Showing papers in "Journal of medicine and life in 2011"

Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging.

Abstract: This paper briefly describes the POP–Q system, by comparison with other staging systems, analyzing its main features and the concept behind it

How much do antiretroviral drugs penetrate into the central nervous system

Abstract: The central nervous system can act as a compartment in which HIV can replicate independently from plasma, and also as a sanctuary in which, under suboptimal drug pressure, HIV antiretroviral genetic variants can occur. Continuous replication of HIV in brain can contribute to neurocognitive impairment. Therefore, reaching adequate concentrations of antiretrovirals in the central nervous system might be essential in providing neuroprotection and improving neurocognition. Antiretrovirals have a restricted entry into the brain, due to several factors: the unique structure of the blood-brain barrier, and the existence of efficient efflux mechanisms. However, there is a high variability of antiretrovirals in reaching therapeutic drug concentrations in cerebrospinal fluid, that depend on the characteristics of the antiretrovirals (molecular weight, lipophilicity, protein binding) and on their capacity to be substrate for efflux transporters. The review aims to discuss the main mechanisms that interfere with antiretroviral penetration into central nervous system, and to summarize the current data concerning the penetrability of different antiretrovirals into the cerebrospinal fluid.

Probiotics and periodontal health

Abstract: Periodontitis is one of the most common chronic inflammatory diseases. The etiology is clearly bacterial and a number of putative bacterial pathogens have been associated with the disease, including Aggregatibacter actinomycetemcomitans, Tannerella forsythus and Porphyromonas gingivalis. Comparatively, little attention has been paid to the identification of health-associated and potentially beneficial bacterial species that may reside in the gingival sulcus. Probiotic technology represents a breakthrough approach to maintaining oral health by using natural beneficial bacteria, commonly found in healthy mouths, to provide a natural defense against those bacteria which are thought to be harmful to teeth and gums. This article endeavors to introduce the concepts of probiotics in periodontics.

Collagen-based scaffolds for skin tissue engineering.

Abstract: The aim of this study was to obtain four collagen based porous scaffolds and to assess their in vitro biocompatibility and biodegradability in order to use them for skin tissue engineering. We have prepared four variants of collagen-based biodegradable sponges by liophilization of type I collagen solution and three variants of collagen-agarose mixture in different ratios 2:1 (A), 1:1 (B) and 1:2 (C). These scaffolds had microporous structure with a higher than 98% porosity and a reduced biodegradation after their exposure to UV radiation. The incorporation of agarose into the collagen scaffolds has improved their structural stability. In vitro biocompatibility testing for the four types of sponges was performed on a stabilized fibroblast cell line and showed that both cell viability and morphology were not altered by collagen and collagen-agarose variants A and B sponges. These three porous sponges demonstrated potential for future application as cell scaffolds in skin tissue engineering.

Tinnitus in elderly population: clinic correlations and impact upon QoL.

Abstract: Introduction: Tinnitus is a common health problem that affects between 10 - 30% of the population, approximately 3 - 4% presenting to the doctor at least once in their life. There are many causes that lead to tinnitus in elderly population, including otology, metabolic, neurologic or cardiovascular conditions. The aim of this study was to determine the association of tinnitus with these chronic comorbidities among elderly community and its impact upon their quality of life. Materials and Methods: We performed a clinical retrospective study on 471 ENT patients hospitalized for various diseases, up to 60 years old, for a period of 24 months. All subjects were assessed for subjective tinnitus, neuro-vascular comorbidities and QoL by use of the brief version of the World Health Organization QoL instrument. Results: Tinnitus was reported in 114 patients, giving a prevalence of 24,2%. Variables like gender, residence, economic status, alcohol or smoking were not significantly associated with tinnitus. On the other hand, otic and sinonasal pathology, dizziness, hypertension, arteriosclerosis or diabetes were significantly correlated. All patients with tinnitus presented a more negative perception of their overall health and a poorer QoL, compared to those without. Conclusions: Tinnitus is a common pathology among elderly community. Its association with chronic treatable health comorbidities reduces QoL and highlights the need of cooping strategies among this group population. Abbreviations: RR = Relative Risk; 95%CL=95%Confidence Level; OR = Ods Ratio; QoL= quality of life

Coarctation of the aorta in adults: what is the best treatment? Case report and literature review.

Abstract: Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. We report the case of a 45 year-old women, diagnosed with severe coarctation of the aorta just distal to the left subclavian artery, with poststenotic dilatation of the descending aorta and difficult control of blood pressure values. The patient was successfully treated interventionally, by balloon angioplasty with deployment of a covered stent. We review here the different methods employed for the treatment of coarctation of the aorta in adults, including surgical or percutaneous balloon angioplasty with or without stent placement, underlying their complications and the factors that influence the choice of the best coarctation repair method.

Cannabinoid system and cyclooxygenases inhibitors.

Abstract: Rationale. The cannabinoid system consists of a complex array of receptors, substances with agonist/antagonist properties for those receptors, biosynthetic machineries and mechanisms for cellular uptake and degradation for endocannabinoids. This system is in interrelation with other systems that comprise lipid mediators like prostaglandins/leukotrienes systems. A clear antagonist, additive or synergic effect of nonsteroidal anti–inflammatory drugs (NSAIDs)–cannabinoid associations was not yet demonstrated. Aim. The present study tried to summarize the existent data on NSAIDS-cannabinoid system interactions. Methods and results A bibliographic research in Medline, Scirus, Embase was made using as keywords cannabinoid, nonsteroidal anti–inflammatory drugs, aspirin, ibuprofen, flurbiprofen, diclofenac, indomethacin, acetaminophen, coxibs, antinociceptive, antinociception, analgesia DiscussionsA systematization of the results focusing on the NSAIDs drugs interaction with the cannabinoid system was presented. Out of all the substances analyzed in the present review, acetaminophen was studied the most regarding its interferences with the cannabinoid system, mainly due to contradictory results. Conclusions Some NSAIDs have additional influences on the cannabinoid system either by inhibiting fatty acid amide hydrolase (FAAH) or by inhibiting a possible intracellular transporter of endocannabinoids. All the NSAIDs that inhibit COX2 can influence the cannabinoid system because a possible important degradative pathway for anandamide and 2–arachidonoyl glycerol might involve COX 2. One of the causes for the variety of experimental results presented might be due to pharmacokinetic mechanisms, depending on the route of administration and the dose Abbreviationsdelta9 THC, (–)–(6aR,10aR)–6,6,9–trimethyl–3–pentyl–6a,7,8,10a–tetrahydro–6H–benzo[c]chromen–1–ol; delta9–THC–11–oic acid, 1–hydroxy–6,6–dimethyl–3–pentyl–6a,7,8,10a–tetrahydrobenzo[c] chromene–9–carboxylic acid; Anandamide, (5Z,8Z,11Z,14Z)–N–(2–hydroxyethyl)icosa–5,8,11,14–tetraenamide; Methanandamide, (5Z,8Z,11Z,14Z)–N–[(2R)–1–hydroxypropan–2–yl]–icosa–5,8,11,14–tetraenamide; 2–AG, 1,3–Dihydroxy–2–propanyl (5Z,8Z,11Z,14Z)–5,8,11,14–eicosatetraenoate; HU 210, (6aR,10aR)– 9–(Hydroxymethyl)–6,6–dimethyl–3–(2–methyloctan–2–yl)–6a,7,10,10a–tetrahydrobenzo [c]chromen–1–ol; SR141716A, 5–(4–Chlorophenyl)–1–(2,4–dichloro–phenyl)–4–methyl–N–(piperidin–1–yl)–1H–pyrazole–3–carboxamide; SR144528, N–[(1S)–endo–1,3,3–trimethyl bicyclo [2.2.1] heptan–2–yl]–5–(4–chloro–3–methylphenyl)–1–(4–methylbenzyl)–pyrazole–3–carboxamide; AM251, 1–(2,4–dichlorophenyl)–5–(4–iodophenyl)–4–methyl–N–(1–piperidyl)pyrazole–3–carboxamide; AM 404, (5Z,8Z,11Z,14Z)–N–(4–hydroxyphenyl)icosa–5,8,11,14–tetraenamide; WIN 55,212–2, (R)–(+)–[2,3–Dihydro–5–methyl– 3–(4–morpholinylmethyl)pyrrolo [1,2,3–de]–1,4–benzoxazin–6–yl]–1–napthalenylmethanone; AM 281, N–(morpholin–4–yl)–5–(4–iodophenyl)–1–(2,4–dichlorphenyl)–4–methyl–1H–pyrazole–3–carboxamide; AM 630, [6–Iodo–2–methyl–1–[2–(4–morpholinyl)ethyl]–1H–indol–3–yl](4–methoxyphenyl)methanone; Ibu Am–5, N–(3–methylpyridin–2–yl)–2–(4'–isobutylphenyl)propionamide; CP 55, 940, 2–[(1R,2R,5R)–5–hydroxy–2–(3–hydroxypropyl) cyclohexyl]–5–(2–methyloctan–2–yl)phenol; NS–398, N–[2–(Cyclohexyloxy)–4–nitrophenyl]methanesulfonamide; SC–560, 5–(4–chlorophenyl)–1–(4–methoxyphenyl)–3–trifluoromethylpyrazole; AM 1241, (3–iodo–5–nitrophenyl)–[1–[(1–methylpiperidin–2–yl)methyl]indol–3–yl]methanone; Met F AEA, 2–methyl–arachidonyl–2'–fluoro–ethylamide; PMSF, Phenylmethylsulfonyl fluoride; URB 597, [3–(3–carbamoylphenyl)phenyl] N–cyclohexylcarbamate; TRPV1, Transient receptor potential vanilloid type 1; CGRP, Calcitonin gene related peptide; COX1, cyclooxygenase type 1; COX2, cyclooxygenase type 2; CB1R, cannabinoid receptor type 1; CB2R, cannabinoid receptor type 2; FAAH, fatty acid amide hydrolase; NSAIDs, nonsteroidal anti–inflammatory drugs; p.o., per os; i.p., intraperitoneally; i.th., intrathecally; s.c. subcutaneously; i.pl., intraplantar; i.v., intravenously; CB cannabinoid.

Modern risk stratification in coronary heart disease

Abstract: The prevalence and impact of cardiovascular diseases in the world are growing. There are 2 million deaths due to cardiovascular disease each year in the European Union; the main cause of death being the coronary heart disease responsible for 16% of deaths in men and 15% in women. Prevalence of cardiovascular disease in Romania is estimated at 7 million people, of which 2.8 million have ischemic heart disease. In this epidemiological context, risk stratification is required for individualization of therapeutic strategies for each patient. The continuing evolution of the diagnosis and treatment techniques combines personalized medicine with the trend of therapeutic management leveling, based on guidelines and consensus, which are in constant update. The guidelines used in clinical practice have involved risk stratification and identification of patient groups in whom the risk-benefit ratio of using new diagnostic and therapeutic techniques has a positive value. Presence of several risk factors may indicate a more important total risk than the presence / significant increase from normal values of a single risk factor. Modern trends in risk stratification of patients with coronary heart disease are polarized between the use of simple data versus complex scores, traditional data versus new risk factors, generally valid scores versus personalized scores, depending on patient characteristics, type of coronary artery disease, with impact on the suggested therapy. All known information and techniques can be integrated in a complex system of risk assessment. The current trend in risk assessment is to identify coronary artery disease in early forms, before clinical manifestation, and to guide therapy, particularly in patients with intermediate risk, which can be classified in another class of risk based on new obtained information. Abbreviations: ACS = acute coronary syndrome; AMI = acute myocardial infarction; BNP = brain natriuretic peptide; BP = blood pressure; BPs = systolic blood pressure; CHD= coronary heart disease; CRP = C-reactive protein; CX= circumflex artery; EF= ejection fraction; LAD= left anterior descendending coronary artery; LV = feft ventricle; MI= myocardial infarction; NGAL= neutrophil gelatinase associated lipocalin; NT-proBNP = N-terminal pro B-type natriuretic peptide; RCA= right coronary artery; RV= right ventricle

Neuronal T-type calcium channels: what's new? Iftinca: T-type channel regulation.

Abstract: This review summarizes recent advances in our understanding of neuronal T-type calcium channel regulation as well as their physiological and pathophysiological roles Through their ability to conduct calcium across the cellular membrane at potentials close to the resting potential, T-type calcium channels are critically important for regulating neuronal excitability, both in the central and peripheral nervous system T-type channels are also linked to an increasing number of neurological disorders such as the absence epilepsy and neuropathic pain Although there is substantial literature dealing with regulation of native T-type channels, the underlying molecular mechanism has only recently been addressed It is, therefore, critical to understand the cellular mechanisms that control T-type channel activity and expression, because this could provide important insight into designing novel therapeutic strategies targeting these channels

Traumatic brain injury in infants and toddlers, 0-3 years old.

Abstract: OBJECT: Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma. METHODS: We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. RESULTS: We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases. CONCLUSION: Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome. Language: en

Factors in relation with self-regulation of hypertension, based on the model of goal directed behavior in Yazd city.

Abstract: Introduction: Hypertension is a chronic disease, which represents one of the most common public health problems in the world and afflicts about 28% of the North Americans, 44% of the Europeans and 26% of the East Mediterranean people aged 35 to 64 years. In Iran, about 11.5% of the people who are over 15 years old are afflicted. Hypertension is the most prevalent cardiovascular disease; it is the leading cause of stroke, heart attack, kidney disease and aortic aneurysm. Materials and Methods: This is a cross–sectional study, carried out on 200 patients who were referred to the Health centers of Yazd city in center of Iran. We adapted tools from previous studies. All patients were asked to express their personal goals with respect to their hypertension values. The reliability and validity of the questionnaire were determined and their Alfa cronbach was (a=0.83). Results: The mean number of years with hypertension was 8.7[+/–]7.6. Men and women showed moderately high means for attitudes, subjective norms, and positive anticipated emotions toward trying to reduce or maintain their blood pressure. The data indicated there is significantly different between the personnel and housewives, with p<0.001. In addition, the personnel's mean grade scores for trying the self–regulation of their blood pressure was (15.9[+/–]4.08) and, in the housewives was (12.49[+/–]4.33). Conclusion: The results of this study showed that the Model of Goal Behavior can explain more than 52% of the self–regulation of hypertension, so, this Model can be a basic Model for intervention in education, in order to decrease and control hypertension in patients.

The role of confocal microscopy in the dermato-oncology practice.

Abstract: Reflectance-mode confocal microscopy (RCM) is a new in vivo skin imaging technique. We present our one-year experience in RCM examinations in skin tumors and the retrospective analysis of patients enrolled in the Dermatological Department of 'N. Paulescu' Institute using the Fotofinder Dermoscope IIŴ for the dermatoscopy analysis and VivaScope 1500Ŵ for in vivo RCM. We established the rank of RCM in the complex algorithm of skin cancer diagnose, showing that the presented experience can open new possibilities to implement this automated image analyzing system in the routine practice. Our analyzed cases clearly showed that confocal microscopy, therefore, optical biopsy, could guide the clinician towards an accurate diagnosis before surgical removal. Moreover, we emphasized that the development of this technique increases the potential of future teledermatologic applications.

Can ageing be slowed?: Hormetic and redox perspectives.

Abstract: Redox metabolism has long been considered to play important roles in aging and the development of age-related diseases Both dietary and pharmacological manipulations of redox metabolism have been associated with the extension of lifespan Increasing new evidence s also suggests that the process of aging may derive from imperfect clearance of oxidatively damaged material The accumulation of this molecular “garbage”, relatively indigestible, further hinders cellular functions, induces progressive failure of maintenance and repair and increases the probability of death One important trend in anti–aging strategy is, therefore, to prevent or even revert the accumulation of these oxidatively altered molecules by stimulating the maintenance and repair systems through hormesis A promising approach for slowing down ageing and achieving a healthy senescence is represented by repeated exposure to various mild stresses (caloric restriction, moderate exercise, nutritional or pharmacological hormetins) This article reviews the potential therapeutic tools available to date for increasing longevity and obtaining and successful ageing from the redox and hormetic perspective

Two implant overdenture--the first alternative treatment for patients with complete edentulous mandible.

Abstract: Given the increasing life expectancy in the coming years, dental practitioners, as other specialists from different medical fields, will encounter an increasing number of complete edentulous patients. These patients, with a longer active life and higher standards of life quality, will have different expectations for their complete dentures, higher than the standard treatment that uses conventional complete dentures. Two-implant overdenture is considered the first alternative treatment in complete edentulous mandible, according to current medical standards established by a team of specialists in prosthodontics and implantology, and globally known as the McGill Consensus from McGill University, Montreal, Canada. The Consensus was established during a-day-and-a-half session of presentations done by experts who presented data, scientific information on the subject, and, not less significant, personal experiences of participants and patients. Overdenture on implants, as an alternative treatment for complete edentulous mandible, has multiple benefits in achieving better conditions of prosthesis: balance and effectiveness, with positive effects on oral structures, aesthetics, and quality of life. Mandibular two-implant overdenture, established as a standard treatment by the highest international forum, should gradually become the first choice of treatment in complete edentulous mandible.

Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures.

Abstract: Due to an ever-aging population and a growing prevalence of osteoporosis and motor vehicle accidents, the number of subtrochanteric fractures is increasing worldwide The choice of the appropriate implant continues to be critical for fixation of unstable hip fractures The subtrochanteric region has certain anatomical and biomechanical features that can make fractures in this region difficult to treat The preferred type of device is a matter of debate Increased understandings of biomechanical characteristics of the hip and improvement of the implant materials have reduced the incidence of complications The surgeons choose between the two methods according to Seinsheimer's classification and also to their personal preferences As a general principle, the open reduction and internal fixation were performed in stable fractures, and the closed reduction and internal fixation were performed in unstable fractures The advantages of intramedullary nailing consist in a small skin incision, lower operating times, preservation of fracture hematoma and the possibility of early weight bearing The disadvantages consist in a difficult closed reduction due to important muscular forces, although the nail can be used as a reduction instrument, and higher implant cost In open reduction internal fixation techniques, the advantage is represented by anatomical reduction which, in our opinion, is not necessary The disadvantages are represented by: higher operating time, demanding surgery, large devascularization, higher infection rates, late weight bearing, medial instability, refracture after plate removal and inesthetic approach

Cardiac magnetic resonance imaging in ischemic heart disease: a clinical review.

Abstract: Cardiac magnetic resonance imaging (MRI) has emerged as a prime player in the clinical and preclinical detection of ischemic heart disease (IHD) as well in the prognosis assessment by offering a comprehensive approach for all spectrums of coronary artery disease (CAD) patients. The aim of this review is to provide the reader a state-of-the art on how the newest cardiac MRI techniques can be used to study IHD patients. In patients with suspected/stable CAD, functional and perfusion imaging both at rest and during vasodilatatory stress (adenosine, dypiridamole)/dobutamine stress can accurately depict ischemic myocardium secondary to significant coronary artery stenosis. In patients with acute MI, MRI is a robust tool for differentiating and sizing the jeopardized and the infarcted myocardium by using a combination of functional, edema, perfusion and Gd contrast imaging. Moreover, important prognostic factors like myocardial salvage, the presence of microvascular obstruction (MVO), post reperfusion myocardial hemorrhage, RV involvement and infarct related complications can be assessed in the same examination. In patients with chronic ischemic cardiomyopathy, the role of the MRI extends from diagnosis by means of Gadolinium contrast scar imaging to therapy and prognosis by functional assessment and viability testing with rest and dobutamine stress imaging. In all the circumstances mentioned, MRI derived information has been proven valuable in every day clinical decision making and prognosis assessment. Thus, MRI is becoming more and more an accepted alternative to other imaging modalities both in the acute and chronic setting.

Proinflammatory cytokines in peritonitis.

Abstract: Rationale: We performed this study with the purpose of revealing different aspects of the systemic inflammatory response syndrome in peritonitis. Objectives: The aim of the presentation was to make a research on some of the immune response mediators in secondary peritonitis and to observe their capacity to anticipate the evolution towards septic complications. Methods and Results: We have undertaken a study on a group of 100 patients with acute diffuse peritonitis, between 2009 and 2011, in which we have accomplished the dosage of IL–1 beta, IL–6 and TNF alpha cytokines in the serum of patients, in dynamics, for 7 days by using the Elisa method. Subsequently, we have compared the results to the ones of a control group. The data obtained indicated high levels of proinflammatory cytokines in the patients who subsequently suffered an unfavorable evolution towards septic complications. Discussion: The study of IL–1 beta, IL–6 and TNF alpha blood dynamics, offers valuable information about the severity of a systemic inflammatory response syndrome in peritonitis. They can be valuable biomarkers in establishing the unfavorable evolution of patients, helping the physician to establish a sustained and specific treatment, even from the early phases of the illness.

Management of odontogenic orbital cellulitis.

Abstract: This work describes a series of patients with odontogenic orbital cellulitis (OOC), focusing on rate of abscess formation, need for surgical intervention, and imaging findings helpful for rapid diagnosis. Review of a current case and 22 patients with OOC from the scientific literature demonstrated periapical lucency as the most commonly (36.4%) reported finding on facial and orbital computerized tomography (CT) scan. Orbital abscess occurred in 72.7% of cases, and tooth extraction and/or abscess drainage was required in 95.5% of cases reviewed for control of infection. The current case presented with periapical lucency on CT scan, developed orbital abscess despite broad spectrum antibiotic therapy, and required multiple surgical interventions for disease resolution. Though our patient regained excellent vision, OOC often can result in severe vision loss. Periapical lucency on CT can help identify this atypical origin of cellulitis that is strongly associated with abscess formation and need for surgical intervention.

Emergence, self-organization and morphogenesis in biological structures.

Abstract: The paper discusses the connection between emergence, pattern formation and nonlinear dynamics, focusing on the similarity between discrete patterns and fractal structures, and then describes different solutions to model reaction–diffusion systems as representative processes in morphogenesis. A specific example is the diffusion limited aggregation growth process, illustrated by the simulation of the evolution of a bacterial colony that shows the roles of instability and sensitivity in non–equilibrium pattern formation. Based on this particular case, it is shown how self–organization could be achieved from non–organized agglomeration of separate entities, in a region of space. We conclude with some brief remarks about universality, predictability and long–term prospects for this field of research.

In vitro biocompatibility testing of some synthetic polymers used for the achievement of nervous conduits.

Abstract: Biocompatible synthetic polymers are largely used in the bio–medical domain, tissue engineering and in controlled release of medicines. Polymers can be used in the achievement of cardiac and vascular devices, mammary implants, eye lenses, surgical threads, nervous conduits, adhesives, blood substitutes, etc. Our study was axed on the development of cytotoxicity tests for 3 synthetic polymers, namely polyvinyl alcohol, polyethylene glycol and polyvinyl chloride. These tests targeted to determine the viability and morphology of cells (fibroblasts) that were in indirect contact with the studied polymers. Cell viability achieved for all the studied synthetic polymers allowed their frame in biocompatible material category. Cell morphology did not significantly change, thus accomplishing a new biocompatibility criterion. The degree of biocompatibility of the studied polymers varied. Polyvinyl alcohol presented the highest grade of biocompatibility and polyvinyl chloride placed itself at the lowest limit of biocompatibility. The results achieved allowed the selection of those polymers that (by enhancing their degrees of biocompatibility due to the association with various biopolymers) will be used in the development of new biocompatible materials, useful in nervous conduits manufacture.

Electrophoresis of tear proteins as a new diagnostic tool for two high risk groups for dry eye: computer users and contact lens wearers

Abstract: Rationale: Dry eye is the most prevalent condition seen by the ophthalmologist, in particular in elderly. The identification of new common risk factors (computer use and contact lens wear) extends the disease among the young people. The early diagnosis of dry eye is essential, but difficult, because the biochemical changes in tear film usually occur before any detectable signs. Due its advantages, electrophoresis of tear proteins could be an important tool for diagnosis of tear film impairment in high risk groups for dry eye. Objective: The role of tear proteins electrophoresis in early diagnosis of dry eye related to computer use and contact lens wear, as well as the biochemical changes in these high risk groups are presented. Methods: This review will summarize the actual data concerning the electrophoretic changes of tear proteins in computer users and contact lens wearers, two common high risk groups for dry eye. Discussion: Electrophoresis of tear proteins using automated system Hyrys–Hydrasys SEBIA France is an important tool for early diagnosis of tear film alterations and monitoring of therapy. The quantification of many proteins in a single analysis using a small quantity of unconcentrated reflex tears is the main advantage of this technique. Electrophoresis of tear proteins should became a prerequisite, in particular for computer users less than 3h/day, as well as at prescribing contact lenses. Abbreviations: DED– dry eye disease, EGF–epidermal growth factor, IL interleukins, MMP–metalloproteinase, ELISA– Enzyme–linked immunosorbent assay, SDS– sodium dodecyl sulfate, CVS– computer vision syndrome, CLRDE– contact lens– related dry eye

Management of gall bladder perforation evaluation on ultrasonography: report of six rare cases with review of literature

Abstract: Background: Perforation of the gall bladder with cholecystohepatic communication is a rare cause of liver abscess. We are reporting here six rare cases of gall bladder perforation with variable clinical presentations. Materials and Methods: Most patients presented with right hypochondrium pain and fever but two patients presented with only pain in the abdomen. Ultrasonography (USG) and Computed Tomography (CT) were used for diagnosis. The patients were also successfully treated. Results: There was a gall bladder perforation with cholecystohepatic communication, leading to liver abscess formation in most cases on USG and CT. The final diagnosis was confirmed on surgery. Conclusion: The perforation of the gall bladder which leads to liver abscess is a rare complication of acute, chronic or empyema gall bladder. USG and CT scans are the most important diagnostic tool in diagnosing this rare complication. In the set up, where advanced options are not available, the only treatment of choice is the conservative one or surgery, according to the status of the patients.

Atrial Septal Defect in an Elderly Woman–a Case Report

Abstract: Rationale. The atrial septal defect is one of the most common congenital anomalies in adults, but it is rarely diagnosed. It is characterized by a defect in the interatrial septum that allows pulmonary venous return to pass from the left to the right atrium. Objective. A case of a 75–year–old female who presented with dyspnea, orthopnea, lower extremities swelling and palpitations is reported here. She had a 3 years history of atrial fibrillation and one–year history of cardiac failure NYHA (New York Heart Association) class Ⅱ. Methods and results. Transthoracic echocardiography revealed a dilated right atrium of 74,2 mm, a dilated left atrium of 55,2 mm, a dilated left ventricle of 64/72,3 mm, a dilated right ventricle of 44,4 mm. Atrial septal defect ostium secundum type, with left–to–right shunt. Severe tricuspid insufficiency with a maximum gradient of 55,4 mm Hg. 4th degree mitral insufficiency. Severe pulmonary hypertension of 75 mm Hg. The ejection fraction of 29%. Atrial fibrillation. Interventricular sept with paradoxical motion. Discussion. Ostium secundum defect is the most common type of atrial septal defect and accounts for 60–70% of all cases. The malformation often goes unnoticed for decades because symptoms may be absent and because physical signs are subtle. Symptoms usually take 30–40 years to develop. They are the consequences of pulmonary hypertension, atrial tachyarrhythmias and, sometimes, associated mitral valve disease. The echocardiography can establish the size and location of the atrial septal defect, the magnitude and hemodynamic impact of the left–to–right shunt, and the presence and degree of pulmonary hypertension. The particularity of this case is that the patient lived for over 70 years almost asymptomatic.

Map syndrome (MYH Associated Polyposis) colorectal cancer, etiopathological connections.

Abstract: The case presented raised our scientific curiosity and it is worthy of being brought in front of the medical audience because of several reasons presented below. Presently, there are 3 hereditary syndromes that have a demonstrated etiological relationship with the colorectal cancer: Familiar Adenomatous Polyposis (FAP syndrome), HNPCC syndrome (Hereditary Nonpoliposis Colorectal Cancer) and MAP syndrome.Discovered only in 2002, the MAP syndrome (MYH associated polyposis) is the first hereditary syndrome that has autosomal recessive transmission. The APC gene can be mutated in several ways during the colonic oncogenesis: congenital in the FAP syndrome, somatic in sporadic colorectal cancers and secondary to the MYH gene inactivation in MAP syndrome. MAP phenotype is similar to the FAP phenotype because of the somatic mutations to the APC gene. Colonic polyposis is lower than FAP syndrome and appeared later, in the 40's and 50's. Colorectal cancers are frequent and discovered in the same moment as the colonic polyposis. Patients are diagnosed mostly in cancer stages. Colonoscopy shows polyps disseminated around the entire colic frame. Treatment in these cases is total rectocolectomy with ileoanal anastomosis. When working in a general emergency surgery clinic, physicians are often faced with colorectal cancers in different evolutive stages, and mostly they are faced with their complications.

Plasmatic markers in hemorrhagic stroke.

Abstract: Stroke is the third most common cause of death in the United States and it is the leading cause of disability. Early diagnosis and immediate therapeutic interventions are important factors to reduce the extent of brain tissue damage and the risk of stroke–related death. A rapid blood test that can confirm the clinical or imaging diagnosis or that can add to the stratification of the risk would be very useful. Such a test has to be validated in large studies and has to be based on a simple and low–cost technology. Many biological markers were tested for their ability to serve as ‘would–be’ stroke biological markers; some of them appear to have a place in the diagnostic work–up of stroke patients. These molecules include Glial Fibrillary Acidic Protein (GFAP), the N–methyl–D–aspartate receptor (NMDA), APO C–III, APO C–I, PARK7, nucleoside diphosphate kinase A (NDKA), S100B, B–type neurotrophic growth factor, von Willebrand factor, matrix metalloproteinase–9, and monocyte chemotactic protein–1. There are obvious limitations to this study, among them the fact that disability does not necessarily correlate with the amount of cerebral tissue lost (the site of stroke may be more important) and the role of the blood–brain barrier in delaying the release of the neuronal proteins in the blood stream. Further studies are awaited to confirm the role of these molecules in the management of acute stroke patients.

Marked hypereosinophilia in a toddler: a case report.

Abstract: Background. Human toxocariasis is primarily a soil–transmitted zoonosis, so children with geophagia are at an increased risk of toxocariasis, especially those living in homes with puppies that have not been dewormed. Case report. A 17–months–old female presented to our department with fever, abdominal distention and marked eosinophilia. Iron deficiency anemia, marked leukocytosis (79,000 cells/mm3) accompanied by marked eosinophilia (55,000 cells/mm3), and hyper–gammaglobulinemia were noted. On the basis of the strong serological positivity for toxocariasis, marked eosinophilia, and low–density lesions in the liver at computed tomography, a diagnosis of visceral larva migrans syndrome was made. Conclusion. Visceral larva migrans is usually suspected in a young child with history of geophagia, pets exposure, hepatomegaly, whose complete blood count reveals leukocytosis and marked eosinophilia. Abbreviations: VLM–visceral larva migrans, OLM–ocular larva migrans, ESR–erythrocyte sedimentation rate, HBV– hepatitis B virus, HCV–hepatits C virus, EBV–Epstein–Barr virus, CMV– cytomegalovirus infection, HIV–human immunodeficiency virus, CT– computed tomography, ELISA–Enzyme–linked immunosorbent assay, CBC–complete blood count.

Influence of the acute alcoholism on the phagocytic function of the mononuclear phagocytic system.

Abstract: Rationale:Alcoholics are more likely to have infections, mainly in the respiratory system. Alcohol seems to inhibit the immune system. Despite the extensive literature related to alcoholism, data related to the immune system are still not conclusive. Objective: The purpose of this study was to verify the influence of acute alcohol intake on colloid distribution in the organs of the mononuclear phagocyte system. Methods and Results: Thirteen male Swiss mice were divided into two groups: Group 1 (n = 5) – control, and Group 2 (n = 8) – animals that received 0.5 ml ethanol 50%, 30 minutes before the experiment. Colloidal sulphur labeled with ⁸⁸mTc was used to evaluate colloid distribution in the liver, spleen and lungs. Colloid clearance was assessed as well. A gamma camera was used to measure the radioactivity of these organs and of a blood clot. No difference was found in the presence of colloid in the organs of both groups. The liver showed the highest phagocytic intake, followed by the spleen and lungs (p = 0.021 for Group 1 and p = 0.003 for Group 2). A minimum amount of radiation remained in the blood of both groups. Discussion: According to the experiential conditions of this work, acute ingestion of alcohol did not interfere with the phagocytic function of the mononuclear phagocyte system in mice.

A personalized medicine target: heart failure in women

Abstract: It is increasingly known that gender differences affect disease presentation, clinical pathways, diagnostic yield and prognosis of patients with cardiovascular disorders. There are novel insights regarding heart failure that provide a platform for personalized medicine. This is a review of the existent data about heart failure in women, a neglected topic that has gained considerable interest in the past years. Heart failure in women differs in many aspects from that of men. Part of the difference is attributable to age, ventricular function and cause of heart failure, with women being generally older at heart failure onset, more often without left ventricular systolic dysfunction and less often having heart failure due to ischaemic heart disease, in comparison with men. Elucidation of the genetic and pathophysiological basis of sex differences, together with clinical trials designed to study the impact of treatments in women, could lead to sex based heart failure management.

Cytokine gene polymorphisms support diagnostic monitoring of Romanian multiple myeloma patients.

Abstract: Introduction: cytokines and their receptor genes are very polymorphic. SNPs in the promotor region of the gene may influence the rate of cytokine secretion and may affect the biological activity of the encoded cytokine. A number of cytokines and cytokine receptors have been directly linked to the development of human cancers. The aim of our study was to determine the cytokine gene polymorphism in Romanian multiple myeloma patients. Material and methods: cytokine genotyping was performed in 80 patients and 100 healthy blood donors using molecular biology methods (SSP–Invitrogen, USA). Results: analyzing each polymorphic site, there was an increased frequency of the following genotypes in patients compared to control group: Interleukin–1beta (IL–1β) pos.+3962 TT, IL–12 pos.–1188 CC, gamma–Interferon (γ–IFN) pos.+874 AA, Transforming Growth Factor– beta1 (TGF– β1) codon10 TT, IL–2 pos.–330 TG and pos.+166 TT, Interleukin–4Receptor alpha (IL–4Rα) pos.–33 TC, IL–10 pos.–1082 GG and pos.–592 CC, IL𢀓6 pos.–174 GG. It should be noted that almost one third of multiple myeloma patients had IL–6 pos.–174 GG genotype and 62% IL–10 GCC haplotype. These identified haplotypes are high interleukins producer, and this fact was confirmed by serum IL–6 and IL–10 levels performed by ELISA and enhanced chemiluminiscence methods. Conclusion: these markers could be successfully used, together with other specific clinical and biological parameters, as reliable individualized prognostic factors in multiple myeloma patients.

Actual concepts in scaphocephaly: (an experience of 98 cases)

Abstract: Craniosynostoses are recognized as a group of birth defects that impair the skull structures by early closure of one or more sutures, causing an abnormal cranial shape. Among the "simple" craniosynostoses, (a single closed suture) the most common is scaphocephaly. The 3D CT scan is the most relevant and rapid diagnostic test. The authors present the personal experience of 98 scaphocephaly cases diagnosed and surgically treated in the Neurosurgical Department of "Bagdasar-Arseni" Emergency Hospital during a period of 10 years (2000 – 2009). The procedure of choice was the Stein & Schut (1977) extensive craniotomy that removes the early closed suture. There were no post-operatory death cases and no abnormally closed sutures. The routine use of the craniotome facilitates the lateral osteotomy that allows a normal brain growth and a normal symmetrical skull shape development. The authors advocate for early surgery during the first 6 months of life.