Showing papers in "Journal of medicine and life in 2009"

Current data and strategy in glioblastoma multiforme

Abstract: Glioblastoma multiforme (GBM) or astrocytoma grade IV on WHO classification is the most aggressive and the most frequent of all primary brain tumors. Glioblastoma is multiforme, resistant to therapeutic interventions illustrating the heterogeneity exhibited by this tumor in its every aspect, including clinical presentation, pathology, genetic signature. Current data and treatment strategy in GBM are presented focusing on basic science data and key clinical aspects like surgery, including personal experience; adjuvant modalities: radiotherapy, chemotherapy, but also for experimental approaches. Therapeutic attitude in recurrent GBM is also widely discussed.

Saliva--a diagnostic window to the body, both in health and in disease.

Abstract: Saliva, the most available and non–invasive biofluid of the human body, permanently ‘bathes’ the oral cavity and is trying to cope with an ever–changing milieu. The oral cavity, a very complex and unique milieu due to its dual function, is the only place in the body where the mineralized tissue is exposed to the external environment in which there are complex interactions between various surfaces: host soft and hard tissues, food, air, and microorganisms. Saliva includes a large number of inorganic and organic compounds, which act as a ‘mirror of the body's health.’ In addition to its other functions, saliva could constitute the first line of defense against oxidative stress. Due to its composition and functions, saliva could have a significant role in controlling and/or modulating oxidative damages in the oral cavity. As a diagnostic fluid, saliva offers distinctive advantages over serum. Furthermore, saliva may provide a cost–effective approach for the screening of large populations. Gland–specific saliva can be used for diagnosis of pathology specific to one of the major salivary glands. Whole saliva, however, is most frequently used for diagnosis of systemic diseases. As we enter the era of genomic medicine, sialochemistry will play an increasingly important role in the early detection, the monitoring and progression of the systemic and oral diseases. We reviewed the current data within literature and of our research concerning clinical potential of the saliva.

Saliva between normal and pathological. Important factors in determining systemic and oral health.

Abstract: There is a tendency in current medical research to explore the importance and symptomatology of saliva. The question to which increasingly more researchers from the medico-legal, systemic and dental fields tried to answer and bring together arguments for a greater emphasis is referring to the role of saliva in the health of the patient. Up until our time, people have looked at the importance of saliva from another perspective: saliva helped in pasting envelopes or stamps, or mostly in reported cases of public speakers faced with the impossibility of having a coherent speech due to sensations of dry mouth. This 'dry mouth' condition, named xerostomia in medical terms, has been used since antiquity as a test in detecting lies, knowing since then that the inhibition of emotional salivary glands, the feeling of 'dry mouth' is caused by anxiety, thus being a potential incrimination. Although hundreds of publications have insisted on the etiology and complications of the salivary gland hypofunction, only a few health professionals used to harvest saliva tests. As in the case of urine and blood, saliva quality and quantity are affected by a multitude of medical conditions and treatments, as well as the patient's psychological state. A review of the formation, function and dysfunction of salivary glands may convey the significant role played by saliva in health and disease, especially in detection and recognition of salivary gland hypofunction, systemic disease, and the psychological states, and thus prevent complications caused by these conditions.

Cardiac dysfunctions following spinal cord injury

Abstract: The aim of this article is to analyze cardiac dysfunctions occurring after spinal cord injury (SCI). Cardiac dysfunctions are common complications following SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. We reviewed epidemiology of cardiac disturbances after SCI, and neuroanatomy and pathophysiology of autonomic nervous system, sympathetic and parasympathetic. SCI causes disruption of descendent pathways from central control centers to spinal sympathetic neurons, originating into intermediolateral nuclei of T1-L2 spinal cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant cardiac dysfunction. Impairment of autonomic nervous control system, mostly in patients with cervical or high thoracic SCI, causes cardiac dysrrhythmias, especially bradycardia and, rarely, cardiac arrest, or tachyarrhytmias and hypotension. Specific complication dependent on the period of time after trauma like spinal shock and autonomic dysreflexia are also reviewed. Spinal shock occurs during the acute phase following SCI and is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe bradycardia and hypotension. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Besides all this, additional cardiac complications, such as cardiac deconditioning and coronary heart disease may also occur. Proper prophylaxis, including nonpharmacologic and pharmacological strategies and cardiac rehabilitation diminish occurrence of the cardiac dysfunction following SCI. Each type of cardiac disturbance requires specific treatment.

Genetics of craniosynostosis: review of the literature.

Abstract: Craniosynostosis represents a defection of the skull caused by early fusion of one or more cranial sutures. The shape alteration of the cranial vault varies, depending on the fused sutures, so that compensatory growth occurs in dimensions not restricted by sutures. Craniosynostosis can be divided into two main groups: syndromic and nonsyndromic. Nonsyndromic craniosynostosis is typically an isolated finding that is classified according to the suture(s) involved. Syndromic craniosynostosis is associated with various dysmorphisms involving the face, skeleton, nervous system and is usually accompanied by developmental delay. In the last 15 years, research on craniosynostosis has progressed from the description of gross abnormalities to the understanding of the genetic basis of certain cranial deformities. Mutations in the genes encoding fibroblast growth factor receptors 1, 2 and 3 (FGFR-1, FGFR-2, FGFR-3), TWIST and MSX2 (muscle segment homebox 2) have been identified in certain syndromic craniosynostosis. The molecular basis of many types of syndromic craniosynostosis is known and diagnostic testing strategies will often lead to a specific diagnosis. Although the clarification of a genetic lesion does not have a direct impact on the management of the patient in many cases, there is a significant benefit in providing accurate prenatal diagnosis. This review summarizes the available knowledge on cranisynostosis and presents a graduated strategy for the genetic diagnosis of these craniofacial defects.

The importance of the olfactory sense in the human behavior and evolution.

Abstract: Not long ago it was believed that the human olfactory sense had a low importance, a vision which turned into the exploration of the environment. Recent studies have shown that, despite the weak representation of the olfactory receptor common in other species too, the cortical areas of integration of the olfactory sensations are very large and have important interconnections with memory, language, and neuro-vegetative areas. In humans, olfaction has a small contribution in identifying objects or other people, but plays an important social and emotional part. People learn to love or to hate certain foods or objects only by appreciating their odor and this proved to be a very important economic factor. The most significant role of olfactory signals in humans appears to be the modulation of their behavior and interpersonal relationships, of their affiliation to certain groups or social classes, having a major influence in their tastes and personality. signal that will be sent to the specialized areas in their tastes and personality.

Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt.

Abstract: The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. Methods: We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Results: Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free–disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts(months– years). Laparoscopic treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the tube in shunt malfunction due to excessive length of intraperitoneal tube a nd hernioraphy. One diagnostic laparoscopy was performed in a peritoneal irritation syndrome, which found only CSF ascites. There were no conversions to open surgery. The overall mortality was of 5.88% and postoperative morbidity was of 11.76%. In 7 patients operated for abscesses, peritonitis, pseudocysts, and CSF ascites the shunting system was converted in to a ventriculocardiac shunt. Conclusions: Abdominal complication following VP shunt can be successfully performed laparoscopically. Abdominal surgery required, in selected cases, the repositioning of the distal catheter, frequently as a ventriculocardiac shunt. There are abdominal complications with no indication of surgery, like peritoneal irritation syndrome and CSF ascites. Free– disease interval varies from days (peritoneal irritation syndrome, abscesses) to month–years (pseudocyst, ascites), according to type of complication.

Current opinions concerning the restoration of endodontically treated teeth: basic principles

Abstract: The goal of this general article is to present a survey of the current knowledge about the clinical approach of restoring endodontically treated teeth. The best way to restore teeth after root canal treatment has long been and still is a controversial subject of debate to this day. The clinical approach of restoring endodontically treated teeth needs taking into consideration several issues: aims of coronal restoration, criteria for establishing the various modalities of coronal restoration, clinical solutions of restoring teeth after endodontic treatment, guidelines regarding restorative materials and techniques, possibilities and limits of restoration using direct adhesive materials and techniques. The aims of coronal restoration of endodontically treated teeth are generally considered to be the following ones: to prevent recontamination of the root canal system and/or periapical space, to replace missing hard dental tissues and to restore coronal morphology and functions, to provide the necessary strength for the restoration/tooth complex in order to withstand functional stress and prevent crown and/or root fracture. The criteria for establishing the modalities of coronal restoration for endodontically treated teeth are: amount and quality of remaining hard dental tissues, topography and coronal morphology of the tooth, functional occlusal forces that the restoration/tooth complex has to withstand, restoring requirements in order to include the treated tooth in a comprehensive oral rehabilitation treatment plan, esthetic requirements.

Antimicrobial resistance induced by genetic changes.

Abstract: Decoding the mechanisms of resistance to antibiotics is essential in fighting a phenomenon, which is amplifying everyday due to the uncontrolled excessive and many times unjustified use of anti-microbial substances. At present it has become a matter of public health, together with the resistance of Mycobacterium tuberculosis to tuberculostatic or the spreading of the AIDS virus which not only affects the European countries but the entire globe. This paper presents the genic mutations taking place at the level of bacterial chromosome and inducing the resistance to antibiotics.

Neuroprotective and consequent neurorehabilitative clinical outcomes, in patients treated with the pleiotropic drug cerebrolysin

Abstract: Background: Discovery of neurotrophic factors–emblematic: the nerve growth factor (NGF)–resulted in better approaching central nervous system (CNS) lesions. Recently, another crucial property has been unveiled: their rather unique pleiotropic effect. Cerebrolysin is a peptide mixture that penetrates the blood–brain barrier in significant amounts and mimics the effects of NGF. Methods: Comparative analysis: Cerebrolysin treated (10 ml x 2/ day, i.v. x 3 weeks) vs. non–treated, in patients (all received aside, a rather equivalent complementary, pharmacological and physical, therapy). Two lots of patients, admitted in our Physical and Rehabilitation (neural–muscular) Medical–PR(n–m)M–Clinic Division, during 2007–2009: 69 treated with Cerebrolysin (22 F, 47 M; Average: 59.333; Mean of age: 61.0 Years old; Standard deviation 16.583) and 70 controls (41 F, 29 M; A: 70.014; M.o.a.: 70.5 Y.o.; S.d.: 6.270) were studied. The total number of assessed items was 13: most contributive in relation with the score of Functional Independence Measure at discharge (d FIM), were: admission (a FIM), number of physical therapy days (PT), number of hospitalization days (H), age (A) and–relatively–days until the first knee functional extension (KE). Concomitantly, the main/ key, focused on neuro–motor rehabilitative outcomes, functional/analytical parameters, have been assessed regarding the speed in achieving their functional recovery. Results: Concerning d FIM, there have not been objectified significant differences between the two lots (p=0.2453) but regarding key, focused on neuro–motor rehabilitative outcomes, functional/analytical parameters: KE (p=0.0007) and days until the first time recovery of the ability to walk between parallel bars (WPB–p=0.0000)–highly significant differences in favor of Cerebrolysin lot resulted. Conclusion: Cerebrolysin administration, as neurorehabilitative outcomes, proved to hasten, statistically significant, especially the recovery of some critical, for standing and walking, parameters. Thus encouraged, we have now initiated a comprehensive national, 5 year retrospective, multi–centre – based on unitary data acquisition frame and mathematical apparatus–study, to evaluate the results of the treatment with Cerebrolysin in traumatic brain injuries (TBI).

Diagnosis and treatment of erectile dysfunction--a practical update.

Abstract: During the last decades, erectile dysfunction was considered a direct consequence of aging and, although of a great concern for the affected patient, little was available to evaluate and treat this problem. If aging could not be invoked in all cases, than the psychogenic etiology was the only explanation. Over the coming years, a better understanding of the physiology involved in the penile process of tumescence and detumescence has allowed for better approach of each disease asociated with erectile dysfunction so that adequate treatment modalities can be applied to the pacient. As we all know, every pacient is a particular case. The development of modern PDE–5 inhibiters, along with other more or less invasive therapies, puts a new light on the medical approach of ED.

Patients' perspectives and motivators to participate in clinical trials with novel therapies for rheumatoid arthritis.

Abstract: Background and purposes Successful advances in the treatment of rheumatoid arthritis rely on enrolment of patients into clinical trials with novel agents. The aim of this study was to assess the patients' perspectives and motivators to participate in clinical trials. Methods Consecutive patients with rheumatoid arthritis attending three rheumatology departments in Romania underwent structured questionnaire interview regarding the motivation/possible causes of acceptance or drawbacks to participate in a clinical trial. Results A total of 96 patients, mean age 48, 30% men 70% women answered. Response rate was 95%. Previous participation in other clinical trials was 23%. Patients were highly motivated to participate in order to help themselves or other patients and to enhance the knowledge about the disease. Patients were prone to ask for advice about their enrolment in the study from the family and their current physicians, including the general practitioner. The need for supplementary information about the study was felt because they had not dared to ask for the information, although they trusted their current doctor. A high percentage considered payment and free complete blood tests as a stimulus, especially among patients with lower levels of education (p = 0.03, Fisher's ANOVA). Advertising for investigational medical product for purposes of patient recruitment was important for 57%, not only for safety or trust, but also for transparency and as a tool to get information. 73% of the persons agreed to the usefulness of patients association. 26% of them were willing to be actively involved, especially to report and include adverse events in the study settings. 58% were motivated if they knew other patients were consulted. Patients were not motivated because of the adverse events, placebo effect, treatment discontinuation, limited previous experience, availability of alternative therapies and doctor reimbursement for the study. Conclusions The current study suggests that awareness of factors (positive and negative) which influence motivation to participate in a clinical trial may help to refine patient's education and to consider new strategies for future trials.

Current considerations concerning endodontically treated teeth: alteration of hard dental tissues and biomechanical properties following endodontic therapy.

Abstract: The aim of this general article is to present an overview of the current knowledge about composition and structural changes and also about specific biomechanical alterations related to vitality loss or endodontic therapy. For a long time, these issues have been controversially approached from a clinical standpoint and are therefore still confusing for many practitioners. Vitality loss or endodontic procedures seem to induce only negligible changes in hard dental tissue moisture. Physico-chemical properties of dentin can be modified by some of the endodontic chemical products used for chemo-mechanical debridement. On the other hand, tooth biomechanical behavior is affected, since tooth strength is reduced proportionally to coronal tissue loss, due to either pre-existent carious/non-carious lesions or cavity acces preparation, besides restorative procedures. The related literature shows the lack of accepted clinical standards and consensus regarding the optimal way of approaching the specific tooth biomechanics following endodontic therapy.

Hyperhomocysteinemia in renal diseases.

Abstract: Homocysteine is a sulfurated amino acid used for the synthesis of methionine. The last decade's researches proved that hyperhomocysteinemia is an independent risk factor for atherosclerotic vascular disease. The vascular injury induced by several mechanisms of hyperhomocysteinemia is the hallmark of homocysteine's atherogenic properties. Hyperhomocysteinemia is present in 85% of the patients with chronic renal failure (cardiovascular diseases are the main cause of mortality) and persists after initiating dialysis or after renal transplantation. Although folic therapy or folinic acid therapy reduce homocysteine levels with 20-40% in hemodialysis patients, the effects on cardiovascular morbidity have yet to be proven in future studies.

Hyperthyroidism--cause of depression and psychosis: a case report.

Abstract: Psychiatric symptoms have been reported quite frequently in certain thyroid diseases, but more frequently in association with hypothyroidism. Thyrotoxicosis can be associated with various psychiatric symptoms, such as emotional lability, anxiety, restlessness and rarely frank psychosis. Psychotic symptoms in the context of hyperthyroidism typically present as an affective psychosis. The link between psychosis and hyperthyroidism is poorly understood. Because of this association of psychiatric symptoms is important to exclude a somatic cause, when assessing a patient first. We present the case of young woman who was followed over 2 years and who initially presented to psychiatric consultation for depressive symptoms, after being diagnosed with hyperthyroidism and specific therapy instituted, but who developed psychotic symptoms.

The role of p53, PCNA and Ki–67 as outcome predictors in the treatment of laryngeal cancer

Abstract: The aim of our study was to determine the importance of p53, PCNA and Ki-67, evaluated by immunohistochemistry, in the treatment and prediction of the laryngeal carcinoma. Out of a total of 319 patients with laryngeal carcinoma that underwent surgery in our department between 1999 and 2007, we performed a retrospective study on 71 cases who benefited by immunohistochemical guidance before the beginning of the treatment. All these patients have been followed-up two to five years after surgery. The values of p53, PCNA and Ki-67 are strongly correlated with the histological grading, by means of descriptive statistics (confidence level 95%); the mean values of these three markers corresponding to each HP grade. A highly statistical significant positive correlation (r = 0.84, p < 0.001 ) between the values of p53 and PCNA was observed. The values of p53, PCNA and Ki-67 in the patients from this study are strongly correlated with the absence of the loco-regional lymph node metastases, by means of descriptive statistics (confidence level 95%). Ki-67 only is correlated significantly to the presence of lymphatic metastases in the regional lymph nodes (stage N1, N2 or N3 TNM). P53 and PCNA are not correlated significantly with the presence of the metastases in the regional lymph nodes.

Bipolar resection of the bladder and prostate--initial experience with a newly developed regular sized loop resectoscope.

Abstract: Objective: Bipolar transurethral resection (TUR) has been introduced in the clinical practice nowadays. Benefits from bipolar TUR are represented by the use of saline irrigation, which avoids hypoosmotic hyperhydration (TUR–Syndrome), as well as by the reduced risk of obturator nerve stimulation. However, the previously introduced smaller bipolar resection loop caused prolonged operating–time. We report our initial experience with a newly developed regular sized loop for a bipolar resectoscope. Materials and Methods: Different loop calibers and configurations were tested and compared to a previously introduced bipolar system and conventional resection devices in TUR of benign prostate hyperplasia (BPH) and bladder tumors (TURP and TURBT). The resected tissue was pathologically examined for thermal damage and compared to a control group of monopolar conventionally resected tissue. Results: The handling of the resectoscope was comparable to that of the conventional ones. Cutting control, cutting speed and coagulation effectiveness were excellent, and no obturator nerve stimulation occurred. The resection area could easily be assessed and tissue examination showed no differences in terms of quality and quantity of thermal damages, since tissue carbonization was reduced. There was no sticking of the resected tissue on the loop. Conclusion: Regular sized loop bipolar resection is safe and efficient. Coagulation and cutting extent control seem superior to conventional TUR. Due to reduced carbonization, the resection ground can be easily assessed. The risk of obturator nerve stimulation is reduced. The histological quality of the tissue is not impaired. This device combines the advantage of a regular size resection loop with bipolar resection in normal saline. It has the potential to become a valuable alternative to monopolar TUR.

Pituitary incidentalomas--how often is too often?

Abstract: INTRODUCTION Clinical nonfunctional pituitary microadenomas, also known as incidentalomas are accidental observations made due to the application of high resolution imaging techniques as computed tomography or magnetic resonance. There are no standards regarding the follow-up of these tumors and taking into account their increased frequency among general population (during the last years they were based on the high performances of the imaging methods), we decided to study their dimensions and their evolution over time. We have also analysed their behavior with respect to their endocrine phenotype and the minimum period of time needed for the repetition of the imagistic procedure. AIM To observe the natural evolution of tumors' dimensions in a group of patients, diagnosed with nonfunctional pituitary microadenomas based upon hormonal measurements and computed tomography scan. METHOD There is a retrospective observational study on 149 patients hospitalized in our Clinic between 1994 and 2006. Initially, all the pituitary hormones and the computed tomography were performed. Only nonfunctional microadenomas were included (the maximum diameter 11 mm). 69 patients were examined for a long period of time--29.75 +/- 24.79 months by CT scan and secretory profile, repeated at different periods of time. RESULTS At the end of 29.75 months, the aspect of microadenoma was still present, without any statistically significant changes of the diameter. One of the cases became macroadenoma and another proved to be a microprolactinoma. Only 5 cases of all 149 presented a double lesion. No case of pituitary apoplexy was registered. These observations lead to the conclusion that it is not necessary to repeat the computed tomography scan sooner than 2 years once the diagnosis ofincidentaloma was established.

Thymoglobulin--new approaches to optimal outcomes.

Abstract: Thymoglobulin has a proven safety and efficacy profile both as treatment of acute rejection and as induction therapy in organ transplantation. The most common adverse events associated with Thymoglobulin are cytokine release syndrome, thrombocytopenia, and lymphopenia. Results of early studies showed an increased rate of cytomegalovirus disease associated with Thymoglobulin treatment, but recent studies indicate that routine administration of modern antiviral prophylaxis can reduce this risk. More research comparing Thymoglobulin with basiliximab will help individualize regimens by matching the choice of induction agent with the risk profile of each transplant recipient. The proven efficacy and safety profile of Thymoglobulin provides an excellent starting point for future investigations. Horse ATG (hATG) or Thymoglobulin + Cyclosporine are an efficacious treatment for aplastic anemia. Due to its higher potency Thymoglobulin may be superior to hATG, but further studies are required for confirmation. GvHD prophylaxis with Thymoglobulin may result in less acute and chronic GvHD, lower TRM, improved survival and quality of life in myeloablative or reduced intensity conditioning protocols in patients receiving hematopoietic stem cells from related or unrelated donors. Attributable to its polyclonal nature, Thymoglobulin provides multifaceted immunomodulation suggesting that its use should be included in the immunosuppressant therapeutic armamentarium to help reduce the incidence of organ rejection and GvHD, and for treatment of aplastic anemia.

Anti-cyclic citrullinated peptide antibodies--activity markers in rheumatoid arthritis.

Abstract: BACKGROUND Immunological abnormalities in rheumatoid arthritis (RA) imply several antibodies, among which anti-cyclic cytrullinated peptide antibodies (anti-CCP) have the highest sensitivity and specificity. Their diagnostic and prognostic value in RA is well known, although their value as markers of the disease activity has not been established yet. OBJECTIVES The aim of this study is to evaluate the correlation between anti-CCP antibodies and RA activity which eventually leads to the best treatment of choice. PATIENTS AND METHODS 217 consecutive patients hospitalized in the Department of Internal Medicine and Rheumatology, "Sf Maria" Clinical Hospital between 01.01-31.06 2007 were retrospectively studied. They were divided into two groups: group A-111 patients with RA (ACR criteria fulfilled) and group B-106 patients with other rheumatic diseases. The following parameters taken out of the patients files were studied: parameters of the clinical activity of disease (C reactive protein, fibrinogen), rheumatoid factor (RF) and anti-CCP antibodies. Disease activity score (DAS) using 4 variables (number of tender joints, number of swollen joints, erythrocyte sedimentation rate and assessement of the disease activity) was also studied. Data were processed with SPSS program using linear functions, Pearson correlation coefficient and Hi2 test of interdependency. RESULTS The sensitivity of anti-CCP antibodies in patients with RA was 56.75%. The specificity of anti-CCP antibodies in patients with RA was 90.56%. Low seric levels of anti-CCP antibodies were also found in patients without RA, but with other conditions like: osteoarthritis, viral polyarthritis, infectious myositis and Still disease; moderate to high seric levels were found in patients with psoriatic arthritis. Significant correlations were found between anti-CCP antibodies and DAS (r = 0.437), between anti-CCP and fibrinogen (r = 0.32) between anti-CCP antibodies and C reactive protein (r = 0.237) as well as between anti-CCP and RF (r = 0.38). CONCLUSIONS Anti-CCP antibodies are highly specific but moderately sensitive for RA, their highest frequencies and seric levels being found in seropositive RA. Anti-CCP can be used in patients with RA not only as a diagnostic marker but also as a reliable test for assessing the activity of the disease.

Urological management of the patient with traumatic spinal cord injury.

Abstract: Traumatic spinal cord injury is a very comprehensive subject, debated in many scientific papers It interests various medical specialties, but also other sciences, like economy, psychology or social science The patient having a motoric disability, with sphincter troubles and other associated pathologies secondary to a traumatic lesion of the spinal cord, represented a social problem from the antiquity The first centers dedicated exclusively to these patients were established during Napoleon Nevertheless, a systematic approach to these patients was not possible before the end of the Second World War, when scientific and economic development made possible the establishment of medical facilities specialized in the complex evaluation and treatment of patients with spinal cord injury (SCI) Between the two world wars, physicians were concentrating their efforts to keep these patients alive, considering that the main target was to treat or prevent complications which could be fatal to the patient The first scientific papers underlining the essential place of lower urinary tract disorders in the vital prognostic of the SCI patient are dating back to this time In modern times, the target for every patient with SCI should be social reinsertion and obtaining as much autonomy as possible The physician needs to tune up his treatment according to this factor The continuous evolution of medicine, alongside with technical progress and the development of modern social security have created the premises for a real quality of life of the paraplegic or even quadriplegic patient The lower urinary tract becomes not only a key for prolonged survival, but also one of the most important elements for social reinsertion

The electrocardiographic abnormalities in highly trained athletes compared to the genetic study related to causes of unexpected sudden cardiac death.

Abstract: Background: Electrocardiograms in elite endurance athletes sometimes show bizarre patterns suggestive of inherited channelopathies (Brugada syndrome, long QTc, catecholaminergic polymorphic ventricular tachycardia) and cardiomyopathies (arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy) responsible for unexpected sudden cardiac death. Among other methods, genetic analyses are required for correct diagnosis. Objective: To correlate 12– lead electrocardiographic patterns suggestive of inherited channelopathies and cardiomyopathies to specific genetic analyses. Design: Prospective study (2004–2007) of screening 12–lead ECG tracings in standard position and higher intercostal spaces V1 to V3 precordial leads, performed in athletes and normal sedentary subjects aged match. Genetic analyses of subjects with ECG abnormalities suggested inherited channelopathies and cardiomyopathies. Setting: All cardiologic exams and electrocardiograms were performed at ‘Prof. Dr. C.C. Iliescu’ National Institute of Cardiovascular Diseases (Bucharest, Romania). The genetic studies were done at ‘Mina Minovici’ National Institute of Forensic Medicine (Bucharest, Romania). Participants: 347 elite endurance athletes (seniors–190, juniors–157), mean age of 20; 200 subjects mean age of 21, belonging to the control group of 505 normal sedentary population. Results: Seniors. RSR' (V1 to V3) pattern, in 45 cases (23.68%), 5 of them with questionable Brugada sign (elevated J wave and ‘coved’ ST segment,< 2mm in one lead, V1. Typically, Brugada 1 sign was found in one case (0.52%) with no SCN5A abnormalities. One athlete (0.52%) had normal ECG and exon1 SCN5A duplication. MRI confirmed three arrhythmic right ventricular cardiomypathy epsilon waves (1.57%), in one case. ST–segment elevation myocardial injury like in V1–V3 precordial leads in 34 athletes (17.89%).Genetic analyses–no gene mutations. Juniors Upright J wave was found in 43 cases (27.38%). Convex ST segment elevation in V1–V3/V4, in 39 cases (24.84%). Bifid T wave with two distinct peaks was found in 39 cases (24.84%), 5 of them with mild prolonged QTc (0.48 ‘–0.56’) and KCN genes mutations. Nine (5.73%) of the elevated ST segment juniors had questionable Brugada sign, two of which with KCN (n=1) and SCN5A (n=1) gene mutations. Ajmaline provocative test was negative in 4 and was refused by 5 subjects. Conclusion: Bizarre QRS, ST–T patterns suggestive of abnormal impulse conduction in the right ventricle, including the right outflow tract, associated with prolonged QTc interval in some cases were observed in highly trained endurance athletes. The genetic analyses, negative in most athletes, identified surprising mutations in SCN5A and KCN genes in some cases.

Impact of smoking on the immunological profile of patients with laryngeal carcinoma.

Abstract: Immunity plays an important role in the prognosis and the natural development of cancer. Previous studies have shown that the presence of tumor in the body could modify the immune response leading to immunosuppression. The aim of this study was to evaluate the immunological changes of patients with larynx squamous cell carcinoma undergoing potentially curative surgery. We assessed the serum levels of cytokines (IL–1, IL–2, IL–4, IL–6, IL–8, IL–10, IFN–gamma, TNF–alpha, GM–CSF), chemokines (MCP–1 and MIP–1alpha) and growth factors (VEGF and bFGF) in laryngeal cancer patients before, during and after surgery. We have used a novel multianalyte XMap profiling technology that allows simultaneous measurement of multiple parameters in small volumes of samples. To investigate the changes in immune mediators ' profile induced by tumor resection, we assessed the culture supernatants of the peripheral blood mononuclear cells (PBMC) derived from the patients, before and after surgery. The results suggested a predominance of a Th2 type of immune response associated with the presence of the tumor (especially in the case of heavy smokers who smoke more than 40 pack–years). However, shifts towards a Th1 type of immune response as well as an improvement of monocyte functions were noticed after surgery.

Non-biopsy methods to determine hepatic fibrosis

Abstract: The prognosis and clinical management of chronic liver diseases are highly dependent on the extent of liver fibrosis. Bigger the fibrosis, worse the prognosis; and bigger the risk of progression to cirrhosis. In current practice, liver biopsy is most frequently performed to assess the grade of inflammation and stage of fibrosis thereby providing prognostic information on which to base treatment decisions upon. Liver biopsy is becoming more and more useless in the management of chronic liver disease due to large sampling error, consistent inter–observer disagreement, high emotional cost of patient, enormous health care commitment in case of rare but possible severe complications, the fact that it is a snapshot of a process that is everything but a frozen one. Therefore, every methodology that avoids performing this invasive procedure is welcome. The purpose of this article is to present the noninvasive evaluation of patients with chronic liver disease as an alternative of liver biopsy in the assessment of hepatic structure and function.

Markers of vulnerability in schizophrenia.

Abstract: Vulnerability in schizophrenia is an integrative concept, which tries to explain the development of schizophrenia as an interaction between different individual susceptibility factors and environmental risk factors. Vulnerability markers used in genetic studies include biochemical indicators, neuroanatomical, neurophysiologic, and cognitive abnormalities. Among those, the most extensive studied markers were: evoked potentials, smooth pursuit eye movements, and attentional deficits. Some of the potential indicators presented in this paper satisfy most of the criteria necessary for a vulnerability marker, but none meets all of them. Nevertheless, they represent important markers of risk to schizophrenia. Key words: vulnerability, evoked potentials, eye movements, attentional deficits

The importance of residual renal function in chronic dialysed patients.

Abstract: In the last decade, many researches have reached to the conclusion that preservation of residual renal function (RRF) is important after initiating dialysis, as well as in the predialysis period. RRF has been proven to contribue to the quality of life of dialysis patients. Longer preservation of RRF provides a better small and middle molecule removal, improved volemic status and arterial pressure control, diminished risk of vascular and valvular calcification due to better phosphate removal. Deterioration of RRF results in worsening of anemia, inflammation and malnutrition. It is now proven a direct relationship between RRF value and survival in dialysis patient. Several therapeutical intervention have been proven to ameliorate the decline of RRF in dialysis patients. Some of them are identical with those before initiating dialysis: ACE-inhibitors and/or angiotensin-receptor blockers, limiting the use of nephrotoxic drugs, avoiding contrast media procedures, adequate control of blood pressure. Others are specific for dialysis period: adequate dialysis dose, avoiding excessive ultrafiltration, preventing arterial hypotension during dialysis sessions, using biocompatible dialysis membranes, ultrapure water for dialysis, dietary interventions.

TURIS plasma vaporization--initial Romanian experience with a new technology.

Abstract: Bipolar electrosurgical approach represents an increasingly acknowledged technology in the treatment of benign prostatic hyperplasia (BPH), and a promising alternative to standard transurethral resection of the prostate (TURP). In this study, we aimed to evaluate a new method, transurethral resection in saline - plasma vaporization of the prostate (TURIS-PVP), by determining its efficiency, safety and short-term postoperative results. In May 2009, TURIS-PVP was performed in 25 cases of BPH. The investigative protocol included digital rectal examination (DRE), prostatic specific antigen (PSA), International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax) and abdominal ultrasonography assessing prostate volume and post-voiding residual urinary volume (RV). All patients were investigated 1 month after surgery using IPSS, QoL, Qmax and RV. TURIS-PVP was successfully performed in all cases. The average BPH size was 53 ml, the mean operating time was 28 minutes, the median catheterization time was 24 hours and the mean hospital stay was 48 hours. No patient required blood transfusions or re-catheterization, and there were no significant intra- or postoperative complications. Preoperatively, the mean value of IPSS was 21.4, the mean QoL score was 4, the mean RV was 72 ml and the mean Qmax was 9.7 ml/s. The 1 month follow-up emphasized a mean IPSS of 4, a mean QoL score of 1.4, a mean RV of 14 ml and a mean Qmax of 21.5 ml/s. TURIS-PVP represents a valuable endoscopic treatment alternative for patients with BPH, with good efficacy, reduced morbidity, satisfactory follow-up parameters and fast postoperative recovery. IPSS, QoL, Qmax and RV measurements showed significant improvements at the 1 month follow-up.

A life threatening problem in infants: supratentorial epidural hematoma

Abstract: EDH in infants represents a life–threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, the size of EDH, and the presence of a midline structure shift on the head's CT scan.

Neuronavigation. Principles. Surgical technique.

Abstract: Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

Diagnosis and complications of renovascular hypertension in children: literature data and clinical observations.

Abstract: Introduction Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95% of the cases) and the shortening of hipotensive factors (5% of the cases) are responsible for the production mechanism of renovascular hypertension in children. In order to make an early diagnosis regarding the renovascular hypertension in all children suffering from renovascular illnesses, blood pressure must be taken correctly and repeatedly. Materials and methods This paper is a case study on 19 children with renovascular hypertension, aged between 2 and 15 years old. Most cases were divided into two groups: subjects aged 4-7 years old and subjects aged 8-12 years old. Each group represents 34.2% of all cases. The diagnosis of renovascular hypertension in those 19 children was established after correctly taking the blood pressure and comparing it with the normal values for each age. Hypertension was diagnosed before knowing its cause in 8 neglected cases. The blood pressure was repeatedly taken in the other 11 children suffering from renovascular illnesses and the diagnosis of hypertension was early established when blood pressure values increased. Previously, blood pressure was normal in these 11 cases. Results The etiopathogenical diagnosis showed parenchymal diseases in 12 cases--63.1%. Seven patients suffered from renovascular lesions--36.9%. Laboratory exams, radiology, imagistic exams, arteriography and scintigraphy were steps taken in order to establish the etiopathogenical diagnosis. These exams showed the next direct causes of renovascular hypertension: bilateral chronic pyelonephritis in 4 cases--21.4%, hydronephrosis in 3 cases--16.2%, congenital renal hypoplasia in 2 cases--10.4% and doubled kidney in 2 cases--10.4%. The other 8 cases presented acute glomerulonephritis, unilateral renal agenesis, horseshoe kidney, unilateral pyelonephritis, renal artery agenesis, renal trauma, renal abcess and Wilms tumor, one case of each illness--5.2%. The major complications were: retinopathy, chronic renal failure and stroke. Conclusions Laboratory data are just a hint in diagnosing renovascular hypertension. However, radiology, imagistic exams, arteriography and scintigraphy are compulsory in the renourinary status and etiopathogenical diagnosis.