Archive issue

1. Angiogenesis Factors Involved in the Pathogenesis of Colorectal Cancer

ALEXANDRU MIHALACHE(1), I. ROGOVEANU(2)

Colorectal cancer stands at the top of oncologic pathology in the world, and in the same measure in Romania because is the third most frequent cancer diagnosed in men and women. Colorectal cancer develops as a result of mutations in genes that control proliferation and cell death. It was established that in the development of a tumor there is originally a prevascular phase followed by a phase of tumor angiogenesis. In the future it is necessary to develop new clinical protocols that angiogenesis inhibitors are associated with chemo or radiotherapy, conventional or other methods such as immunotherapy and gene therapy.

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2. Pharmacological Mechanisms Underlying the Association of Antipsychotics with Metabolic Disorders

ILEANA CRISTINA MIRON(1), VICTORITA CATALINA BAROANA(1), FLORICA POPESCU(2), FLORIANA IONICA(3)

Obesity and metabolic syndrome in association with an increased risk of cardiovascular disease and type II diabetes are significant problems that contribute to lower life expectancy of patients with schizophrenia. Understanding the pharmacological mechanisms of the current antipsychotic treatment is clearly the key to the improvement of pharmacotherapy, to avoid or to mitigate the metabolic adverse effects.

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3. Intrapartum Ultrasound Assessment of Fetal Head Position, Tip The Scale: Natural or Instrumental Delivery?

G. ADAM(1), O. SIRBU(1), C. VOICU(1), D. ILIESCU(1), STEFANIA TUDORACHE(1), N. CERNEA(1)

Objectives: The main objective of this study was to observe the behavior of the fetal head position during labor, when starting from occiput anterior or posterior position and also to determine their importance in labor management (if the starting fetal head position can be a strong argument in favour of vaginal or cesarean delivery). Methods:187 patients in labor 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 the ultrasound assessed parameters were: fetal head position at the beginning of labour and fetal head rotation during labour. Results: 89,18 percent of the patients starting from OTP (occiput transverse or posterior position) had a vaginal birth after an anterior rotation of the fetal head, and only 10,82 % presented persitent occiput posterior requiring cesarean section for delivery. Furthermore, considering only initial occiput posterior position, we observed an increased rate for cesarean section delivery (22,72%) by persistence of this position during labour. None of the patients starting with an anterior fetal head position rotated posteriorly. Conclusions: vaginal delivery in occiput anterior position was the most common result in both OTP and OP fetal head initial position. The main reason for cesarean delivery was persistent OP position. Patients with occiput posterior position were subsequent only to an initial posterior/transverse position.

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4. Plasma Levels of Glucose and Insulin in Patients with Brain Tumors

OANA ALEXANDRU(1), L. ENE(1), OANA STEFANA PURCARU(2), DANIELA ELISE TACHE(2), ALISA POPESCU(2), OANA MARIA NEAMTU(3), LIGIA GABRIELA TATARANU(4), ADA MARIA GEORGESCU(5), VALERICA TUDORICA(1), CORNELIA ZAHARIA(1), ANICA DRICU(2)

In the last years there were many authors that suggest the existence of an association between different components of metabolic syndrome and various cancers. Two important components of metabolic syndrome are hyperglycemia and hyperinsulinemia. Both of them had already been linked with the increased risk of pancreatic, breast, endometrial or prostate cancer. However the correlation of the level of the glucose and insulin with various types and grades of brain tumors remains unclear. In this article we have analysed the values of plasma glucose and insulin in 267 patients, consecutively diagnosed with various types of brain tumors. Our results showed no correlation between the glycemia and brain tumor types or grades. High plasma levels of insulin were found in brain metastasis and astrocytomas while the other types of brain tumors (meningiomas and glioblastomas) had lower levels of the peptide. The levels of insulin were also higher in brain metastasis and grade 3 brain tumors when compared with grade 1, grade 2 and grade 4 brain tumors.

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5. The Assessment of Prognostic Histopatholgical Parameters Depending on Histological Patterns of Papillary Thyroid Carcinoma

CRISTINA CALANGIU(1), CRISTIANA SIMIONESCU(1), A. STEPAN(1), M. PARNOV(2), LILIANA CERCELARU(1)

Papillary thyroid carcinoma represents common injuries that can have different histological variants that may influence the patient’s prognostic. The study included a total of 44 papillary thyroid carcinomas, for which were followed a series of histological factors of aggressiveness for grading tumors. Most studied papillary carcinomas corresponded to the conventional type, followed by the follicular, micropapillary and tall cell variants. Depending on the presence of nuclear atypia, tumor necrosis, the frequency of mitosis, also the vascular invasion and the extrathyroidian extension there were distributions differences of the cases according to the tumor type, most of the cases belonged to the conventional and tall cell types. The assessment of histopathological parameters of aggressiveness with certain types known to have an unfavorable behavior, justify the use of the histological grading of papillary thyroid carcinomas.

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6. Considerations About Risk Factors for Peripheral Neuropathies in Romanian HIV-Infected Patients

L.I. GIUBELAN(1), A. CUPSA(1), FLORENTINA DUMITRESCU(1), IRINA NICULESCU(1), ANDREEA CRISTINA STOIAN(1)

Purpose: The study aims at detecting risk factors for developing peripheral neuropathy in Romanian HIV infected subjects. Material/Methods: retrospective study (january 1990-january 2009) who analyzed data from patients hospitalized in the Regional Center Craiova. We have compared 26 patients (group N) diagnosed with peripheral neuropathy with 40 patients (group C) without neuropsychological sufferings, randomly selected. We have analysed: age, height, HIV mode of transmission, AIDS status, the average and nadir of CD4 lymphocytes, the mean viral load, the average duration of antiretroviral treatment (ART), use and duration of use of d-drugs, the presence of certain coinfection, diabetes or ethanol abuse. Results: the following differences were statistically significant: age (31,54±14,64 vs 23,9±12,03 years, p=0.024), HIV mode of transmission (parenteral/sexual: 13/13 vs 28/8, p = 0.044), the monitoring time duration (5,31±3,77 vs 7,75±5,4 years, p=0.043), median ART duration (37,2±9,66 vs 45,12±8,75 months, p=0.001). Close to the threshold of statistical significance are the CD4 nadir (97,33±65,6 vs 123,15±43,35 cells/mm3 , p=0.058) and duration of use of d–drugs (22,5±31,94 vs 12,24±8,6 months, p=0.057). Odds ratio (OR) and relative risk (RR) increase with age. ROC analysis for the study group establishes a threshold difference of 29 years (sensitivity 50%, specificity 80%). Conclusions: higher age and advanced immunosupression are the most important risk factors for developing symptomatic peripheral neuropathy in Romanian HIV infected patients; taking into account the small number of cases studied, although not statistically significant, it should be noted the CD4 nadir and the length of drug use.

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7. Adjuvant Treatment of Intermediate Risk Non-muscle Invasive Bladder Cancer

O. DRAGOESCU(1), P. TOMESCU(1), A. DROCAS(1), C. MARIA(1), M. ENACHE(1)

Despite continuous improvement of diagnosis, surgical and adjuvant treatment procedures for non-muscle invasive bladder cancer (NMIBC), their natural development is still influenced by the high rates of tumor recurrence and progression. The study aims at assessing the value of adjuvant intravesical chemotherapy within the therapeutic protocol for operated intermediate risk non-muscle invasive bladder cancers. We analyzed recurrence and progression rates for patients within two samples: group A included 76 patients with intermediate risk NMIBC treated by transurethral resection (TUR) alone between 1995 and 1999 and group B included 89 patients with the same diagnosis with 8 A?? 12 Farmorubicin 50 mg intravesical instillations associated with the initial TUR between 2000 and 2004. For group A we recorded a 3 months recurrence rate of 27.6% and a general recurrence rate of 38.1% at one year and 51.3% at three years. The recurrence rate was lower for group B at 3 months (14.6%) as well as significantly lower (p<0.05) at one (23.6%) and three years (34.8%). Most NMIBC recurrences were recorded within one year of follow-up (75%), more than 50% of them being present at the first cystoscopy (3 months). Progression rate was unsignificantly 3% lower for group B, probably due to incomplete pathology data.

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8. Remission of Walking Parameters in Peripheral Arterial Disease through Association of Galvanic Baths and Kinesytherapy

SIMONA PATRU(1), A.C. BIGHEA(1), ROXANA POPESCU(1)

Chronic peripheral obstructive arteriopathies (CPOA), together with their determinations, play an important role in the elderly pathology and represent one of the most frequent causes of disability, thus having a negative impact on the patientA??s quality of life. Therefore, in this clinical randomized trial we proposed to study the efficiency of several treatment methods based on physical exercise together with other therapeutical approaches specific to physical medicine such as galvanic baths. We formed a group of 111 patients diagnosed with peripheral arterial disease in inferior limbs randomized into three groups: the control group (drug treatment and hygiene-dietary), the exercise group (12 weeks supervised exercises program, followed by another 12 weeks home unsupervised exercises) and the exercise and procedure group (kinesitherapy and galvanic baths). All the subjects performed the exercise treadmill test, according to the Gardner protocol, at the beginning of the study, after 12 weeks and after 24 weeks, at the end of the study and were measured: the time to pain onset (TDC) and the time to maximum pain onset (maximum walking time=TDD). We observed quite high TDC differences in the two groups that performed physical exercises compared to the control group, while the amelioration of walking periods was recorded after the first 12 weeks, and after 24 weeks they reached walking periods 2.5 times higher than at the beginning of the study. Adding hydrotherapy to the physical exercise led to even higher TDC values. After 12 weeks, we obtained a 54% TDD remission in the exercise group (p<0.005) and a 65% remission in the exercise and hydrotherapy group (p<0.005) and at the end of period, the TDD remission was 90% in the exercise group (p<0.005) and 100% in the exercise and hydrotherapy group (p<0.05). The kinetic-physical modalities show its efficiency in ameliorating the walking parameters in the patients with claudication and may offer low risks compared to the revascularization methods, high addressability, diminished costs.

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9. Total thyroidectomy without the use of drainage - case series of 66 patients

K. SAPALIDIS(1), T. STRATI(1), I. ANASTASIDIS(1), N. PANTELI(1), L LIAVAS(1), I. KESISOGLOU(1), I. KANELLOS(1)

Aim: The aim of this series is to study the need of drainage use after total thyreoidectomy. Material and Methods: Retrospective study of a series of patients who underwent total thyroidectomy from 2005 up to 2013. The presence or not of hematomas, seromas and hemorrhage were recorded. Results: Out of the 66 patients included in this series, only one case of post-operative hematoma was recorded. Neither a hemorrhage nor a seroma were identified despite the volume, the underlying pathology and the co-morbidity of the patients involved. Conclusion: In our experience a thyroidectomy with adequate hemostasis does not require the use of drains.

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10. Bullous Pemphigoid Associated with Psoriasis, Breast Cancer and Parkinson Disease

LOREDANA ELENA STOICA(1), V. PATRASCU(1), RUCSANDRA CRISTINA DASCALU(2), M.E. CIUREA(3)

Bullous pemphigoid (BP) and psoriasis vulgaris represent two clinically well characterized, inflammatory, chronic skin diseases. A 62 years old female patient, from rural areas, was admitted for the presence of erythematous plaques covered by large tense blisters with clear fluid, located symmetrically on the anterior part of the upper limbs, the trunk, the neck and the lower limbs. Also the lesions were intense itching. Lesions occurred three days before presentation at the clinic. Medical history revealed psoriasis diagnosed 28 years ago, breast cancer treated with surgery, radio and chemotherapy three years ago and Parkinson disease diagnosed 3 weeks prior to presentation to the dermatology clinic. Histopathology examination revealed: atrophic epidermis with subepidermal presence of a blister containing numerous eosinophils and neutrophils. In the papillary dermis neutrophils and eosinophils predominantly vascular. Bullous pemphigoid has multiple etiology. Bullous pemphigoid is an autoimmune subepidermal bullous dermatosis which may be associated with psoriasis. Medical literature and cases reported in dermatology journals claim that bullous pemphigoid is often associated with psoriasis, though the immunogenetical and immunopathologycal mecanismes are still not known. Our patient has three different diseases but their etiology and pathogenesis can interfere.

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11. Secondary Haemochromatosis in a Patient with Thalassemia Intermedia

IONELA ROTARU(1), AMELIA GAMAN(1), G. GAMAN(1)

Haemochromatosis is due to excessive accumulation of iron in tissues and organs impairing their function. The most common haematologic disorders that are subject to an intensive transfusion regimen bringing excess iron in the body are: thalassemia and myelodysplastic syndrome. The value of serum ferritin in these patients (indicator of iron stores condition) reaches high values. Red cell substitution bringing additional iron intake must be accompanied by administration of chelation therapy in order to prevent haemochromatosis and related complications. We present the case of a patient with thalassemia intermedia, integumentary secondary haemochromatosis, cirrhosis with haemochromatosis, and secondary diabetes, who died at the age of 33 years because of upper gastrointestinal bleeding due to the rupture of oesophageal varices.

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12. A Rare Case of Ocular Myositis

CARMEN ALBU(1), B. CTLIN(2), CORNELIA ZAHARIA(1)

We report the case of a 43 year old man who presented recurrent left abducens palsy. His medical history included arterial hypertension, ischemic cardiomiopathy, dyslipidemia, rhinitis, maxillary sinusitis. Physical examination revealed a overweight patient, horizontal gaze diplopia, left nerve VI paresis, mild left retro-orbital pain. The orbital MRI also didn�t offer new information: mild external edema on the left eye, with normal tendon aspect, no thickening or enhancement of the muscle belly and also normal aspect of the bony orbit. Recurrent palsy of EOMs can be caused in rare cases by ocular myositis.

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13. An Unusual Tumor of the Breast - Extraskeletal Ewing Sarcoma

FUNDA TASLI(1), GULIZ OZKOK(1), AHMET AYKAS(2), HAKAN POSTACI(1), ADAM USLU(2)

Extraskeletal Ewing Sarcoma/Primitive Neuroectodermal Tumor presenting as a breast mass is uncommon. It may pose a diagnostic challenge. In order to increase awareness and identify potential diagnostic pitfalls, we report a 24 year-old woman extraosseous Extraskeletal Ewing Sarcoma/Primitive Neuroectodermal Tumor arising in the breast.

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14. Varicella-Zoster Myocarditis Mimicking Acute Myocardial Infarction

I. DONOIU(1), O. ISTRATOAIE(1)

A 23-year-old male was admitted with chest pain. The electrocardiogram showed ST elevation in leads DI, aVL, V2-V6. Troponin T was 1.1ng/mL. Left ventricular systolic function was globally reduced (ejection fraction 45%). The patient was treated with thrombolytic. Twenty-four hours after admission pruriginous vesicles with a clear content and surrounded by a pink halo appeared on his face, head and torso, suggesting varicella-zoster infection. This case illustrates the difficulties of diagnosis in acute myocarditis.

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