Current issue

Current Health Sciences Journal

vol. 44 no. 1, 2018

1. T4 Colon Cancer - Current Management

M. DIACONESCU, F. BURADA, C.S. MIREA, E. MORARU, M.C. CIORBAGIU, C.V. OBLEAGA , I.D. VILCEA

Colorectal cancer is the third most often encountered type of cancer and represents the third leading cause of cancer related deaths, on both sexes. One of the most important prognostic parameters is the tumor’s stage at the time of the diagnosis. T4 cancers represent advanced tumors associated with penetration of the visceral peritoneum (T4a) and/or direct invasion in adjacent structures (T4b). Preoperative diagnosis is influenced by the inability of the existent imaging modalities to accurately differentiate the true invasion from the simple, inflammatory adherence to the neighboring structures. As a consequence surgical treatment must follow the principle of en bloc resection; however the ability of achieving an R0 resection depends on the tumor location, invaded organ, and the type of the surgical procedure required. Neoadjuvant treatment for advanced colon cancer it may be very difficult to be applied. This review is focused on preoperative workup, therapeutic strategies and sub

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2. Periprocedural Role of Nurses During Interventional Endoscopic Procedures Under Deep Sedation

ELENA DANIELA BURTEA, ANCA DIMITRIU, ANCA ELENA MALOS, A. SAFTOIU

Background. Most of endoscopic procedures, either diagnostic or therapeutic, are nowadays performed under sedation, used as a standard practice in most of the centers. Consequently, the number and complexity of endoscopic procedures has increased as sedation diminishes anxiety and discomfort for patients, also improving the quality of endoscopic examinations, and outcomes in therapeutic endoscopy. Compared to standard diagnostic upper or lower GI endoscopy, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are often longer and more complicated procedures, thus requiring higher doses of sedatives. Sedation levels and medication types depend on a variety of factors, related both to patient characteristics (age, comorbidities, preference, etc.), and procedure types (simple diagnostic endoscopy or more complex therapeutic procedures). Propofol has become undoubtedly the induction agent of choice as it is easy to administer, enables prompt awakening, and

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3. Histopathological Patterns of Microinvasion in Ovarian Serous Borderline Tumors

ANDREEA-ELENA CIRSTEA, A.E. STEPAN, ROXANA EUGENIA ZAVOI, CRISTIANA EUGENIA SIMIONESCU

Stromal microinvasion in ovarian serous borderline tumors can take various aspects, some of which are difficult to identify. Thus, the identification of stromal microinvasion is relatively simple for typical intracystic papillary proliferations such as serous borderline tumors, but may be difficult for tumors with glandular component. The study analyzed 14 cases of ovarian serous borderline tumors diagnosed in patients with mean age of 47,1 years. Histopathologically all tumors corresponded to typical forms in which we identified only two cases of stromal microinvasion. In one case, microinvasion was of eosinophilic type, and in the other case was observed a glandular and micropapillary pattern, being associated with the noninvasive peritoneal implants.

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4. Ultrasound Evaluation of Fetal Biometry and Doppler Parameters in the Third Trimester of Pregnancy Suspected of Intrauterine Growth Restriction

MARIA VIOLETA NOVAC, D.G. ILIESCU, STEFANIA TUDORACHE, MAGDA MANOLEA, RALUCA ELENA MEETESCU, SIDONIA VRABIE, M.B.NOVAC, D.O. ALEXANDRU, LORENA DIJMARESCU

Purpose. The purpose of this study was to investigate fetal biometry and Doppler parameters in the third trimester of pregnancy with suspected restriction of fetal growth as potential predictors of unfavorable neonatal status. Material/Methods. The uterine artery, umbilical and middle cerebral artery, cerebroplacental ratio (CPR), and estimated fetal weight (EFW) were evaluated in a cohort of 126 pregnancies that resulted in the birth of a fetus <10 percentiles (SGA). Results. The demographic data of the studied cases did not show a significant difference between the parameters studied in the two study groups: Late SGA fetuses and Early SGA fetuses. Analyzing fetal biometry we found a significant difference for some parameters in relation to the two study groups. Our study showed that the Early SGA fetuses group had a lower birth weight, a lower gestational age at birth, an increase in the incidence of premature birth with an increase in Doppler abnormal incidence. Conclusions. Ultraso

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5. Gender-Related Electrocardiographic Changes in Athletes

OANA MARIA CORICI, OANA MIREA-MUNTEANU, I. DONOIU, O. ISTRATOAIE, CORNELIA ANDREEA CORICI, MARIA IANCAU

Objectives: To assess gender differences in training-related electrocardiographic (ECG) patterns of athletes, highlighting the importance of these differences for ECG interpretation used in the cardiovascular screening of athletes. Design: Observational cross-sectional study. Methods: 315 athletes were enrolled in the study (150 males and 165 females, mean age 23,7±6,6 and 20,7±6,8, respectively). All study participants underwent clinical examination and 12-lead electrocardiogram (12-lead ECG), scored according to 2017 International recommendations for electrocardiographic interpretation in athletes. Results: Males were older (23,7±6,6 years vs. 20,7 years±6,8; p<0,0001) and had more years of training (11,8±6,7 vs. 9,07±6,1; p=0,0003) than female athletes. Female athletes had significantly higher resting heart rates (67/min vs. 61/min; p<0,0001) and QTc intervals (424,5±19,4ms vs. 338,6±22,3ms; p<0,0001). Male athletes were more likely to have isolated QRS voltage criteria for

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6. The Influence of Physical Exercise on Smoking Patients with Peripheral Arterial Disease

SIMONA PATRU, IULIA RAHELA MARCU, DANIELA MATEI, A.C. BIGHEA

Smoking should be identified as a major risk factor for Peripheral arterial disease. The purpose of this prospective, randomized, controlled clinical study was to determine whether a rehabilitation program is more efficient than the usual healthcare assistance (medication, hygiene and diet) for improving walking function on the smoking and nonsmoking patients with PAD. For smokers, there were no significant differences after 12 weeks and also 24 weeks, although the 4MWS mean values increased compared to the control. At 24 weeks study time point nonsmokers in the group performed special massage techniques along with the supervised kinesytherapy had significantly greater improvement in their 4MWS, compared to the group with physical exercises or control. A well-structured rehabilitation program, in terms of intensity, duration and frequency may be of great help for improving the functional status of these patients with peripheral ischemia syndrome.

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7. Epidemiological Aspects in Lip Tumors in Oltenia Region of Romania During 2012-2016

A.I. SALAN, A. CAMEN, ALEXANDRA CIUCA, A. PATRU, MONICA SCRIECIU, SANDA MIHAELA POPESCU, D.O. ALEXANDRU, ADINA ANDREEA TURCU

Alexandra Ciuca, PhD Studies School, Oral and Maxillofacial Surgery Department, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, Romania, e-mail:ciuca.al@gmail.com

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8. Involvement of Oxidative Stress in COPD

CRISTINA MARGINEAN, M.S. POPESCU, M. VLADAIA, DIANA TUDORASCU, D.C PIRVU, F. PETRESCU

Chronic obstructive pulmonary disease (COPD) is a disease that affects the lungs and is defined by a variety of symptoms that combined with co-morbidities lead to a decline of the patients quality of life. The principal etiology of chronic obstructive pulmonary disease is smoking and air pollution that lead to oxidative and carbonyl stress. This review based on a search of PubMed, OxLIP+/SOLO (Bodleian Libraries) database (from 1991 to 2017) of relevant articles based on assessment of oxidative stress pathways involvement in COPD. Intracellular reactions that take place in organisms and aerobic cells have as by-products reactive oxygen species (ROS) and free radicals. Oxidative stress involved in pathogenesis of COPD is the result of lowered antioxidative potential combined with increased burden of oxidants. Molecular mechanisms underlying COPD pathways are not yet well understood, despite intensive research all over the world. A change in balance between Oxidants and antioxidants in t

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9. Proliferative Activity in Basal Cell Carcinomas

DIANA FLORESCU, A.E. STEPAN, C. MARGARITESCU, DESDEMONA STEPAN, CRISTIANA EUGENIA SIMIONESCU

Basal cell carcinomas (BCCs) represent one of the most common human neoplasias. The excellent prognosis of the diagnosed early lesions and the low metastasis rate are particularities that required the investigation of the mechanisms of carcinogenesis on these lesions. In this study we analyzed the proliferation rate for 53 cases of BCC in relation to the clinicopathological parameters of the lesions using Ki67, considered a true indicator of cellular proliferation. The results indicated statistically significant differences in Ki67 immunoexpression related to histological type and lesion stage. The highest Ki67 values were observed in the adenoid and morpheaform subtypes, and in advanced tumor stages. This aspects may be useful for stratification of lesions in terms of tumor aggressiveness.

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10. Correlations between CD34 Immunolabelled Blood Vessels and CD34 mRNA Expression in Colorectal Cancer

S.C. TOMA, C.D. USCATU,3), B.S. UNGUREANU, C.S.MIREA, T. DUMITRESCU, E.F. GEORGESCU, M. SCHENKER, V. SURLIN, I. GEORGESCU

Purpose: This study aims to determine the correlation between microvessel density of CD34 immunolabelled blood vessels and CD34 mRNA gene expression in colorectal cancer tissue. Material/Methods: Standard immunohistochemistry and gene expression was perform on samples collected from 76 patients with colorectal cancer in order to determinate the number of CD34 immunolabelled blood vessels and the relative quantity of CD34 mRNA. Results: For the study group, the mean CD34 immunolabelled microvascular density (MVD) was of 307/mm2, and the mean CD34 gene expression value for colon cancer was 2.303. The low p value (<0.001) of the Spearman correlation test showed a significant direct correlation between CD34 MVD and CD34 gene expression for the entire study group. Conclusions: CD34 gene`s expression can be looked at as a prognostic factor in colorectal cancer.

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11. Urinary Bladder Tumors Clinical and Statistical Retrospective Study

M.L. STEFANESCU, P.I. TOMESCU, M.C. FORTOFOIU, L.E. STOICA, OANA BADEA, L. MOGOANTA, NINA IONOVICI

Nowadays, urinary bladder cancer represents a major health problem, due to very high medical and social costs. This disease affects mainly the elderly. We performed a study on 1073 patients admitted to the Urology Clinic within the Emergency Clinical Hospital of Craiova, between 2013-2015 with bladder cancer. Of the 1073 cases, 741(69.06%) were diagnosed in men, and 332 (30.94%) were found in women, the men/ women ratio being of 2.23/1. The highest incidence of bladder tumors was recorded in individuals aged between 60 and 79 years old. In this age group, there were admitted 734 patients with bladder cancer, representing 68.44%. Regarding the tumor recurrence, out of 1073 bladder tumors, a number of 608 (56.66%) patients were diagnosed with primary tumors, while a number of 465 (43.34%) patients presented recurrent tumors. Of the symptoms presented by the patients, the most frequent were haematuria (present in about 87% of the patients), pollakiuria (present in 64% of the patients), dy

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12. Laparoscopic Excision of an Adrenal Ganglioneuroma Presented as an Incindentaloma of the Retro Peritoneum

K. SAPALIDIS, S. MANDALOVAS, I. KESISOGLOU

Adrenal ganglioneuroma (GN) is a benign tumor of retro-peritoneum that is presented as an incidentaloma. GNs most commonly have been diagnosed by imaging examinations notably by CT scan. Differential diagnosis from other malignant adrenal tumors is often difficult. The only examination that confirms diagnosis is only the histopathological one. Surgical excision of a GN has been proposed as the best solution for both diagnostic and therapeutic purposes. This case report is about a 68-year old male patient presenting with a non-typical abdominal pain. The imaging investigation showed an incidentaloma over 4cm at its large axis. The patient underwent laparoscopic excision of the tumor. We present the steps followed during the diagnosis the appropriate treatment and the follow up examinations as a result of this rare finding.

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13. A Severe Case of Aneurysmal Malformation of the Vein of Galen, Cardiac Failure and Intrauterine Fetal Death

M.C. MARINAS, I. MINDRILA, G.L. ZORILA, STEFANIA TUDORACHE, R.G. CAPITANESCU, M.V. ZORILA, D.G. ILIESCU

Aneurism of the vein of Galen is a rare congenital anomaly, where complex arteriovenous malformation are identified between multiple choroidal arteries and the median prosencephalic vein of Markowski, which is a precursor of the vein of Galen, with subsequent aneurysmal enlargement of the respective arteriovenous system. The congenital malformation develops during week 6 to 11 of fetal development. Infants often die from high-output congestive heart failure. We present a case of a 40 years old patient, presented the first time at hospital at 28 weeks of gestation for lower perception of fetal movements. The patient was referred to our Prenatal Diagnosis Unit for a suspected cardiac malformation. We diagnosed cardiomegaly along vein of Galen aneurysmal malformation (VGAM) with severe cardiac failure, ascites, and critical fetal distress. Fetal demise was noted 24 hours later, during the corticosteroid procedures for fetal maturation. A stillborn weighting 2000g with a severe hydropic as

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14. A Case of Severe Advanced Takayasu Arteritis with Acute Myocardial Infarction as First Manifestation

A.R. MIHAILOVICI, I. DONOIU, O. ISTRATOAIE, G.C. TARTEA, A. BUCA

We present the case of a 53-year-old female who presented in the emergency room accusing chest pain, dyspnea to moderate physical strain and physical asthenia. The clinical exam highlighted the absence of pulse in the left upper limb, weak pulse at upper right and lower limbs. The angiography revealed severe coronary lesions, bilateral subclavian occlusion, bilateral renal artery occlusion, infrarenal aortic occlusion. The patient was diagnosed with Takayasu`s disease. Sequential interventional revascularization was performed. Takayasu arteritis is a rare disease that can easily be overlooked. It can present with severe coronary lesions which require a complex interventional and medical management.

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15. Morphological Survey of Placenta in Trombophilia Related Hypoperfusion of Maternal-Fetal Blood Flow

ELENA LOREDANA CIUREA, C. BERCEANU, NICOLETA LOREDANA VOICU, DIANA PIRNOIU, SABINA BERCEANU, A.E. STEPAN

Complex and modern obstetric medical care provides a constant improvement for the pregnancy prognosis. Thus, young women with an undiagnosed pathology become pregnant and, during pregnancy, the previously undiagnosed pathology, without any clinical signs and symptoms, becomes present during pregnancy, having an unfavorable impact on the fetus and the health state of the pregnant woman. The gestational syndromes during pregnancy influence the woman’s health state over a long period of time and the quality of the conception product. The recommendation, performance of laboratory tests and imagistic investigations at the right time during pregnancy, as well as a correct interpretation of their results, may prevent the onset of catastrophic occurrences including fetal death in utero and/ or maternal death. We report the case of a 30-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, severe preeclampsia, severe IUGR and thrombophilia.

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16. Diagnosis Particularities of Amyotrophic Lateral Sclerosis in an Elderly Patient

IULIA-RAHELA MARCU, SIMONA PATRU, A.C. BIGHEA

Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease (MND) which prognosis is poor. Early diagnosis permits to set up immediately adapted treatment. Available diagnostic criteria are based on the detection of both central and peripheral motor neuron injury in bulbar, cervical, thoracic and lumbar regions. Electrodiagnostic tests are key tools to identify peripheral motor neuron involvement. In the absence of a diagnostic biomarker of ALS, a careful clinical and neurophysiological work-up is essential to rule the differential diagnosis. The study presents the case of a 74 years-old woman who was diagnosed with ALS using clinical examination and electromyography.

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