Archive issue

1. Of Mice and Ethics

C. T. STREBA, C. C. VERE, CRISTINA MISCU, D. I. GHEONEA, LARISA SANDULESCU, T. CIUREA, I. ROGOVEANU, A. SAFTOIU

Using animals in research has always been a subject of debate amongst scientific communities worldwide. The decision to perform certain experiments on live animal subjects is always taken after a series of experiments were already performed, leaving this as a final requirement before live human testing. It should always be performed when it is determined that it will provide a significant advancement in the field and will later result in an improvement to the human, social or environmental well-being. Historically, animals have been used in scientific experiments since ancient times. Their usage has varied greatly, and so did the moral implications. As medicine advanced through the centuries, using live or dead animals was of crucial importance for physiology or anatomy experiments. In modern society, animal experiments are a right attributed to competent researchers who can ensure humane care and use of the animals in controlled environments, with as little discomfort as possible to the living animal. Mice were used as prime subjects for medical experiments, especially in pharmacokinetics studies and treatment

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2. Diagnosis Correlations in Ovarian Tumors

LORENA DIJMARESCU, CARMEN GHETA, FLORENTINA TANASE, COMANESCU A ,MAGDA MANOLEA, LILIANA NOVAC

Background. Alongside with understanding physiological phenomena that occur in the ovary, both during the menstrual cycle, and pathological processes, including the mechanisms of carcinogenesis ovarian, the ability to discriminate benign lesions from the malignant ones has acquired a new importance. Patients and method. Assessment of patients was based on a diagnostic algorithm - RMI, which included clinical examination, ultrasound examination (internal wall structure, formation wall thickness, presence of septa and echogenicity) and serological testing for CA125.After obtaining the results patients were classified in the benign / malignant groups. Correlations were then made with the results of histopathological examination.Results. The results of the MRI correlation with histopathology were also framed in three categories: overvaluation, undervaluation and diagnosis. We recorded a 0.2% rate of undervaluation (tumors that have proven to be malignant), 65% overvaluation (tumors that proved to be benign) and a 33.8% rate of correct diagnosis. Conclusions. The results of this study show that preoperative accurate diagnosis in ovarian tumors is difficult, which is uncorrelated with histo-pathological results. They failed to establish reproducible ultrasound features of these tumors, therefore the recommendation for histopathological examination for a suspected ovarian masses remains valid

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3. The Value of Interleukine 6 in Premature Birth

T. DAIANU(1), N. CERNEA(2), A. GOGANAU(2), OANA DAIANU(3), LILIANA NOVAC(2)

The aim of this study was to correlate the levels of interleukin 6 from the cervical-vaginal fluid(IL-6cv), fetal fibronectine (fFN) and the length of the cervical channel (LCC), in the case of women with premature birth risk (PTB) and the superiority of the testing  IL-6cv for 24 hours, an independent predictor of PTB. Material and method The study comprised a number of 64 patients from which 36 pregnant women with PTB risk were selected in order to be evaluated for the determination of the level of IL-6 and fFN in the cervical-vaginal liquid, the exam of vaginal secretion and through trans-vaginal ultrasound in the single pregnancy.  Results and discussionsUnder the presence of bacterial vaginosis, the increase of IL-6cv was correlated with the growth of fFN, test used in order to assess the premature labour. Therefore, we observe that IL-6cv provides a connection between the inflammatory stimulus and delivery, being a key citokine in this process, by increasing its concentration in the cervical-vaginal fluid before the emergence of the clinical signs of birth and the positivisation fFN. Suprisingly, in the case of these pregnant women, the level of IL-6cv has significantly increase in 24 hours from sampling, and this was due to the release of this pro-inflammatory citokin from the cells of the vaginal epitelium. Conclusions IL-6cv and fFN are tests which should be frequently used in the medical practice in order to be able to avoid the immediate and late neonatal complications

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4. The value of transperineal ultrasound in persistent occiput-posterior position

G. ADAM, O. SIRBU, C. VOICU, D. ILIESCU, S. TUDORACHE, N. CERNEA

Objectives: The main objective of this study was to observe the values of transperineal ultrasound parameters in labour both in occiput anterior and occiput posterior (OP) position, and also to verify their importance in labour management. Methods: 91 patients in labour were included in this study, with gestational age over 37 weeks and estimated fetal weight over 2500 g, singleton pregnancy, cephalic presentation, empty urinary bladder. For these patients several ultrasound parameters were assessed: angle of progression, distance of progression, head direction, fetal head rotation, and fetal head-perineum distance. Results: 36 of 91 patients included in the study had an occiput posterior (OP) position     (39.56%) at the first ultrasound exam. 5 patients (5.49%) presented persistent OP position, all of them primiparous. 85 patients (93.4%) had vaginal delivery, 6 patients requiring cesarean section, 5 of which were patients that presented persistent OP position and lack of progress in labour. Ultrasound parameters were measured at the beginning of labour and they showed favorable values in all 5 cases with persistent occiput posterior position. However, in the second stage of labour, values maintained favorable in only one case. Conclusions: The vast majority of OP position had vaginal delivery in occiput anterior position. Similarly, the large majority of cesarean cases presented persistent OP position, with favorable ultrasound parameters values in the first stage of labour, and one case maintaining favorable values in the second stage of labour. Patients with occiput anterior position presented favorable parameters values throughout the labour

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5. The Contribution And The Importance Of Modern Ultrasound Techniques In The Diagnosis Of Major Structural Abnormalities In The First Trimester

DRAGUSIN ROXANA(1), FLOREA MARIA(1), D. ILIESCU(1), SMARANDITA COTARCEA(2), STEFANIA TUDORACHE(1) , LILIANA NOVAC(1), N. CERNEA(1)

We describe a series of cases where modern ultrasound (US) techniques diagnosed major structural abnormalities of the fetus in the first trimester (FT), unapparent when using the basic protocol of US investigation. In some cases, major structural abnormalities can be revealed in the FT scan solely to specialized personnel. Perhaps early screening should be confined in specialized centers, because congenital abnormalities detailed diagnostic has a huge impact in counseling the couple and also in prenatal advice of future pregnancies

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6. Clinical and epidemiological study of occlusive peripheral arterial disease of the lower limbs

D. MANESCU(1), P. MANESCU(2), R. NEMES(2)

Aim: study of risk factors for the disease, its clinical manifestations, and laboratory diagnostic elements (vascular functional explorations). Material and method: 50 consecutive patients operated in the Department of Surgery no. 1 of the Emergency County Clinical Hospital of Craiova who underwent retroperitoneoscopic lumbar sympathectomy (RLS) are analysed, the study group being a part of a total of 680 patients with occlusive peripheral arterial disease of the lower limbs (PAD), hospitalized and treated in our clinic between 2007 and 2011. Results: sex ratio = 1/7.9 in the group which includes all arterial diseases hospitalized (586 males and 74 females), sex ratio = 1/15.6 in patients who underwent sympathectomy (47 males and 3 females). The comorbidity evaluation highlighted the presence of high blood pressure (HBP)  in 50% of patients who underwent sympathectomy, which is within the range of data obtained on the entire group (52.5%). Chronic ischemic heart disease (20% in patients who underwent sympathectomy and 48.6% in patients of the entire group), acute myocardial infarction (16% in the RLS group and 11.4% in the PAD group) and ischemic stroke (8% in the RLS group and 4.8% in the PAD group) certify the plurifocality of arterial lesions. Diabetes was present in our study in 26% of patients with PAD and 18% of patients with RLS. Smoking was encountered in 72.6% of patients in the reference group and 70% of RLS patients. Twenty one cases had a history of disease of 1 year or less, while the remaining 29 cases have been suffering even for more than 6 years. The clinical picture was dominated by pain, present in all cases. We found no arterial pulsation in the posterior tibial and pedal arteries in 88% of the cases (44 patients). Changes of the hair and nails were present in 21 cases (42%), and in 28 cases (56%) we found hypotrophy of calf and crural muscles. Trophic lesions were present in a total of 24 patients (48%), assigned as stage IV patients. Oscillometric index values were below the normal range in all cases. Skin temperature values were close to normal values (26°C) in only 13 patients (26%); 27 patients (54%) had a distal systolic index (DSI) < 0.5, corresponding to a severe critical ischemia. Conclusions: The development of the disease is caused by the association of several pathogenic factors, the most important ones being age, smoking, diabetes, and HBP. Symptoms at onset were generally mild, insidious, with clinical distress extending over variable periods of time, with oscillating evolution but slowly progressing worsening trend. The clinical picture was dominated by pain. Changes of the skin, hair, nails, and muscles are common objective signs

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7. A pilot study of real time elastography in the differentiation of focal liver lesions

LARISA SANDULESCU(1), V. PADUREANU(2), CRISTIANA IULIA DUMITRESCU(2), NATALIA BRAIA(2), C.T. STREBA(1), D.I. GHEONEA(1), S. CAZACU(1), T. CIUREA(1), I. ROGOVEANU(1), A. SAFTOIU(1)

Introduction: Real time-sonoelastography (RTE) is a new developed technique that reveals the physical properties of the tissue by characterizing the difference in hardness between diseased tissue and surrounding tissue. Elasticity measurements have been already reported to be useful for the diagnosis and differentiation of many tumors: breast lesions, prostate cancer, lymph nodes and pancreatic masses but there are only few studies for the focal liver lesions. The aim of the study was to analyze whether computer enhanced dynamic analysis of elastography images is able to better characterize and differentiate benign and malignant liver lesions. Material and methods: The study group included, in total thirty nine liver tumors. RTE was performed by EUS or transabdominal ultrasound.  ROC analysis for the mean hue obtained through histogram analysis of the region of interest (liver lesion) after averaging individual pixels over a 10-second elastography movies was used to assess the color information inside the region of interest and to consequently differentiate benign and malignant liver lesions. Based on a cutoff of 170 for the mean hue histogram values recorded on the region of interest, the sensitivity, specificity, and accuracy of differentiation of benign and malignant masses were 92.5%, 88.8%, and 88.6%, respectively. The positive and negative predictive values were 86.7% and 92.3%, respectively. In conclusion, real time sonoelastography is a promising technique that might improve the characterization and differentiation between benign and malignant focal liver lesions visualized during transabdominal or endoscopic ultrasound

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8. Utility of endoscopic ultrasound multimodal examination with fine needle aspiration for the diagnosis of pancreatic insulinoma - a case report

A. POPESCU, ADRIANA-MIHAELA CIOCALTEU, D. I. GHEONEA, SEVASTITA IORDACHE, CARMEN FLORINA POPESCU, A. SAFTOIU, T. CIUREA

Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta cells. Symptoms are caused by hypoglycemia and clinical diagnosis is based on establishing their relationship to fasting, usually via a fasting test. The most conclusive imaging tests are endoscopic ultrasound (EUS) and CT. Surgery is the treatment of choice. A 33 year old male presented with a 2-year history of hunger which had intensified in the previous 6 months with added accompanying symptoms, culminating with an acute episode - loss of consciousness and seizures - which resolved after administering i.v. glucose. A fasting test was performed, with results suggestive for an insulinoma. Dual-phase CT showed a mass in the tail of the pancreas but no contrast enhancement. EUS was used for further assessment: B-mode showed a hypoechoic focal mass with a cystic component, on contrast enhancement the pattern was hypovascular, and elastography showed soft tissue. EUS fine needle aspiration (FNA) was performed and the immunohistochemistry (IHC) assay was conclusive for a neuroendocrine tumor of the pancreas. Treatment consisted of caudal pancreatectomy, with no recurrence after 1-year follow-up. Although this case started with a classic clinical presentation of an insulinoma, imaging studies related to tumor vascularization raised doubts about the actual diagnosis. Nevertheless, multimodal EUS assessment with FNA was considered to be the most appropriate diagnostic technique for detection, characterization and staging of the mass. EUS findings together with the IHC assay were able to offer the definite diagnosis of a benign neuroendocrine tumor and allowed us to refer the patient for appropriate treatment.

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9. The treatment of giant rhinophyma - Case Report

D. POPA(1), GEORGETA OSMAN(2), H. PARVANESCU(1),RALUCACIUREA(3), M. CIUREA(1)

The aim of the article is to present an update on the pathophysiology, clinical features and treatment of rhinophyma. A 56 years old patient, living in urban area, presented with a giant rhinophyma which caused him not only upper airways obstruction and difficulty in eating, but also aesthetic and psycho-social disadvantages.The treatment of  the patient was a surgical intervention consisting in removal of the nasal tumor and split-thickness skin grafting of the defect. The aesthetic result after surgical intervention was very good, there were no postoperative complications or recurrences.Rhinophyma represents the most advanced form of acne rosacea. The diagnosis is easy to establish based on the clinical features of the disease. In advanced forms of rhinophyma, when the tumor is giant, the main method of treatment is surgery

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