Archive issue

1. Osteoraticular Tuberculosis - Brief Review of Clinical Morphological and Therapeutic Profile

I. PROCOPIE(1), ELENA LEOCADIA POPESCU(1), VERONICA HUPLEA(2), R.M. PLESEA(3), S.M. GHELASE(4), G.A. STOICA(5), R.F. MURESAN(6), V. ONTICA(6), I.E. PLESEA(7), D.N. ANUSCA(8)

Osteoarticular tuberculosis (OATB) is a rare form of tuberculosis (TB) whose incidence rose significantly nowadays especially in the underdeveloped countries. The main risk factors predisposing to this new challenge for the medical system are the Human Immunodeficiency Virus (HIV) epidemic, the migration from TB endemic areas and the development of drug and multidrug-resistant strains of Mycobacterium tuberculosis (Mt). The disease affects both genders and any age group although the distribution depending on gender is controversial and that depending on age has a bimodal pattern. In most cases the initial focus is elsewhere in the organism and the most frequent pathway of dissemination is lympho-haematogenous. The clinical picture includes local symptoms as pain, tenderness and limitation of motion, with some particularities depending on the segment of the osteoarticular system involved, sometimes accompanying systemic symptoms specific for TB and other specific clinical signs as cold abscesses and sinuses. The radiographic features are not specific, CT demonstrates abnormalities earlier than plain radiography and MRI is superior to plain radiographs in showing the extent of extraskeletal involvement. Both CT and MRI can be used in patient follow-up to evaluate responses to therapy. TBhas been reported in all bones of the body, the various sites including the spine (most often involved) and extraspinal sites (arthritis, osteomyelitis and tenosynovitis and bursitis). Two basic types of disease patterns could be present: the granular type (most often in adults) and the caseous exudative type (most often in children) one of which being predominant. The algorithm of diagnosis includes several steps of which detection of Mt is the gold standard. The actual treatment is primarily medical, consisting of antituberculosis chemotherapy (ATT), surgical interventions being warranted only for selected cases. It is essential that clinicians know and refresh their knowledge about manifestations of OATB.

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2. Diagnosis and Treatment Algorithms of Acute Variceal Bleeding

L.A. BARBU(1), N.D. MARGARITESCU(2), M.V. SURLIN(2)

Esophageal varices are about 10%-15% of UGIB. Over 90% of patients with cirrhosis develop portal hypertension (PHT), but not all patients with PHT and liver cirrhosis have esophageal varices. At the time of diagnosis, only 60% of patients with cirrhosis have esophageal varices. In the case of variceal bleeding suspects, vasoactive drugs should be given as soon as possible and before endoscopy. Balloon tamponade is used to obtain temporary hemostasis by direct compression of hemorrhagic varices. The variceal band ligation is already the first place in the treatment and prevention of variceal bleeding, but also in rebleeding prevention. TIPS is used as a rescue therapy after failure of drug and endoscopic therapy. The mortality assigned to the hemorrhagic episode is substantially, estimated at 13-19% of the overall mortality in hepatic cirrhosis. Current recommendations for the treatment of acute variceal bleeding are the use of combination therapy: vasoactive drugs, balloon tamponade, elastic ligation and TIPS, whose staging is done in various diagnosis and treatment algorithms.

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3. The Importance of Imaging Techniques in the Assessment of Biliary Tract Cancer

L.M. FLORESCU(1), D.N. FLORESCU(2), IOANA ANDREEA GHEONEA(1)

Biliary tract cancer is reported to be uncommon among most countries in Europe. On the other hand, higher incidence values were recorded in Southeast Asia due to various local hepatobiliary flukes and other risk factors. The malignant process can develop anywhere along the biliary tract and it can be divided into three different types according to their anatomic location: cholangiocarcinoma, carcinoma of the ampulla of Vater and gallbladder cancer. The biggest problem that we are currently facing with this type of malignancy is that patients are usually diagnosed in late stages with few alternatives regarding therapy. Due to its silent, yet fatal evolution, clinicians require additional help from imaging techniques. Initial evaluation of the biliary tract is usually performed with the help of ultrasonography (US) which can determine if an additional imaging procedure will be required next for further evaluation. Some of these imaging techniques include magnetic resonance imaging (MRI), computed tomography (CT), percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) and MRI with magnetic resonance cholangiopancreatography (MRCP). The purpose of this Review is to evaluate the advantages and disadvantages of various imaging procedures for the assessment in this type of malignancy.

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4. Interleukin-8 mRNA Expression in Locally Advanced Colorectal Cancer Patients

A. BARBALAN(1), IOANA STREATA(2), ELENA TATIANA IVAN(3), IRINA CHERCIU(4), V. SURLIN(5), M. IOANA(2), A. SAFTOIU(6)

Purpose: Interleukin-8 (IL-8) has been proven to promote progression of malignant tumours and control angiogenesis processes. We aim to determine and compare interleukin-8 (IL-8) gene expression level in colorectal tumors (CCR) and peritumoral samples obtained through endoscopic biopsy. Material and methods: Total mRNA was obtained from both tumoral and peritumoral tissue samples collected from patients diagnosed with colorectal cancer. Through Quantitative Real Time PCR, IL-8 gene expression was assessed in both pathologic tissue and adjacent normal mucosa. Results: In our cohort, IL8 expression was higher in adjacent normal mucosa than in tumoral tissue, in all the samples. Further studies on larger groups are required to validate our results.

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5. In Vitro and In Vivo Evaluation of Different Solid Dosage Forms Containing Captopril

G.A. ABDALRB(1), I. MIRCIOIU(2), M. AMZOIU(3), IONELA BELU(3), VALENTINA ANUTA(4)

Aim. Comparison of Captopril generic formulations on the Romanian market with the reference formulation Capoten (Bristol Myers Squibb), in terms of in vitro release kinetics of active substance and in vivo pharmacokinetics. Materials and methods. Dissolution studies were performed using Apparatus 1 (Basket), DT 800H, Erweka, Germany in acidic medium (0.01 N hydrochloric acid) and an agitation speed of 50 rpm. Experiments were run on 12 tablets of each formulation. Quantification of Captopril was achieved by using a spectrophotometric method, ?=205nm. Clinical pharmacokinetics was determined in the frame of four different bioequivalence studies comparing a single dose four different Captopril 50mg generic tablet products to the innovator drug, Capoten 50mg (Bristol Myers Squibb). Results. Different batches of the reference formulations achieved dissolution profiles of the same form and very closed to each other at all dissolution points. Dissolution profiles of the tested formulations shown similar behavior for all references. Two generic formulations achieved a slower release at early dissolution time points, their release being “diffusion controlled”, described by law of Higuchi. In vivo, products proved to be bioequivalent, but variability of space distribution and forms of plasma profiles was much bigger than for the in vitro release curves. Due to very rapid in vitro dissolution, a direct Level A in vitro-in vivo correlation was not possible, but, strangely, the fraction absorbed vs. time clearly followed the same Higuchi law. Conclusion. All the studied formulations achieved more than 85% dissolution after 15 minutes which means that whatever the values of dissolution metrics f1 and f2, formulations behave like a solution and generally should not have therapeutic equivalence problems. Slower dissolution profiles correlates with in vivo absorption being described by the same square root law of Higuchi which describe diffusion controlled transport phenomena.

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6. Profile of Respiratory and Extra-Respiratory Tuberculosis in Patients Living with HIV in Dolj County between 2005-2015

V.I. GRECU(1), CRISTINA CALARASU(1), M. OLTEANU(2), ADINA ANDREEA TURCU(3), ADINA RIZA(4), FLOAREA MIMI NITU(2)

Introduction: Tuberculosis (TB) is the commonest and the deadliest opportunistic infection in patients living with HIV/ AIDS. Purpose: The paper aims to assess patients with and without TB-HIV coinfection in Dolj county registered in Regional and National database in order to identify risk factors for progression to active TB for immunodepresive patients. Material and method: We performed a retrospective descriptive study using records of 336 patients infected with HIV (PIH)-data from medical charts between 2005-2015 and we compared with the data for 1120 patients without HIV between 2005-2012. Results: 64,1% were females and 35,89% were males. Most cases were from rural areas (61,54%) most of them graduating primary (17,94%) and secondary school (48,71%). Most of them don’t have a job (87%) and are supported by state with a monthly miminum income. Majority is born between 1980-1990 (64,1%), with predominance of Romanians (92.31%) compared to the Roma. Regarding all TB diagnoses (pulmonary and extrapulmonary) 117 had at least one episode of active TB. TB and HIV have been diagnosed almost at the same time in 25,64% cases. At the time of TB diagnosis 87% of patients had CD4+lymphocytes count <200cel/ml. We also noticed the absence of prophylaxis for TB in PIH, high incidence of hepatitis B among those with HIV/TB coinfection (34%). Conclusions: Active TB in patients with HIV infection is correlated with severe immunosuppression, poor education, and atypical clinical expression and radiological findings and more cases of extrapulmonary TB.

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7. P21 Immunoexpression in Actinic Keratosis and Cutaneous Carcinomas

A. MARINESCU(1), C. MARGARITESCU(2), A.E. STEPAN(2), ALIS MAGDALENA MARINESCU(3), CRISTIANA EUGENIA SIMIONESCU(2)

Actinic keratosis is a precancerous lesion of the skin with variable rates of transformation into non-melanocytic carcinomas. The present study aims to analyze p21 expression in actinic keratosis and cutaneous squamous carcinomas. P21 expression analysis revealed a positive reaction in 63 (71.4%) of the investigated cases. The immunostaining analysis revealed positivity in 82.1% of the studied actinic keratosis cases and in 43.9% of the investigated carcinomas. High scores of immunoreactions were identified only for the well-differentiated and for the carcinomas in initial stages. Association of p21 expression with pre-invasive or well-differentiated invasive lesions in early stages of tumor progression suggests that p21 may be an early event in squamous carcinogenesis.

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8. Utility of Cerebroplacental Ratio in IUGR Fetuses from Pregnancy with Preeclampsia in Prediction the Risk for Perinatal Complications

MARIA VIOLETA NOVAC(1), AMIRA MOLDOVEANU(1), STEFANIA TUDORACHE(2), NUTI DANIELA OPRESCU(3), MIHAELA MIESCU(1), MIRELA ANISOARA SIMINEL(4), SIDONIA VRABIE(2), M.B. NOVAC(5), D.G. ILIESCU(2)

Purpose. The aim of this study was to show that is the incidence of intrauterine growth restriction (IUGR) in women with preeclampsia (PE), assessment of cerebroplacental ratio (CPR) to establish the diagnostic value of CPR in fetuses with preeclampsia with/without IUGR. Material and Methods. We performed an analysis of 49 cases with gestational hypertension and PE and 16 cases with normal pregnancy for control lot, study in Obstetrics and Gynecology Clinic of the Municipal Hospital Filantropia, Craiova, between October 2013 and October 2015. It was performed clinical and laboratory evaluation and management of each case. CPR ratio was measured in the third trimester in all cases, being studied according to the normal and abnormal values obtained, following the evolution of the newborn. Results. Mild PE cases were predominant with 21 cases (19.27%), severe PE accounted for 16 cases (14.68%) and gestational hypertension was found in 16 cases in our study. Distribution of IUGR cases presented interesting and contradictory data, because we met cases of IUGR in pregnancies without PE, at a rate of only 1.54%. The incidence of IUGR was significantly higher in cases with severe early-onset PE (10.20%). Cases of severe PE, but with late-onset, had IUGR in only 2.04% of cases. We found a significant statistical significance (p <0.005) on the incidence of IUGR in cases with severe early-onset PE. CPR identified adverse perinatal outcomes in 18.46% of cases with CPR <1.08. Conclusions. This study shows that early onset severe PE and concomitantly IUGR affects a significant proportion of pregnancies. CPR can be used to identify fetuses with an increased risk of intrauterine compromise.

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9. Upper Gastrointestinal Bleeding - Initial Manifestation of Pancreatic Head Carcinoma

C.V. OBLEAGA(1), C.C. VERE(2), S.S. MOGOANTA(1), C. FIRUT(1), C. MESINA(1), M.C. CIORBAGIU(1), C.S. MIREA(1), I.D. VILCEA(1)

Pancreatic head carcinomas are a rare cause of upper digestive bleeding and the diagnosis and the treatment of these pose particular problems. We selected 6 cases from a number of 283 patients who were hospitalized for surgery between January 2014 and December 2016 with signs of upper digestive bleeding with no varicose origin who were subsequently diagnosed with pancreatic head carcinomas. The diagnosis was established by endoscopic and surgical methods. The evolution of these patients was influenced by whether there was active digestive bleeding or history of digestive bleeding and the possibility of tumor resection. Four patients needed emergency surgery due to continuous bleeding or rebleeding. The resectability of the cephalo-pancreatic tumor was determined and then subsequently performed in two patients who had a favorable postoperative outcome, while in two patients the tumor resection was impossible. The other two patients with upper digestive haemorrhage responded favorable to drug therapy, and digestive endoscopy and CT explorations were negative. After a 5-month interval they presented with clinical signs of a pancreatic neoplasm with invasion into the common bile duct, unwanted weight loss, abdominal pain, and icterus of the sclera and skin. The surgical intervention resulted in the confirmation of locally advanced pancreatic head carcinomas and the performing of bilio-digestive derivations. Pancreatic head carcinomas may be associated with upper digestive tract haemorrhage due to duodenal or bile duct invasion. The clinical picture of these patients can vary from occult haemorrhage to severe upper digestive tract haemorrhage accompanied by hypovolemic shock.

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10. CD44 Immunoexpression in the Progression of Actinic Keratosis and Cutaneous Squamouscarcinoma

A. MARINESCU(1), A.E. STEPAN(2), C. MARGARITESCU(2), ALIS MAGDALENA MARINESCU(3), ROXANA EUGENIA ZAVOI(3), CRISTIANA EUGENIA SIMIONESCU(2)

CD44 seems to confer the needed conditions for malignant neoplasms to grow and progress. The present study aims to investigate the role of CD44 expression in pre-invasive and invasive squamous lesions of the skin. We investigated 89 cases of preinvasive and invasive cutaneous lesions, of which 28 corresponded to actinic keratosis (KIN- keratinocyte intraepithelial neoplasia) with varying degrees of severity and 61 cases of squamous cell carcinoma with variable degrees of differentiation. The statistical analysis of CD44 immunoexpression indicated significantly higher values for KIN I and II compared to KIN III, as well as for KIN lesions in comparison with squamous cell carcinomas. Similar results were observed in well differentiated carcinomas compared to moderate and poorly differentiated lesions. These observations suggest that CD44 expression plays a role in the progression of cutaneous squamous neoplasia.

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11. The Role Played by Growth Factors TGF-?1, EGF and FGF7 in the Pathogeny of Oral Pseudoepitheliomatous Hyperplasia

ROXANA MARIA PASCU(1), STEFANIA CRAITOIU(2), MONICA MIHAELA CRAITOIU(1), ALMA MARIA FLORESCU(1), LUMINITA DAGUCI(1), ILEANA CRISTIANA PETCU(1), C.L. PTRU(3)

Pseudoepitheliomatous hyperplasia is an epithelial proliferation that develops in the dermis or lamina propria. It is a lesion associated to another pathology, which appears as a response to a great variety of infectious, neoplastic, inflammatory or traumatic stimuli. The etiopathogeny of this lesion is not clear yet. Therefore, we performed an immunohistochemical study on a group of 20 cases of pseudoepitheliomatous hyperplasia cases associated with inflammatory and neoplastic conditions, by investigating TGF?1 (Beta growth and transformation factor), EGF (Epidermal growth Factor), and FGF7 (Fibroblast growth factor) expressions during in its development. The TGF-?1 expression was recorded in all the layers of the oral hyperplastic epithelium, going from the basal to the superficial layers, but with a different immunoreactive pattern, according to the region. Our study showed the absence of EGF immunoexpression in the carcinomatous proliferation areas associated to pseudoepitheliomatous hyperplasia and an almost exclusive presence in the hyperplasia lesions associated with inflammatory conditions (in about 30% of the investigated lesions) of a expression varying from poor to moderate for EGF. According to our investigations, we observed the presence of an immunolabeling for FGF7 in 80% of the investigated cases of pseudoepitheliomatous hyperplasia, a maximum of intensity being observed within the cases associated with inflammatory conditions.

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12. Correlation between Immunohistochemical Subtype and Clinicopathological Features in Patients with Diffuse Large B-cell Lymphoma

ANA-MARIA PATRASCU(1), LILIANA STREBA(2), S. PATRASCU(3), JANINA NACEA(1), L. MOGOANTA(4), IONELA ROTARU(1)

The aim of this study was to establish correlations between certain clinical, biological, therapeutic factors and diffuse large B-cell lymphoma (DLBCL) subtypes. For this purpose, between January 2007 and December 2016 a total number of 97 patients with de novo diffuse large B-cell lymphoma were analyzed. Patients with a high prognostic index and non-GCB DLBCL positively correlated and exhibited lower survival rates than low IPI, GCB patients. IPI scoring system and cell-of-origin classification should be used together as a single valid prognostic evaluation tool for DLBCL.

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13. Clinical, Epidemiological and Etiopathogenic Study of Ischemic Stroke

RALUCA PAVALOIU(1), L. MOGOANTA(2)

Introduction: We conducted a retrospective study on patients who were diagnosed with ischemic stroke and hospitalized in Neurology I Neuropsychiatric Hospital of Craiova, Romania, between 2010-2014. We based our study on 6391 patients admitted with ischemic stroke. Material and Methods: We evaluated patients based on demographic data (age, sex, environment); neurological and cardiological examination; risk factors and comorbidities. Results: After analyzing the results the most of the pacients included in our study by origin of country, most of them were from rural areas (61%-4201 cases), and the rest were from urban areas (39%-2730 cases). From the risk factors the most common was high blood pressure present in about 70% of all patients. The most common etiopathogenic mechanism was due to cerebral artery thrombosis 86% followed by cerebral artery embolism 11%. Conclusions: The high blood pressure was found to be significantly associated with risk of ischemic stroke. Regarding etiopathogenicity in our study cerebral artery thrombosis was present in most cases.

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14. Prevalence of Erythrocyte Changes in Patients with Heart Failure

MIRELA ZAHARIE(1), DOINA CARSTEA(2), A.P. CARSTEA(3), S.I. ZAHARIE(4)

Heart failure (HF) is one of the most common causes of hospitalization in patients over the age of 65. Purpose The objective of our study was to assess the prevalence of anemia and characterize the morphology of red blood cells in patients admitted for HF decompensation. Material and Methods We have included patients with decompensated HF with FEVS. ?45% successively hospitalized at Filantropia Clinical Hospital Craiova. Results A total of 397 patients, including 204 males (51.39%) were included. The prevalence of anemia in our group was 38.54% (153 patients). The mean age of patients with heart failure and anemia was significantly higher compared to those with normal hemoglobin (75.05±7.16 years vs. 72.27±7.91 years, p=0.00047). The majority of anemias (68.62%) were normocytic normochromic, defined as mean corpuscular hemoglobin (MCV) value between 80 to 98fl and mean corpuscular hemoglobin concentration (MCH)>27pg. 20 patients (13.07%) had microcytic hypochromic anemia (MCV<80fL and MCH<27pg), in 16 patients (10.45%) was present normocytic hypochromic anemia (MCV 80-98fl and MCH<27pg) and 12 patients (7.48%) had macrocytic anemia (MCV>98fL and MCH>27pg), respectively. Conclusions Our study suggests that the prevalence of anemia in hospitalized patients for HF decompensation is high and normocytic normochromic anemia was the most common morphological type of anemia.

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15. Therapeutic Options in Diffuse Large B-Cell Lymphoma - A Retrospective Study and Review of the Literature

ANA-MARIA PATRASCU(1), JANINA NACEA(1), S. PATRASCU(2), A. GOGANAU(2), FLORENTINA DELCEA(3), L. MOGOANTA(4), IONELA ROTARU(1)

The aim of this retrospective study was to assess the differences between standard R-CHOP and other Rituximab-associated chemotherapy (R-miniCHOP and R-CHOEP) regimens in terms of survival and potential adverse effects. The six-month survival outcomes of 94 diffuse large B-cell lymphomas (DLBCL) patients indicated no statistical difference between overall survival and disease-free survival in the two subgroups. The biological response to therapy (blood count, LDH levels) was similar in both subgroups. Despite having different clinical indications, R-miniCHOP and R-CHOEP provide viable therapeutic alternatives to the standard R-CHOP regimen.

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16. Acute Bacterial Gastroenteritis as a Healthcare-Associated Infection in Pediatrics

PETRONELA-CRISTINA CHIRIAC(1), LETITIA-DOINA DUCEAC(2), ALINA MANOLE(3), V. POROCH(4), L. STAFIE(5), M. MANOLE(3), V. CARLIG(6)

Despite the fact that acute gastroenteritis can be prevented, the disease still affects children, especially under the age of two. The increased levels of pediatric mortality in most developing regions make diarrheal diseases one of the most common causes of death in the children under the age of 5. The purpose of the study was to describe the cases of acute gastroenteritis reported as healthcare-associated infections in a pediatric hospital deserving the north-eastern urban and rural regions of Romania. Material and methods. A descriptive study was conducted on a group of 615 cases with acute bacterial gastroenteritis as healthcare-associated infections (HAIs), reported in “Sf. Maria” Emergency Hospital for Children, Ia?i, between 2012 and 2016. Results. Most cases of acute bacterial gastroenteritis were registered in 2015 (154 cases-25.04%), and the lowest in 2012 (12.84%). Male gender prevailed in almost all years of study, with no statistical significance (p?0.05). Gastroenteritis with Campylobacter was most commonly reported in pediatric wards, especially in infants of 0-1 years old and children aged of 2-6 years. Cases of HAIs with Salmonella spp were also frequent. Conclusions. A competent management of HAIs especially as acute gastroenteritis in an emergency hospital for children from a region that includes developing rural areas, should be the most important issue for professionals involved in surveillance and control strategies, as well as clinicians, epidemiologist and microbiologist, in order to prevent HAIs burden occurrence and avoid antimicrobial resistance.

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17. Squamous Esophageal Carcinoma Synchronous to Pericolic Malignant Conjunctive Tumor

MANUELA IOANA VASILE(1), S.S. MOGOANTA(2), D.I. VILCEA(2), C.S. MIREA(2), DANA MARIA ALBULESCU(3), T.V. DUMITRESCU(2), M. POPESCU(3), E. MORARU(2)

Esophageal carcinoma represents a great diagnostic and therapeutic challenge due to the anatomical situation and physiopathology of the disease. The medical challenge can be even greater since esophageal carcinoma can evolve concomitant to another malignant tumor with different localization. This paper’s aim is to present a case of squamous esophageal cancer associated to another primitive malignant tumor-malignant pericolic conjunctive tumor, this kind of association being singular in medical literature from our knowledge. Upon emergency presentation the patient was sketching a sub-occlusive syndrome with mild anemia and inflammatory syndrome, somehow suggesting a possible right colon cancer. However, discreet upper digestive pole symptomatology that, on first sight, seemed secondary, made the consultant to perform a superior digestive endoscopy that raised a strong suspicion of early stage esophageal carcinoma. Further exploration was not completed because occlusive complication occurred and the patient needed emergency surgery. On laparotomy a stenotic right colic angle tumor was discovered that later proved to be extra-mucosal, with conjunctive origin. Our paper focuses on highlighting the crucial importance of the imagistic explorations in the primary diagnosis of esophageal carcinoma, in the correct staging (lymphatic extension, loco-regional or distant metastases) and also for malignant tumors with another localization that can radically modify the therapeutic strategy.

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18. A Case of Squamous Cell Carcinoma of the Oropharynx Invading Skull Base

V.P. RAICA(1), ANA MAGDALENA BRATU(2), C. ZAHARIA(2), IULIA ALECSANDRA SALCIANU(2)

Squamous cell carcinoma is the most common type of neoplasia which affects the mucosa of the upper aero-digestive tract. We present the case of a male patient that at the clinical exam showed a tumor mass at the rhinopharynx. The CT examination showed a tumor mass developed from the upper portion of the oropharynx, from the soft palate. The tumor was invasive into the nasopharynx, and into the structures of skull base the skull base, and with bilateral lymphnodes metastasis. At histopathological examination, the fragments of tumor biopsy revealed the aspect of a moderately differentiated keratinised squamous cell carcinoma, with lymph node metastasis, and with invasion in the adjacent fibro-muscular tissue.

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