Archive issue

1. Primary Gastric MALT-Type Lymphoma Pathogenesis

ROTARU IONELA(1), CIUREA T.(2), GAMAN G.(1), NEAMTU SIMONA(1)

Gastric lymphoma is considered to be primary when the initial symptoms of the disease are located in the stomach or when the tumour mass is located in the stomach. MALT lymphoma represents 35-40% of primary gastric lymphomas. If the involvement of Helicobacter pylori in the primary gastric lymphoma etiopathogenesis and the favourable response of the disease to the eradication therapy tend to become postulated, much less known is the role of the host’s immune response in pathogenesis, as long as only a small proportion of infected patients develop lymphoma. Besides the tumour specific T cells, it is necessary for Helicobacter pylori that malignant B cells have also certain features allowing their uncontrolled proliferation at their stimulation by T lymphocytes. There are probably some genetic abnormalities that confer them growth advantage or abnormal biological properties such as the ability to recognize autoantigens. Gastric lymphomas are characterized by microsatellite instability (MALT lymphoma) and chromosomal instability, involving loss or gain of large chromosomal regions or even chromosomes. In MALT lymphoma there are found at least three recurrent chromosomal translocations in most cases (65%): t(11;18)(q21;q21) that results in the appearance of a chimerical fusion gene API2-MALT; t(1;14)(p22;q32) that alters the expression bcl10; and t(14;18)(q32;q21) that causes the alteration of the MALT1 expression. Concerning different genes, all these translocations result in the activation of nuclear factor kB (NFkB), which has an important regulator role of numerous genes involved in immunity and apoptosis, and consequently in the progression of lymphoma

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2. Immunological Profile in Patients with Lupus Nephritis and Correlations with the Histological Pattern

DRAKOULOGKONA OURANIA(1), RICA IOANA(2), BARBULESCU ANDREEA(2), MUSETESCU ANCA(2), CIUREA PAULINA (2)

Lupus nephritis (LN) is a common manifestation in patients with systemic lupus erythematosus (SLE). Certain serum autoantibodies are associated with the presence of nephritis. Objective. The aim of the study is to describe and analyse the immunological antibody profile associated with the development of nephritis in patients with systemic lupus erythematosus and to find possible correlations with the histological pattern. Patients and methods. We designed a retrospective case control study of 61 patients with biopsy proven LN and 110 patients with SLE without LN. We used standard methods for laboratory testing of anti-dsDNA, anti-ENA and anti-phospholipid antibodies. Results. Patients with LN were significantly younger at the time of diagnosis ((26.4 (6.4) years versus 35.2 (10.6) years; p<0.001)  A higher frequency of anti-dsDNA, anti-Sm and LA was seen in the group with nephritis (p=0.002; p=0.005; p=0.0001).There were no significant correlations with gender, or the tipe of WHO histological classes identified in patients with lupus nephritis compared with those without renal disease. Conclusions. The factors associated with LN outlined in the current study are the presence of anti-dsDNA, anti-Sm antibodies and of LA

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3. Antioxidant Capacity of Plasma may Predict the Wounds Healing Process

NICOLAE CORINA IVONA (1), NOVAC M. (2), VRABETE MARIA (3)

We associated conventional other new parameters, to show the ratio between the endogenous (exogenous) oxidants and antioxidants and the influence exercised by this ratio upon the sensibility of organism to the standard therapy applied. In the same time, we sustain that a good and frequently clinic and paraclinic observations of evolution assure the possibility to select the opportunity for applying the most adequate schema of treatment, to correct the functional and humourale disequilibrium. The capacity of tissues to be very sensible to the applied therapy could be evaluated by means of the new parameters proposed. Understanding the basic mechanisms underlying the organ failure, suggests that efficient therapies have to be developed, and applied early, not as a very known classical schema, but as a pathophysiological one, before the irreversible alterations to appear, and so to reduce death rates.

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4. Nonepithelial Gastric Tumours - Diagnostic Problems

MARTIN R.

Aim: retrospective study based on the analysis of the observation sheets, tracking the main clinical and laboratory traits, of the surgery protocols as well as the results of the histopathologic exam. Material and method: During the period from January 1998 – December 2007 374 patients having gastric tumours have been admitted and treated surgically of whom 351 have been diagnosed with epithelial tumours and 23 with nonepithelial tumours (mesenchymal). Clinical diagnosis of gastric disease was guided by clinical symptoms and physical examination of patients that revealed: epigastria pain, nonspecific, unsystematised dyspepsia,  upper gastrointestinal bleeding or antroduodenal stenosis ,neoplastic impregnation . Clinical diagnosis was supported and complemented by laboratory explorations. Results:Clinical examination, laboratory investigations and especially the bioptic histopathology examination facilitated by the endoscopic and ecoendoscopy, contributed to the preoperative diagnosis of nonepithelial gastric tumour. Conclusions: Diagnostic errors are due to nonspecific clinical signs, with insidious evolution, the development of tumours deep in the gastric wall and the specificity and sensitivity of stomach examination procedures

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5. Colorectal Cancer - Prognostic Correlations

VASILE L.(1), PIRSCOVEANU M.(1), MUNTEANU M.(1), PLESEA E.(2)

Significant advances about carcinogenesis and natural history of colorectal cancer (CRC), particularly the establishment of filiations polyp-cancer, are important objectives for a new approach to diagnosis of this disease. Decade 1990-2000 was the decade of CRC detection and prevention, but the decade 2000-2010 is the period of application of new diagnostic and therapeutic concepts. The aim of this study was to highlight the epidemiological, clinical, therapeutic, evolution and prognosis aspects of this cancer. The research was based on examination of the computerized system of C.E.U.H. of Craiova, observation sheets, operation protocols and anatomic-pathological results, from which we identified from January 2003 until December 2005 a number of 134 patients with CRC investigated, treated and followed completely. This was possible thanks to collaboration between surgical, gastroenterology, oncology clinics and anatomopathology laboratory of C.E.U.H. of Craiova, they accumulated a rich experience in diagnosis and treatment of digestive cancers, particularly colorectal one

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6. A Cause Of Falsely High Noise Level In Signal Averaged Electrocardiogram Recordings

DONOIU I., MUSTAFA ROXANA EDMEE, IONESCU D.D.

Signal averaged electrocardiogram (SAECG) is a well-established noninvasive method of exploration in patients at risk for sudden cardiac death. The time-domain SAECG analysis has a set of well-defined standards, including the value of accepted noise level. In very rare instances, the final noise level appears to remain unacceptably high even after carefully preparing the skin of the patient and averaging a great number of QRS complexes. We encountered three such cases in patients who had a SAECG done for a 40 Hz high-pass filter, which showed a high noise level in contrast with the visual impression of a good quality of the recording

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7. The Role of Biliodigestive Derivations in the Treatment of Choledocholithiasis

RAMBOIU S., GHITA F., NICOLI RALUCA-ELENA, GEORGESCU I.

The obstructive jaundice is a complex syndrome with both benign etiology (choledocholithiasis, hydatid cyst, chronic pancreatitis) and malignant (cancer of the pancreas, cholangiocarcinoma and gallbladder cancer) and it has a special place in biliopancreatic pathology, with up most importance due to changes in local and general status of the organism, difficult etiologic diagnostic problems for the clinician and whose solution requires teamwork, which involves both the surgeon, gastroenterologist, anesthesiologist etc. The introduction of laparoscopic approach and upper gastrointestinal endoscopy for gallstone disease giving the opportunity to solve choledocholithiasis only  by laparoscopic approach or by combining laparoscopic cholecystectomy with extraction of the common bile duct stones using endoscopic retrograde cholangiopancreatography, which greatly restricted the classical surgical indications. In these circumstances, I consider appropriate to review the place and indications of biliodigestive derivations in obstructive jaundice caused by coledocholithiasis

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8. Therapeutic Options for Breast Cancer

GEORGESCU MILENA, GEORGESCU E., NEMES R.

Breast cancer remains a major public health problem, being the second cause of cancer death in women. There is a marked tendency to restrict the extension of surgical gesture, which directly led to the emergence of two different attitudes: radical surgery and conservative surgery, to which, at least in our country there are still some delays. Prospective and retrospective studies have shown that in 20 years, conservative and radical therapy were about the same rate of survival and disease-free interval, at least for breast cancer stage I and II, the only real counterargument against conservative surgery is that it is encumbered by a higher rate of recurrence local constraint can be removed but by postoperative radiotherapy in principle. Finally, the survival rate is the main parameter distance evaluation assessing the effectiveness of treatment in breast cancer, as in all forms of cancer

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9. Disease Activity and Subclinical Atherosclerosis in Systemic Lupus Erythematosus

A.L. BARBULESCU(1), F. VREJU(2), A.E. MUSETESCU(2), I.R COJOCARU-GOFITA(2), P.L CIUREA(2)

Background: Atherosclerosis is the most common pathologic process leading to cardiovascular disease and systemic immune and inflammatory diseases, such as systemic lupus erythematosus (SLE), are associated with increased morbidity and mortality, most of it attributable to cardiovascular events. Non invasive measurement of arterial stiffness allows the detection of early vascular injury and help the clinicians improve the long term prognosis of these patients. The aim of this study was to evaluate the relationship between non invasive vascular assessment and SLE disease activity index. Methods: Our prospective study included 53 patients with SLE, from Rheumatology department, Emergency County Hospital Craiova. All of them have fulfilled the American College of Rheumatology revised criteria for SLE. Results: As expected, most of the patients were women (50, 94%), with a a mean age of 31,92 years (SD 5,55; limits 22-44), similar in women and men. Patients with persistent active disease (SLEDAI>8), had a mean  AIx  of 35,91% (SD 7,04; 95%CI 32,786 - 39,032), 1,31 times higher than the ones with SLEDAI<8 (27,39%; SD 5,89; 95%CI 25,228 - 29,546), statistically significant (p<0,001), a higher cfPWV-9,523m/s (DS 0,407; 95%CI 9,342-9,703), but not statistically significant (p=0,301) and a mean CIMT of 0,909mm (SD 0,03182; 95%CI 0,895-0,923) versus 0,897mm (SD 0,03699; 95%CI95% 0,884-0,911) in patients with SLEDIA<8, with no significant differences (p=0,242). AIx was the only marker of subclinical atherosclerosis that moderately correlated with SLEDAI (r=0,46; 95%CI 0,2134 - 0,6476; p<0,001). Conclusion: The results of our study show that SLEDAI significantly correlated with AIx, suggesting that disease flare or aggravation may play a permissive role in vascular injury through vascular inflammation and endothelial dysfunction, which will decrease arterial compliance.

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10. Surgical Management of Pre-invasive Lesions of the Cervix

MUNTEANU M., ADAM G., SIRBU O., MITROI S., COMANESCU AL., ILIESCU D., COTARCEA SMARANDITA, CERNEA N.

The natural history of the low grade lesions is most to spontaneous healing, but can also be to persistent lesions and progression to high grade lesions. Unlike the natural history of LSIL, HSIL has a major potential to progress to invasive cancer. The main goal in the management of high grade lesions  must be to remove the entire transformation zone in both surface and depth (7 mm tissue), and that can be achived either by ablation (laser CO2, criotherapy) or excision (ERAD, cold knife conisation, amputation, hysterectomy). Postoperative complications are rare (1-2%) and are typically hemorrhagic or infectious nature. A small percentage of patients may experience some postoperative sequelae: transformation zone ascend, unsatisfactory colposcopy, cervical stenosis, failure of conization.  Obstetrical prognosis is not severely affected after a single intervention, but repeating the procedure may increase risk of infertility and obstetric complications cervico-isthmic (incompetence, premature rupture of membranes, low birth weight, increased neonatal morbidity and mortality due to prematurity)

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