CHSJ

Archive issue

Current Health Sciences Journal

vol. 39 no. 3, 2013

1. The Role of Cervical Length Measurement in the First Trimester of Pregnancy for the Prediction of Preterm Delivery

P. ANTSAKLIS1,3, A . ANTSAKLIS 1,3, A. KURJAK 2,3

Preterm delivery (PTD) is the leading cause of perinatal mortality and long-term morbidity. Because of the implications of PTD, we underwent a meta-analysis of current literature to assess the relationship between cervical length and the risk of PTD.

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2. The Clinical Implications of the Alpha 1- Antitrypsin Deficiency

F. PETRESCU1, V. BICIUSCA1, C. VOICAN1, ILEANA-OCTAVIA PETRESCU2, DANIELA CIOBANU1, DIANA TUDORASCU1

Alpha1-antitrypsin deficiency, one of the three most common potentially lethal genetic disorders among whites, an autosomal recessive genetic disease, leads to early-onset panacinar emphysema, increased lung cancer risk, chronic liver disease and skin disorders. It has recently been studied the causal relationship of alpha1-antitrypsin deficiency (mainly the Z allele) to inflammatory bowel disease, but also to the increased incidence of extraintestinal manifestation, the most frequent being the cutaneous, articular and hepatic ones, as well as its relation to fibromyalgia.

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3. Histopathological Study of the Urothelial Bladder Carcinomas

A. STEPAN, CRISTIANA SIMIONESCU, C. MARGARITESCU, RALUCA CIUREA

Introduction: In this study we analysed the most important parameters necessary for the hystopathologic diagnosis of urothelial carcinoma, a tumor which frequently develops at the vesical urothelial’s level. Material and metods: It is presented a study which contained a number of 150 cases of urothelial carcinoma of the bladder, selected during year 2011. We described histopathological aspects corresponding to the growing pattern, tumoral differentiation and invasion depth, as well as the associated lesions, especially those of the urothelium adjacent to the tumors. Results and discussions: The urothelial carcinoma located at the bladder level had various histopathological features. The evaluation of the cytologic atypia and neoplastic configuration, as well as the identification of atypical mitosis, allowed us to graduate the tumors.The analysis of biopsies allowed us to identify the invasion at muscularis propria level in most cases. The lesions associated with invasive urothelial carcinoma were represented by carcinoma in situ, dysplasia, squamous metaplasia, inflamation. Conclusions: The tumoral differentiation degree was correlated with the growing pattern and also with the invasion depth. Some tumors have few associated modifications, enhancing the complexity of the lesions and posing diagnosis setting problems.

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4. Comparative Aspects of Microglia Reaction in White and Gray Matter

B. CATALIN1,2, SMARANDA MITRAN1, CARMEN ALBU3, MARIA IANCAU1

Objectives: Microglia are considered as the primary immune effector cells in the brain and have a critical role in all brain lesions. We wanted to find out if there is any difference in the way that white and gray matter microglia react to the same type of lesion. Material and Method: We used 14-16 weeks old single transgenic CX3CR1-EGFP mice, whereon microglia were labeled by expression of the green fluorescent protein EGFP and the L1-L2 dorsal spinal columns were exposed. After 10 min of continuous base line image acquisition, we made a micro-lesion by focusing and raising the power of the laser and, than, we monitored it for an additional hour. Laser-lesion and image recording were also made in the right somato-sensory cortex. We quantified microglial response and compared white vs. grey matter. Results: 5-10 min after the lesion, microglia already showed signs of polarization by extending their processes both in white and gray matter. Processes were sent by the microglial bodies situated at a distance of 50 to 100 µm, depending on the lesion size. Microglial processes did not display a preferred target site from the lesion; in contrast, they formed a uniform “shielding” ring around the lesion. Conclusions: Microglia showed targeted responses to acute injuries in grey and white matter also; no major differences were observed besides the speed of the process, due probably to particular cortex and spine architecture.

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5. Dental Morphology as an Aesthetic Reference in Prosthetic Reconstruction of Lateral Maxillary Areas

M. R. POPESCU1, L. CHIRIGIU2, L.P. DRAGOMIR1

The purpose of this study was to assess the impact of prosthetic reconstruction of the lateral maxillary areas on the dental-facial aesthetics. The so called buccal corridors can have different sizes, influencing the total or partial visualization of the lateral group represented by premolars and molars, with negative consequences upon global aesthetics. The compliance with the dental morphology, but with possibilities of embellishment of prosthetic constructions, influences the smile topography. The assessment of the patients, men and women, started by establishing a research protocol comprising, besides the clinic investigation, a specific sequential approach, which cumulated the additional investigations (x-ray investigation, study of document models, frontal and profile photos). The clinical data were reported and selected depending on the limitative possibilities of the occlusal status, so that a gradual visualization of the dental units at the level of lateral maxillary and/or mandibular areas when smiling, to which the existence or inexistence of the local symmetry is added, associated with the size of the buccal corridor, to allow a relevant planning and assessment of the influential possibilities of the local parameters regarding the smile improvement at this level. The chromatic association of the future prosthetic construction of the current dental constructions as well as the used therapeutic versions, associated with data about age, gender and the training level of the patients, to which we added our experience, have represented references in the final assessment of this study.

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6. Antipsychotic Drugs And Salivary Leptin Levels In Wistar Rats

MARIA BOGDAN1, ANCA BERBECARU-IOVAN1, CRISTINA DUMITRESCU1, CATALINA PISOSCHI2, A. CAMEN3

Purpose. Mental dissorders such as psychosis, agitation, mania, dementia and bipolar disorder are treated with variable doses of antipsychotics. However, these drugs are often associated with metabolic side effects (weight gain), endocrine disruptions, diabetes mellitus and cardiovascular diseases.Unfortunately, a single reliable predictor of weight gain has not been found, but a relation is to be mentioned between the levels of circulating leptin, administration of antipsychotics and weight increase. The aim of this study was to assess the effects of exposure to antipsychotics from both generations on the salivary leptin levels. Material and Methods. Salivary leptin was determined by the ELISA technique, on three groups of male Wistar rats treated with haloperidole, haloperidole decanoate and aripiprazole for 4 weeks.Results. The present study evidences a significant statistical difference between the values of salivary leptin prior to and after the drug treatment with the first generation agents. Aripiprazole produced no changes. Conclusions. The treatment with haloperidole and haloperidole decanoate induces an increase in salivary leptin levels.

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7. Surgical Drainage versus Endoscopic Drainage in Pancreatic Pseudocyst

S. SANDULESCU1,2, V. SURLIN1,2, D. MARGARITESCU1,2, E. GEORGESCU1,2, I. GEORGESCU1,2

Pancreatic pseudocyst (PP) is an intra or peripancreatic fluid collection, without an epithelial coating, containing pancreatic juice rich in proteolytic enzymes, without clinical signs of infection. It is one of the most frequent complications of acute and chronic pancreatitis, patients with these disorders often benefit from interventional therapy, surgical or minimally invasive. We compared results obtained by open surgery with endoscopic treatment in 20 patients with pancreatic pseudocyst, admitted in Craiova Surgery I Clinic in the period 2006-2011. In 13 patients (65%) the endoscopic drainage was attempted and was successful in 10 (76.7% efficiency). Failure was due to puncture site bleeding, thick wall of PP or abundant collateral circulation. Endoscopic drainage consisted in transgastric drainage (5 cases), transduodenal in (3 patients) and transpapillary by ERCP (2 patients). Conventional surgery was required in 8 patients (40%), 7 of them as elective surgery and one in emergency due heavy bleeding after endoscopic internal drainage attempt. We practiced 4 pseudocyst-gastrostomy, 3 pseudocyst-jejunostomy and 3 external drainage (2 patients with dual localization of PP). There was a severe postoperative complication - upper gastrointestinal bleeding from the splenic artery which required reintervention. Results were positive by both therapeutic approaches, with differences in the number of days of hospitalization, patient comfort and post interventional evolution in favour of endoscopic approaches.

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8. Epidemiologic Study of Avascular Necrosis of the Femoral Head

DIANA KAMAL1, RODICA TRAISTARU2, D. O.ALEXANDRU3, D. C. GRECU4, L. MOGOANTA5

Avascular necrosis of the femoral head is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. The disease affects mostly young adults within their 3rd and 5th decade, the majority of the patients being men. The aim of this paper is to present the findings of our epidemiological study that concerned patients diagnosed with avascular necrosis of the femoral head, admitted in the Orthopaedics Department of the Clinical and Emergency Hospital Craiova between 2007 and 2011. Material and method: The study group included 92 patients diagnosed with avascular necrosis of the femoral head and who were admitted in the Orthopaedics Department of the Clinical and Emergency Hospital Craiova between 2007 and 2011. Inclusion criteria were that the residential county of the patients had to be Dolj County. The obtained findings were processed statistically to correlate clinical and laboratory data of patients diagnosed with this condition. Results: We noticed an increase in the number of patients admitted with the diagnosis of 11 patients in 2007 to a total of 25 patients in 2011. Most patients included in the study, 85.87% were diagnosed in advanced evolutionary stages of the disease, stages III and IV. The main risk factors detected in patients were represented by smoking (36.96%), alcohol intake (20.65%), trauma (11.96%), and corticosteroid therapy (8.70%). In 29.35% of the patients we were not able to find any risk factor, we considered that the cause to be idiopathic. Conclusions: The results of the epidemiological study presented in this paper correspond with related research results found in the consulted literature. There were some variables of our study that we haven’t been able to find correspondence for in the literature.

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9. Histologic Aspects and Outcome of Laparoscopic Cholecystectomy in Chronic Acalculous Cholecystitis

V. SURLIN1, A. ROSU2, E. GEORGESCU1, D. MARGARITESCU1, CRISTIANA SIMIONESCU3, I. GEORGESCU1

Aim: to investigate the histologic lesions and outcome of laparoscopic cholecistectomy in chronic acalculous cholecystitis. Material and method: analysis of 63 cases of chronic acalculous cholecystitis operated on between 2003-2007. There were 50 women and 13 men with median age of 52 years. Clinic, laboratory and imagistic investigations eliminated other digestive diseases mainly in the gastro-duodenal area. Surgical intervention consisted in laparoscopic cholecistectomy. All removed gallbladders were sent to histologic examination. The patients were questioned by telephone upon the persistence of symptoms and the degree of satisfaction of surgery. Results: there were no Intraoperative accidents. Postoperative complications were minor. There was no postoperative mortality. In 59 cases (93,65%) histologic lesions were noted: chronic cholecystitis – 26 cases, chronic cholecystitis and cholesterolosis – 10 cases, cholesterolosis – 7 cases, focal acute cholecystitis on chronic cholecystitis – 6 cases. In 4 cases (6,35%) the histologic examination found no lesion. 61 patients (96,8%) expressed the disappearance of the symptoms and a good and very good degree of satisfaction. Conclusions: In chronic acalculous cholecystitis the indication for surgery is based upon patient`s symptoms and exclusion of other digestive diseases. The histologic examination establishes the diagnosis of certitude. The laparoscopic approach offers conditions of full security and satisfaction for the patients.

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10. Retrorectal Dermoid Cyst: a Rare Clinical Entity

I. MUNTEANU1, ADRIANA BADULESCU1, B.MASTALIER2, MIHAELA LUMINITA MUNTEANU3, EMILIA DIACONU4, CARMEN POPESCU5

The retrorectal space represents the anatomical site at which level we identify the embryologic reminiscents in which it can develop liquid tumors - cysts or solid tumors - neoplasia. These tumors are rare but pose a diagnostic and therapeutic interest. This paper presents the case of a young 18 years-old diagnosed incidentally at a gynecological examination, with a palpable tumor developed, at the retrorectal space. Imaging examinations - transvaginal ultrasound and abdominal - pelvic computer tomographic exam - have supported the presence of a cystic tumor with a maximum diameter of 7.8 cm., in the space retrorectal. The lesion presented surgical indication, so it needed a posterior approach with resection of the coccyx enough for the control and safety of the operation. Histopathological examination revealed a dermoid cyst. Five years after surgery the patient is presented in good general condition, asymptomatic without clinical and imaging signs of local-regional recurrence.

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11. Patient`s Nutrition in Palliative Care: Ethical Values

ADRIANA ILIESCU, B.V. COTOI

Diet is inseparable from the concept of life. When this function cannot be physiologically done by the patient receiving palliative care, may she always be replaced by invasive medical therapy? What are the benefits of nutrition and hydration in terminally ill patients versus the risks posed by this type of intervention? This issue is dealing with the representations related to life, death and health. Parenteral nutrition can be justified medically and ethically, in the same extent?

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12. Principles of Diagnosis and Management in the Ovarian Hyperstimulation Syndrome

ALINA ONOFRIESCU1, A. LUCA2, A.BORS3, M.HOLICOV2, M. ONOFRIESCU2, CARMEN VULPOI4

Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of ovulation induction and in vitro fertilisation (IVF), potentially resulting in death in its extreme manifestation. How best to manage this condition has been the subject of considerable study, with primary emphasis on risk recognition before commencing the IVF stimulation sequence. The exact etiology of OHSS remains unknown. The aim of this guideline is to provide clinicians with up-to-date information about the diagnosis and treatment of OHSS, based upon the best available evidence. This guideline covers outpatient management, criteria for hospital admission and basic inpatient management. Intensive care management of OHSS is not covered in detail. OHSS is an exaggerated response to ovulation induction with FSH and HCG. OHSS is a self-limiting disorder with a broad spectrum of clinical manifestations related to increased capillary permeability and fluid retention mediated by many inflammatory mediators including vascular endothelium growth factor. OHSS is a systemic disease resulting from vasoactive products released by hyperstimulated ovaries. The pathophysiology of OHSS is characterized by increased capillary permeability, leading to leakage of fluid from the vascular compartment, with third space fluid accumulation and intravascular dehydration. Severe manifestations include a tendency to develop thrombosis, renal and liver dysfunction and acute respiratory distress syndrome (ARDS), causing serious morbidity. The role of this guideline is to outline the risk factors, clinical features and appropriate management of severe OHSS. The guidelines also aim at assisting the determination of the appropriate site of care.

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