Archive issue

1. The Role of Imaging Techniques in Diagnosis of Breast Cancer

GHEONEA IOANA ANDREEA(1), RALUCA PEGZA(2), LUANA LASCU(3), SIMONA BONDARI(1), ZOIA STOICA(1), A. BONDARI(1)

Breast cancer is the most common type of cancer in women worldwide. Advances and ongoing improvements in imaging technologies have improved the sensitivity of breast cancer detection and diagnosis, but each modality is most beneficial when utilized according to individual traits such as age, risk, and breast density. Mammography is considered the “gold standard” in the evaluation of the breast lesions from an imaging perspective. Ultrasound examination and magnetic resonance imaging are being offered as diagnostic techniques and as adjuncts to the pre and postoperative workup. Despite all of these advances, it is still the case that no single imaging modality is capable of identifying and characterising all breast abnormalities and a combined modality approach will continue to be necessary. In this overview we evaluate the role of various imaging techniques in the diagnosis of breast cancer based on an assessment of current trends

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2. Morpho-functional Novelties Concerning the Retina and Visual Prosthesis

D. ALEXANDRU(1), M. GEORGESCU(2), B. CATALIN(2), D. GEORGESCU(1), MARIA IANCAU(2)

The technological development in the last decade led to advances in the study of the retina. Using new techniques of immunohistochemistry and miniature electrodes, several new subtypes of cells and their functions were detected. These discoveries allowed researches to better describe the data processing that occurs at retinal level and to create superior models of this particular neural structure. Because of this accumulation of essential information about the way retina works, several attempts of replicating its behaviour are under develompent. At this moment there are several research teams trying to create a fully functional visual prosthesis. Among these, two are most successful, one from Germany, using a subretinal implant, and one from the Unite States, using an epiretinal implant

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3. The Outcome of Patients with Lupus Nephritis and the Impact of Cardiovascular Risk Factors

O. DRAKOULOGKONA(1), A.L.BARBULESCU(2), I. RICA(2), A.E MUSETESCU(2), P.L. CIUREA(2)

Background: Systemic lupus erythematosus (SLE) is the prototype of autoimmune connective tissue diseases. Renal disease is a frequent manifestation of SLE that influences the outcome of the patients. The aim of the current study was to determine and analyze the clinical features and subsequent outcome of 70 patients with LN, followed in our department over the past 5 years, focusing on the impact of cardiovascular risk factors in the renal outcome and mortality. Patients and methods: Our prospective study included 70 patients with SLE and LN and 70 patients with SLE without signs of renal involvement, all patients fulfilled the revised ACR (American College of Rheumatology) criteria for the classification of SLE. Demographical data, risk factors and comorbidities were recorded. Results: Patients with lupus nephritis had a mean age of 37 years (range 15-65, SD 1.8). During the study, we had a rate of drop off of 15 patients with lupus nephritis (21%) and 19 patients without nephritis (26%). Patients with LN had a higher prevalence of positive anti-dsDNA antibodies (85.4% vs 49%, p<0.001, RR=2.2) and a lower percent of rheumatoid factor (FR) positive (5.45% vs 15.68%, p=0.03, RR=0.34) compared with the controls, a higher prevalence of corticosteroid treatment (65.45% vs 7.83%, p<0.001, RR=2.1) and immunosuppressive treatment (AZA 27.27% vs 3.92%, p=0.01, RR=1.71, CFM 34.54% vs 0%, p<0.001, RR=2.16), a higher frequency of hypertension (47.27% vs 9.8%, p<0.001, RR=2.4), hyperlipidaemia (49.09% vs 1.96%, p<0.001, RR=1.81) and anti-PL antibodies (49.09% vs 20%, p=0.001, RR=2.70),and a higher mortality (16% vs 2%, p=0.02, RR=1.76). 20 patients (36.36%) from the survival group (55 patients), evoluated to renal failure, 9.09% of these with end -stage renal failure, results that are similar with the ones in other studies. Conclusions: The study reveals the fact that cardiovascular risk factors such as hypertension, hyperlipidaemia and antiphospholipid syndrome are associated with a higer rate of mortality and an evolution to end-stage renal disease

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4. A critical Evaluation of Surgical Treatment of Perforated Ulcer

A. RIGOPOULOS(1), S. RAMBOIU(2), I. GEORGESCU(2)

The treatment of perforated ulcer disease continues to evolve because of recent advances in pharmacology, bacteriology, and operative techniques. Despite antisecretory medication and Helicobacter pylori eradication, it is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. A clinical study was carried out on patients with perforated gastric or duodenal ulcer, admitted in the 1st Surgery Department between 2002 and 2008. During the 7 years of study there were admitted 256 patients with perforated ulcer - 212 cases of duodenal and 44 cases of gastric perforated ulcer. The main surgical treatment option was simple closure with Graham patch, followed by ulcer excision and vagotomy with pyloroplasty. The second major objective was the topical treatment of peritonitis and consisted in the lavage of the peritoneal cavity and drainage.  Distal gastric resection has now very limited indications. We recorded no complications postoperatively. In the modern treatment of ulcer, surgery is reserved for the acute (perforation and bleeding) and chronic complications (stenosis / penetration) and exceptionally or the patients with a prolonged history of uncomplicated ulcers with lack of response to conservative therapy

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5. Impact of Inflammation on the Onset and Severity of Vascular Disease in Patients with Ankylosing Spondylitis

DIANA-RODICA TUDORASCU(1), M.E. CIUREA(2), RALUCA CIUREA(3), ANCA ROSU(1), P. TUDORASCU(4), PAULINA CIUREA(1)

Ankylosing spondylitis associates an increase in morbidity and mortality from cardiovascular disease, existing a defined relationship between cardiovascular diseases and ankylosing spondylitis. Recent studies reported impairment of endothelial function, suggesting that atherosclerosis (ATS) induced by systemic chronic inflammation and altered lipid profile could be responsible of cardiovascular mortality increase. We assessed the role of inflammation in the induction and severity of vascular disease in patients with ankylosing spondylitis. We included 73 patients with no other vascular risk factors and assessed subclinical ATS at common carotid artery, the involvement of aorta, aortic valvular regurgitation and the correlation of these pathological changes with inflammatory status. 21 of the 73 patients (29%) showed different types and degrees of vascular disease which was correlated with pro-inflammatory markers, disease activity and the time from diagnosis. The chronic inflammatory status and other common risk factors are involved in the increase of cardiovascular risk in these patients

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6. Immunohistochemical Aspects of Endometrium Hyperplasias in Perimenopause

DANIELA ILIE(1),CLAUDIA VALENTINA GEORGESCU(2), CRISTIANA SIMIONESCU(3), ANCA DANIELA BRAILA(4), M. BRAILA(4)

The present study presents a comparative study of 30 diagnosed cases of endometrial hyperplasia at patients with menopause. The study group was compared with a group with well-differentiated endometrial carcinoma (G1) and a group with normal endometrium. The antibodies studied were represented by markers for hormone receptors (estrogen receptors-ER and progesterone receptor-PR), proliferation marker (Ki-67), epithelial membrane antigen (EMA) and p53 oncoprotein. ER and PGR values in hyperplasia have intermediate values, between the values of these receptors in normal proliferative endometrium and the ones of typical G1 endometrial carcinoma. Mitotic activity decreased with the increasing degree of hyperplasia, likely because the estrogen receptors have been repressed by a number of cofactors. The EMA immune-marking pattern seems to be useful in differentiating hyperplastic aspects without atypical markings. However, EMA cannot distinguish between complex atypical hyperplasia and endometrial carcinoma (G1). The correlation of results, obtained at p53 marking with the ones obtained for cell proliferation, suggests that the presence of wild type p53 protein accounts for the decrease in cellular proliferative activity with the increase of endometrial hyperplasia. Immunohistochemistry accounts for the same response to hormonal therapy in cases of endometrial hyperplasia but does not allow selection of cases presenting atypical hyperplasia, which are likely to develop subsequently into endometrial carcinoma.

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7. Researches upon Practical Implementation of the Pharmaceutical Care Concept in a Community Pharmacy-based in Romania

BACRIA RUXANDRA OCTAVIA(1), POPESCU FLORICA(1)

This research has proposed to evaluate the effects of the pharmaceutical care program upon the blood pressure and also upon the life quality on a batch of community pharmacy-based patients with high blood pressure from Pitesti town. The research was carried out on a batch of 50 patients with high blood pressure under monthly medical surveillance through the program, as compared with a witness batch of patients with high blood pressure. After 6 months of program implementation it was found a drop in systolic blood pressure within the experimental batch from 148,72± 15,2 to 130,24± 14,68 (p=0,043), and in the diastolic blood pressure from 93,09±  13,67 to 76,16 ± 7,42 (p=0,039). It could be noticed an improvement of the adherence to treatment and a life quality increase. Conclusions: A pharmaceutical care program can have beneficial effects in the case of patients with high blood pressure

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8. Jaundice Obstructive Syndrom

TIRZIU C.(1)

Jaundice is a yellowish  pigmentation of the skin, the conjunctival membranes over the sclerae and other mucous membranes caused by hyperbilirubinemia and subsequently causes increased levels of bilirubin in extracellular fluids. The concentration of bilirubin must exceed 1,5 mg/dl, that means three times the usual value. Tipes of jaundice. The jaundice is classified into three catergories , depending on wich part of physiological mechanism the phatology affects: prehepatic : The pathology is occurring prior to the liver. Jaundice is caused by incresed rate of hemolysis . Malaria, leptospirosis, hemolytic uremic syndrome, sickle cell anemia, spherocitosis, , thalasemia and G-6-PDH deficiency can lead to increase red cell lysis. Laboratory findings: Urine  - no bilirubin, urobilirubin >2 units, Serum : incresd unconjugated bilirubin. hepatic: The pathololy is located within thw liver. Jaundice is caused by acute hepatitis, hepatotoxicity, Gilbert’s syndrome, Crigler-Najjar syndrome and alcoholic liver disease,  wereby cell necrosis reduce the liver’s ability to metabolize and excrete bilirubin. Other causes include neonatal jaundice ( is usually harmless, lasting until dsy 8 to 14 in premature births caused by metabolic and physiological adjustments after birth) and primary biliary cirrhosis. Laboratory findings are: Urine : conjugated bilirubin present, urobilirubin > 2 units . posthepatic: The pathology is located after the conjugation of bilirubin in the liver. This jaundice, also called obstructive jaundiced, is caused by an interruption to drenage af bile in the biliary system . The most common causes are gallstones in the common bile duct, cancer in the head of the pancreas. Other causes include : parasites, biliary atresia, ductal carcinoma, pancreatitis, pancreatic pseudocysts, Mirizzi’s syndrome. Laboratory fidings : pale stools and dark urine, elevated serum cholesterol. No test can differentiate the type of jaundice. There are a combination of function tests to arrive at the diagnosis. Phatophisiology of jaudice. Jaundice itself is not a disease, but rather a sign af one many possible underlying pathological processes that occure at some poit along af normal pathological pathway of metabolism of bilirubin. When red cell have completed their live span (aprox. 120 days) traverses throuthout the reticuloendothelial system and are destroid. The  hemoglobin  are phagocytosed by macrophages, and split into hem and globine portions. Two reactions then place whit the hem molecule:an  oxcydation reaction  and results biliverdin (green color pigment),  the next step is reduction of biliverdin to bilirubin (yellow color pigment). This bilirubin is unconjugated or indirect bilirubin. Other sourses of bilirubin  (20%) are represented by ineffective erytropoesisand , breakedown of myoglobine and cytocromes. Once it arrives to the liver, indirect bilirubin is conjugated  whit gucuronic acid and forms direct bilirubin by the enzyme UDP-transferase . Th

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9. Obesity and Overweight in Children - Epidemiology and Etiopathogeny

SIMONA COSOVEANU(1)

In the last few decades, obesity has become one of the most frequent nutritional diseases in the world, resembling a pandemy and being considered the 21st century disease. At present, one can notice an increased tendency with an epidemic character of obesity and overweight frequency, which came to affect, on a world scale, approximately 20-25% of children and 45-50% of the teenagers. According to a study carried out in 79 countries, WHO estimates that there are 250 million obese people in the world, among which approximately 22 million are children aged less than 5 years. Obesity is a plurifactorial disease, its occurrence supposing multiple interactions among genetic, neuroendocrine, social, behavioral, psychological or a combination of these, metabolic, cellular and molecular factors that lead to changes of the energetic balance.

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10. Tuberculosis and Chronic Renal Failure

NITU MIMI(1)

Patients whith chronic renal failure have a high incidence of tuberculosis, possibly due to a decrease in cellular immunity. Treatment of tuberculosis in these patients may be complicated by an increased risk of toxicity from tuberculosis drugs and careful monitoring for side -effects is essential in this group.

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