Archive issue

1. Angiogenesis and Vascular Endothelial Growth Factor in malignant gliomas

ALISA MADALINA POPESCU1,2, STEFANA OANA PURCARU1, B. STOLERU1, LIGIA TATARANU3, DANIELA ELISE TACHE1, MONICA DANIELA DOSA4, ANICA DRICU1

VEGF receptors and their ligands are highly expressed in brain tumor cells but not in the adult normal brain cells. Angiogenesis process has been shown to play an important role in brain tumors cells development and survival. Malignant gliomas are the most common brain tumors with a low survival rate, despite the prompt treatment at diagnosis. Standard treatment consists of resection, radiation and chemotherapy with temozolomide, followed by 6 months of chemotherapy. Recurrence after standard treatment is often seen, indicating the high therapeutic resistance of glioblastoma cells. It has also been reported that glioblastomas are among the most angiogenic of all neoplasms in human. This paper will review recent data of the role of VEGF angiogenic growth factors in malignant gliomas angiogenesis.

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2. The Assessment of Fetal Neurobehavior with 4D Ultrasound: the KANET Test

P. ANTSAKLIS(1,3), A. ANTSAKLIS(1,3), A.KURJAK(2,3)

An evolving challenge for obstetrician is to better define normal and abnormal fetal neurological function in utero, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Especially the diagnosis of cerebral palsy remains one of the most difficult and challenging clinical situations in obstetrics. The fact that a large number of cerebral damage occurs prenatally and also that early intervention in cases of neurological damage shows better results, in combination with the progression of ultrasound technology, which allows better and real time assessment of the fetus, prompted some researchers to explore the possibility of detecting fetal neurological damage in the uterus. Systematic estimation of a number of parameters from fetal behavior, such as quality of spontaneous fetal movements, cranial sutures, the neurological thumb and a high palate, that were included in the prenatal neurological fetal screening, led to formation of a scoring system for the assessment of fetal neurobehavior, called Kurjak’s antenatal neurodevelopmental test (KANET). The introduction of such a test allows a systematic assessment of fetal neurobehaviour and may distinguish between normal and abnormal behavioral patterns, that could make possible the early recognition of fetal brain impairment.

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3. GnRH Antagonist IVF Protocol in PCOS

ALINA ONOFRIESCU(1), ADRIAN BORS(2), ALEXANDRU LUCA(3), M. HOLICOV(3), M. ONOFRIESCU(3), CARMEN VULPOI(4)

Objective. The aim of the present study was to compare the GnRH agonist long protocol with the flexible GnRH antagonist protocol in infertile PCOS women undergoing COS in terms of clinical pregnancy rate (CPR), with special reference to the incidence of OHSS. Materials and Methods. The study was conducted at the Hospital Obstetrics and Gynecology Cuza Voda Iasi and Fertility Reproductive Medical Center Omini Clinic Iasi from June 1, 2010, to September 31, 2012. PCOS as defined by the Rotterdam 2003 consensus, i.e. presence of two of the following three features: presence of oligo- and/ or anovulation, clinical and/or biochemical signs of hyperandrogenism, polycystic ovaries and exclusion of other endocrinopathies. Results. No differences were observed in clinical pregnancy rate (CPR) in the agonist and antagonist protocols, respectively. Incidence of OHSS was lower in the antagonist compared with agonist group (4% versus 28%). Duration of stimulation (13,80 + 1,4 vs 11,85 + 2,4 p < 0,001) and total gonadotrophin required (2435,5 + 884,5 versus 2005, 5 + 545,5 IU p < 0.003) were also lower in the antagonist compared with agonist protocol. Conclusions. The current study suggests that the flexible GnRH antagonist protocol is associated with a similar ongoing pregnancy rate, lower incidence of OHSS grade II, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. The GnRH antagonist might be the treatment choice for patients with PCOS undergoing IVF.

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4. The Contribution of Imaging in Traumatic Lesions of the Spine

ROSANA MANEA

Spinal cord injuries are a major cause of morbidity and mortality. Early identification of spinal lesions reduce long-term negative effects of these traumas. This paper proposes an algorithm for x-ray and imaging in trauma patients with cervical, thoracic or lumbar depending on neurological assessment and compliance neurologicalpatient in a class given the ACR criteria. Radio-imaging evaluation of the spine is the method of choice for assessing the existence, location, extent and type of spinal cord lesions and / or the vertebral body. Application of appropriate imaging means for assessing spine trauma, requires knowledge of indications and limitations of methods.

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5. The value of Doppler cerebral parameters to assess a group of patients with multiple sclerosis

AURA COTEANU(1), SIMONA GUSTI(2), CATALINA COTEANU(3)

Background: The current definition of multiple sclerosis is an inflammatory/degenerative disease of central nervous system with focal demyelination around cerebral veins. In 2007 a theory was proposed that demonstrates an alteration of cerebral venous flow in patients with multiple sclerosis. Our study wants to see if there is a statistically significant differences between cerebral venous hemodynamics in multiple sclerosis patients and healthy people. Methods: We admitted in the study twenty-seven patients with multiple sclerois possible or defined, and thirty clinically healthy persons. All subjects underwent neurological assessment and extra-cranial Doppler examination. We calculated for each internal jugular vein a parameter called ?CSA. The sum of all the venous flows was then calculated in clinostatism and in seated position and the difference between the two parameters has been named ?CVF. We assess the eventual presence of reflux in the internal jugular vein after a short period of apnea. Results: Between results of ?CSA parameter were differences with very high statistical significance. Similarly a negative ?CVF is significantly associated with multiple sclerosis. The persisting presence of reflux in internal jugular vein was observed in 60% multiple sclerosis patients. Conclusions: Studied parameters have revealed that there is a hemodynamic significance in the pathology of multiple sclerosis. Thus data obtained led us to the conclusion that the presence of reflux in the internal jugular vein correlated with a negative ?CVF is statistically significant in patients with multiple sclerosis.

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6. Methods of postoperative analgesia - administration of epidural bupivacaine in patients with colon cancer undergoing surgery

MAGDALENA DIACONU1, C.C GEORGESCU2, M TANTU3

Colon cancer is a disease in Romania whose incidence is increasing in recent years. The purpose of this paper is to present a modern management in the treatment of postoperative pain in patients with colon cancer undergoing surgery without influencing postoperative morbidity and mortality. It is necessary to introduce new approaches for colon cancer in terms of surgical treatment, and preoperative and postoperative care of the patient. Postoperative pain management is very important because it influences, on the one hand the development and recovery of the patient, but on the other hand, chronic pain may occur as a side effect to surgery [1, 2]. Pain assessmentwas performed, postoperatively by using dimensional pain assessment method, that is visual analog scale (VAS) whereas sedation assessment performed postoperatively, after the patients have received benzodiazepines and opioids during general anesthesia was performed using the Ramsay score.

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7. Clinical and therapeutic aspects in dento-alveolar disharmony (DAD) with crowding

ANNE-MARIE RAUTEN1, PETRA SURLIN2, MADALINA OLTEANU3, CAMELIA MAGLAVICEANU3, M.R. POPESCU4, ELINA TEODORESCU5

Dento-alveolar disharmony (DAD) with crowding represents a predispose factor for periodontal pathology installing, especially when septic inflammation is associated. In this context, the identification of integrity or presence of the periodontal structure modifications becomes essential, any discovered element of periodontal pathology transforming into an important factor for a correct and beneficial orthodontic or periodontal-orthodontic therapy setup. The purpose of our study was to reveal the relations between the DAD existence and periodontal modifications within a lot of 528 subjects of 7 to 19 years old wearing different DAD who asked for an orthodontic control, and also the effects of orthodontic therapy upon periodontal structures for the situations in which this therapy was instituted. 74,87% was the percentage for patients with DAD and crowding who accepted the initiation of an orthodontic treatment and 12,75% of them had a friable C type periodontium (with great possibility to evolve towards a periodontal pathology), 25,62% had chronic gingivitis, and in 15,43% there have been noticed gingival recessions more than 2 mm. The orthodontic treatment was finalized for 44,96% of the patients, in 13,43%  we noticed the persistence of C type periodontium, in 8,95% of gingival recessions more than 2 mm, in 25,37% chronic gingivitis and in 22,38% hypertrophic gingivitis. Conclusion: it is important to initiate an exhaustive control of the patient with DAD before, during and after the orthodontic treatment, especially if the patient is susceptible to develop a periodontal pathology, and also to maintain a good oral hygiene along the treatment. 

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8. Surface morphology of leukemic cells from chronic myeloid leukemia under atomic force microscopy

AMELIA GAMAN 1,2, E. OSIAC 1, IONELA ROTARU 1,2, C.TAISESCU1

Atomic force microscopy (AFM) represents an important instrument for measuring mechanical properties of biological materials ranging from single molecules to normal or malignant cells. AFM provides a 3D profile of the surface on a nanoscale, by measuring forces between a sharp probe (<10 nm), supported on a flexible cantilever, and surface at very short distance (0.2-10 nm probe-sample separation). The AFM tip “gently” touches the surface and records the small force between the probe and the surface. The patients were three normal human subjects and nine patients with chronic myeloid leukemia in different phases of disease. With atomic force microscope, numerous spicules were observed on the surface of leukemic cells, especially in blastic phase of CML.

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9. Study of the risk factors and prevention of venous thromboembolism in surgery

M.S. GHELASE(1), A. BORUGA(2), S. RAMBOIU(2), A. ROTARU(2), D. MARGARITESCU(2), D. CARTU(2), F. GHELASE(2)

Venous thrombosis is still a major cause for high morbidity and mortality because of its clinical manifestation – deep venous thrombosis (DVT); establishing an early diagnostic is important because thrombosis can rapidly extend to a potentially lethal complication – pulmonary embolism or it can lead to invalidating consequences. Between 2002 and 2006 10653 patients were surgically treated, among them 3875 (45.5%) presented risk factors which could lead to deep venous thrombosis. Patients were grouped according to the involved risk factors in three severity classes: major risk in 1860 cases (47.87%), medium risk in 1300 cases (33.16%) and with low risk 715 (18.56%). Regardless the severity of the risk factors, patients were included in the preventive treatment protocol for deep venous thrombosis, started 1-2 hours before the surgical intervention. Although there are advantages and good results of using low-molecular-weight-heparins (LMWH), we recorded hemorrhagic complications in 79 cases (2.04%), mainly in those with major risk. Surgical reintervention was necessary in 2 cases while treatment reconsideration, conservative measures, reassessment of risk factors and hematological explorations eliminated these adverse effects. Despite the preventive treatment for the venous thrombosis confirmed by Doppler ultrasound scan, we recorded 36 cases of deep venous thrombosis, 12 cases of pulmonary microembolism who received anticoagulation therapy and 3 patients who died from massive pulmonary embolism.

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10. Purulent Pericardial Effusions with Pericardial Tamponade - Diagnosis and Treatment Issues

C.P. PETCU(1), RODICA DILOF(2), C. BATAIOSU(3), P.D. PETCU(3)

Purulent pericarditis is rarely encountered in the antibiotherapy era, mainly in immunosupressed patients, after cardiac operations, in septicemia. Diagnosis of purulent pericarditis is based upon the analysis of pericardial drainage, obtained through pericardiocentesis or preferably, through a surgical approach. The reported case has following peculiarities: clinical signs of false acute surgical abdomen; altered clinical and biological response to infection; Optimal treatment is early, efficient pericardial drainage, with low risk of tissue contamination and of pericardial constriction; Surgical subxyphoid pericardial drainage is prefered in patients with affected general status. Antero-(lateral) thoracic approach with associated anterior pericardiectomy ensures an efficient pericardial drainage and prevents pericardial constriction, with low risks for pleural contamination.

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