at high risk for tuberculosis infections, and many of the cases encountered have initiated while the individuals were in prison. There are also studies that have estimated the occupational risk of exposure and infection for hospital-based and correctional healthcare workers. To our knowledge, data on the incidence and risk factors associated with tuberculosis are very scanty in Romania, and therefore the aim of this study was to determine the prevalence and associated risk factors for this infections among a sample of prison inmates stationed at Colibasi Hospital Prison.

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8. Occlusal Screening as Basis for the Integration of Conjunct Gnato-Prosthetic Devices

M. R. Popescu(1), C. Daguci(2),L.P. Dragomir(1)

The functional disorders of the masticator apparatus impose the accomplishment of a phased assessment protocol which should permit the marking out and prefigure the future treatment plan, at the same time. The association of clinical data with therapeutic options and last but not least with the patient’s “expectations” represent a particularly important stage within the final occlusal and aesthetic integration. In order to analyse the data collected through examination various assessment systems are available nowadays which permit the correlation of symptoms identified with adequate diagnoses. The planning of the therapy on the basis of clinical registrations associated with the challenges of the bio-aesthetics shall impose a new conduct within the orofacial rehabilitation of patients.

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9. Influence Of Some Dissolution Enhancing Agents On The Pharmacokinetic Profile Of Meloxicam Delivered From Hydrophilic Ointments

Ani-Simona Sevastre(1), R. Cazacincu(2), D. Lupuleasa(3), Ionela Belu(1), Florica Popescu(1)

Meloxicam, a very poorly soluble in water selective COX2 non steroidian antiinflamatory drug, was included in Carbopol 990 hydrogels using dissolution enhancing agents. Carbopol 990 is a high molecular weight polymer, easily soluble in water even at low concentrations, with increased viscosity, transparency and filmogen gel forming properties. To increase the solubility of Meloxicam, in this study we used: Tween 80, Triethanolamine and polyethylene glycol 400 (PEG 400). The kinetic profile of Meloxicam in vitro release from pharmaceutical formulations was studied using Franz diffusion cell. Methylcellulose artificial membrane was used as diffusion membrane.

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10. Lead Determination In Meat Products By Atomic Absorption Spectrometry

Mariana - Luminita Neacsu(1), L. Chirigiu(2), Maria - Viorica Bubulica(2)

The presence of heavy metals in food is the consequence of soil and atmosphere contamination (vegetable products); feeding animals with contaminated feed with heavy metals (animal products); acquisition of polluted waters (fish and other aquatic creatures); due to other sources (technological water, utensils, pots, etc.). The lead content along with other elements in food is of major interest for protection because of cumulative toxicity and animal and human health risks [1, 2]. The presence of lead traces production in many flows of production is also undesirable, because it can possibly go into food and thus be consumed by humans [3].

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11. Remedial Assessment Of Patients With Lumbosacral Pains Caused By Physical Effort

T.Miserlis(1), V.Cirlig(2), C.I.Taisescu(3)

This study presents a simple scale for assessing and monitoring the benefic results of the rehabilitation therapy applied and particularly suggests the treatment of patients with lumbo-sacro-pelvic muscle and ligaments pains in a stages program of medical rehabilitation with physical support. The classification on degrees of severity shows that 79.4% of patients suffered from severe pains (between 7 and 10 points) and the remaining 20.6% suffered from average pains. The initial anti - inflammatory and decontracturant treatment supported by thermal electro – kinetic and massotherapy procedures was applied daily for three weeks. Being well known that lumbosacral muscle and ligaments algofunctional syndromes are affections that relapse frequently, we consider that it is necessary to monitor and treat them by periodic recovery, without waiting for the relapses or for any complications to appear, as they are more difficult to treat.

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12. Facial Hemangiomas Diagnosis

T. N. Sas(1), N. Boutsiadis (2)

Hemangiomas are prominent lesions, circumscribed, red, often lobe, typically found at females (sex ratio of 3:1). The incidence of hemangiomas is 10-12% to infants, preterm infants with a birth weight over 1500 g and to term newborns. Most hemangiomas become distinct lesions during the first 6 weeks of life and proliferate within the first 8-12 months. Frequently hemangiomas are isolated lesions (80%), while 20% of cases have multiple location. Hemangiomas are clinically heterogeneous, defined by the appearance of depth, location and stage of development. In clinical aspect, hemangiomas may take slightly different forms. So in addition of the considered classic hemangiomas can be distinguished four types: deep hemangiomas, covered by normal skin, known as cavernous hemangiomas; macular hemangiomas, hemangiomas similar to „wine stain”; elevated hemangiomas, hemangiomas with persistent increased blood flow. The most common locations of hemangiomas are based on incidence, there are: cephalic extremity (60%); trunk (25%); extremity (15%); extracutaneous areas, such as liver, gastrointestinal tract, larynx, central nervous system, pancreas, thymus, spleen. A common feature of congenital vascular anomalies is the distribution in almost any region of the body in any organ. At patients with multiple hemangiomas, clinical examination and complementary imaging for the diagnosis of visceral lesions in organs derived from the same gill arch structures in the anatomical region which is located hemangiomas. The evolution of modern anesthesia techniques, laser therapy, surgical and medical methods allow effective intervention to treat those lesions considered in recent years as having unacceptable results and allow safe treatment of hemangiomas preventing the occurrence of psychological sequelae of children as a result of this facial hemangiomas.

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13. Periimplantitis. Aetiology, diagnosis, treatment. A review from the literature

F. Bobia (1), R. V. Pop (2)

Orodental rehabilitation through the use of implants offers very high success rates. In this paper, we describe some of the complications involved with this technique, such as periimplant disease and, within this category, periimplantitis, an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, external morphology and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of colour in the gum, bleeding and probing depth of periimplant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of mucositis or periimplantitis. Therapeutic objectives focus on correcting technical defects by means of surgery and decontamination techniques (abrasion with carbon particles, citric acid solution, topical tetracycline application and laser surgery).

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14. Colonic Capsule Endoscopy

C.T.Streba (1), C.C. Vere (1), Corina Lavinia Gruia (2), F.Sima(1), M.C.Sergiu (1), A.G. Ionescu (1)

Colonic capsule endoscopy represents a novel technique used to identify colon lesions. Being a non-invasive procedure, with a high patient compliance and minimal side-effects, it can safely be administered to large population groups with different pathologies. When used in conjunction with a self-absorbing patency capsule, it becomes a safe procedure even if obstruction is present, thus eliminating one of the most important risk factor. On the other hand, colonoscopy currently represents the “gold standard” for colon diagnosis and therapy. The technology has not notably evolved in recent years, as its technique remains basically unchanged. Being an invasive procedure, dependent on the experience of the operator, it puts patients under a considerable amount of stress, thus having low patient compliance. Recent studies advanced the possibility of using colonic capsule endoscopy in colorectal cancer screenings as an alternative or a complementary method to standard colonoscopy. We reviewed such literature trying to present accurate data regarding the safety, feasibility and performance of colonic capsule endoscopy when compared with standard colonoscopy.

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