The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

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Wednesday, November 21 2018 @ 12:48 EET

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Malignant Peripheral Nerve Sheath Tumor Relapse Detected by Positron Emission Tomography

2015-01

Mădălina Olivia Adameșteanu, I. Lascăr, M. Vâlcu, Ioana Teona Sebe

Malignant peripheral nerve sheath tumors (MPNST) are soft tissue tumors showing neuroectodermal differentiation. They arise in connection to a major nerve trunk, a peripheral nerve or a preexisting neuroma in patients with hereditary neurofibromatosis type 1. [1, 2]

They usually develop in the deep soft tissue between anatomic compartments, the root of the limbs (inguinal region, the axilla) being one of the most common sites of occurrence.

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Spontaneous Rupture of the Spleen on a Patient with Splenic Hemangioma and Multiple Cystic Lesions in Kidney and Liver...

2015-01

Spontaneous Rupture of the Spleen on a Patient with Splenic Hemangioma and Multiple Cystic Lesions in Kidney and Liver. Case Report and Literature Review

Andreea Iliesiu, Oana Cristina Ciornenchi, M. Tampa, Clara Matei, Simona-Roxana Georgescu, C. Cirstoiu, N. Zarnescu, Maria Sajin, A. Dumitru

Splenic hemangioma is a vascular malformation which is one of the most common benign neoplasms of the spleen. They may represent small, incidental lesions that can produce significant splenomegaly and predispose to splenic rupture. These tumors are rare and resemble their counterparts in other organs. The vascular spaces are usually irregular and cavernous, containing abundant red blood cells.

Differential diagnoses include benign or malignant neoplasms, metastases, lymphoma, splenic abscess or cystic lesions. The incidence of autopsy examination of their diagnosis ranges from 0.03 to 14% [1], and most often is encountered in adults between the ages of 30 and 50 [2]. Most are small lesions, usually clinically silent, diagnosed accidentally. Sometimes, however, they may be symptomatic, manifested by splenomegaly, abdominal pain, bowel disorders, anemia and thrombocytopenia, Kasabach-Merritt syndrome (anemia, thrombocytopenia and coagulopathy) and in rare cases by spontaneous rupture of the spleen [3].

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Total Pelvic Exenteration for Locally Invasive Cervical Cancer with Vesico-Vaginal Fistula

2015-01

N. Bacalbașa, Irina Bălescu

Cervical cancer still represents an important health problem, many cases still being diagnosed in an advanced stage of disease with already existing invasion of the surrounding viscera. (1,2) The presence of a locally invasive cervical tumor with aggressive surgical behaviour can produce local tumoral invasion which sometimes is associated with continuity solutions between different organs. When it comes to cervical cancer, the viscera most frequently affected by the formation of these fistulas are rectum and urinary bladder. (3,4) We present the case of a 49 year old patient diagnosed with stage IVA cervical cancer in whom a total supralevator exenteration was performed.

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Existing Controversies in Inguinal Hernia Treatment

2015-01

S. Aldoescu, T. Pătrașcu

Inguinal hernia is one of the most frequently encountered adult pathologies requiring surgical treatment, and it represents an important problem for healthcare systems, with multiple consequences on both the social and economic plan. Although its incidence and prevalence are not exactly known, the admitted possibility for an individual to get an inguinal hernia during his lifetime ranges around 27% for men compared to only 3% for women. [1] [2]. The evolution of surgery has brought to the fore multiple technical developments which, although technically alluring, could not manage to become surgical standard procedures. The 80’s saw the development of synthetic alloplastic materials and also "tension-free" repair principles, peaking with the Lichtenstein technique, which decreased the relapse rate so much that it made this procedure the "gold standard" of this type of pathology for many surgeons. The development of minimal invasive surgery gradually overtook all abdominal "organs" and the early nineties, starting with 1993, saw the rapid development of minimal invasive techniques for the treatment of inguinal hernia, which proved to be statistically as efficient as the technique Lichtenstein initially described. From that moment on, the surgical world adopted radically different positions, each surgical school offering arguments for or against classical or laparoscopy methods, a dispute which triggered many controversies, more or less backed by statistical data.

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Therapy Principles in Ischemic Mitral Regurgitation

2015-01

V. Goleanu

Ischemic mitral regurgitation (IMG) is the mitral regurgitation that is determined by the ischemic coronary disease and must be differentiated from the mitral regurgitation, which coexists with ischemic coronary disease. It appears secondary to acute myocardial infarction with angiographic or echocardiographic signs of contraction anomaly of left ventricle in a region vascularized by a critically stenosed coronary artery (1-3).

Ischemic mitral regurgitation is determined by an excess of tethering of one or both mitral valves, as a result of displacement of one or both papillary muscles. All patients have anterior acute myocardial infarction with regional anomaly of left ventricle wall contraction. Statistically, approximately 80% display posterior infarction and 20% anterior infarction (4).

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Current Aspects of Clinical Genetic Diagnosis in Werdnig-Hoffman Spinal Muscular Atrophy

2015-01

Axinia Corches

Type I Werdnig-Hoffman spinal muscular atrophy (SMA) is a progressive neuromuscular disease with recessive autosomal transmission characterized by muscular weakness and atrophy caused by degeneration of motor neurons in the spinal cord and in the brainstem nuclei.

In the early 1980s, Werdnig and Hoffman described a disorder with childhood onset that was characterized by progressive muscle weakness. In terms of histopathology, it showed loss of neurons in the previous horns of the spinal cord. (Katirji B, 2002).

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Surgical Attitude Towards the Hepatic Hydatid Pericystic Cavity

2015-01

I. Brezean, M. Vilcu, I. Pantea, E. Catrina, D. Ferechide

There are a variety of anatomoclinical forms of hepatic echinococcosis. This has led to finding and applying a number of surgical procedures which have the same aim, namely the reduction or elimination of the pericystic cavity. Besides, solving the residual pericystic cavity after the elimination of the parasite represents the main problem of the surgical treatment. The postoperative complications of the hydatid cyst are caused by the failure to adapt the surgical procedures to the morphological characteristics of the pericystic cavity.

In the Romanian medical literature, the surgeries performed for the hepatic hydatid cyst are divided into the so-called conservative surgeries, which abandon the pericystic cavity or resect a part of the pericyst, and the so-called radical surgeries, which completely remove the pericystic cavity by sacrificing a smaller or greater area of the parenchyma of the liver.

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Biomarkers and Imagistic Methods for Early Diagnosis and Prognostic of Laryngeal Cancer

2015-01

Cristina Maria Goanta, Daniela Cirpaciu

For years, intermediate and advanced staged tumors were approached with total laryngectomy and post-operative RT until 1991, when the Veterans Administration Larynx Study and other subsequent organ preservation trials established the role of chemo radiation in the upfront treatment of intermediate laryngeal cancers (stage III and early IV a).

Surgical management of the larynx and hypo-pharyngeal malignancies have become increasingly challenging as surgical organ preservation strategies are applied. Failures of these protocols are often accompanied by post radiation sequels, which enhance post-surgical complications when a salvaging laryngectomy/laryngopharyngectomy is undertaken.

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SIRS and MODS in Acute Pancreatitis

2015-01

C.C. Popa, Octavia Cristina Rusu, Alexandra Kocsis, S.I. Neagu, C.R. Strugaru

Acute pancreatitis is the acute inflammation of the glandular pancreatic acinar cells, the consequence of parenchymal enzyme activation. Acinar local autodigestion which determines tissue destruction and ischemic necrosis sets in. Simultaneously, the local inflammatory reaction is followed by the release of pancreatic enzymes in the systemic circulation. In this situation, inflammatory cells appear, which stimulates the production of inflammatory mediators (1,2).

The loss of local control or exaggerated inflammatory reaction triggers the systemic inflammatory response syndrome (SIRS). The factors involved in determining the systemic response may be infectious (bacteria, viruses, fungi, parasites etc.), noninfectious (trauma, pancreatitis, burns etc.), or a combination of all the above (Fig. 1).

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Ultrastructural Arguments for the Extracellular Location of Amyloid Deposits

2015-01

E. Mandache, M. N. Penescu

Amyloidosis is a disease characterized by deposition and accumulation of insoluble proteins as small or large deposits of a fibrillar material. Despite the fact that these deposits are ultrastructurally identical, the basic proteins are chemically different, so far being recognized over 25 amyloidogenic precursors [1]. All these proteins can be immuno-histochemically identified, thus leading to a more and more precise diagnosis and an appropriate treatment.

Amyloid fibrils have an 8 to 12 nm diameter, are extremely strong, highly ordered and organized and can be formed, as already mentioned, by a large number of proteins and peptides [2]. They are rigid, nonbranching, hollow-cored tubules randomly arranged. Examined in X-ray diffraction they have a characteristic β-pleated sheet configuration. This macromolecular helix of 100 nm periodicity, formed by two twisted β-pleated sheet micelles is responsible for the resistance of amyloid to solubilization or proteolytic digestion. The amyloid precursor peptides may be normal serum proteins, or abnormal degradation variants, which can be repetitively incorporated into a developing amyloid fibril. The P component of amyloid fibril is a pentagonal, 8 nm diameters, doughnut like glyco-protein, similar to complement component C1t and C-reactive protein. P component is probably the cause of amyloid deposit staining with iodine. All amyloids contain a proteoglycans matrix. Pure amyloid contains amyloid fibrils, P component and proteoglycans matrix. In tissue, the deposits are contaminated with varying amounts of plasma proteins and collagen. Variations in staining and density of amyloid result from different amounts of non-amyloid components attached to the fibrilar scaffold.

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IPSS Score and IL-6 Before and During Treatment with Dutasteride in Patients with Benign Prostatic Hyperplasia

2015-01

C.V. Ene, Corina Daniela Ene, Ilinca Nicolae, B. Geavlete, Oana Andreia Coman

Benign prostatic hyperplasia (BPH) is one of the most common pathologies in aging men, associated with lower urinary tract symptoms (LUTS). This pathology has a multimodal approach depending on different factors like age, prostate size, prostate-specific antigen level, and severity of the symptoms [1].

Medical treatment is the first option in what patients with low or moderate LUTS are concerned. There are two major drug classes already established in all international treatment guidelines, 5 alpha-reductase inhibitors and alpha-blockers. 5 alpha-reductase inhibitors block the transformation of testosterone in dihydrotestosterone within the prostate, leading to the decrease of prostate volume, increased peak urinary flow rate, improvement of symptoms, decreasing the risk of acute urinary retention. Their main secondary effects are the erectile dysfunction, the decreasing of libido and of the ejaculate volume, and also gynecomastia [2]. Alpha-blockers act on alpha-adrenoceptor sites found particularly at the bladder neck, at the trigone and within the prostate. They have a fast action on the prostate gland, leading quickly to symptom relief, but without reducing the risk of acute retention or surgical treatment. As secondary effects, alpha-blockers can affect blood pressure [3-5].

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Presence of p53 in Tumor Cells - an Indicator of Disease Severity? Retrospective Study in Patients with NSCC (Partial Results)

2015-01

Antonela Dragomir, M. Alexe, Diana Leonte, Florina Vasilescu, Daciana Marta

The lung cancer is the leading cause of death determined by malignancies in the world, followed by breast, prostate and colon cancer. The malignant cells present a variety of genetic aberrations that can be grouped into six essential pathways: (1) the acquisition of self sufficient or autonomous growth signals; (2) insensitivity to growth inhibitory signals; (3) resistance to signals of apoptosis; (4) unlimited proliferation potential; (5) sustained angiogenesis; and (6) invasion and metastasis1.

The p53 protein is a protein with molecular mass of 53 kDa (from where its name derives). The gene p53 encoding the protein p53 is located on the short arm of chromosome 14. The protein p53 is involved in maintaining control cellular genome stability and its disruption can lead to the emergence of malignancies. In about 50% of human cancers, the mutant protein p53 was detected. At the cellular level it regulating the transcription of some genes involved in cell growth control and apoptosis. The gene p53 can be inactivated by punctiform mutations and protein p53 can be inactivated by the formation of complexes with the cellular proteins or by proteolysis.

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NBI Guided TURBT in NMIBC Management - "The Right Path" to Better Tumor Ablation

2015-01

B. Geavlete, C. Ene, C. Bulai, I. Al. Checheriță, P. Geavlete

Over the past few years, the conventional transurethral resection of bladder tumors (TURBT) has undergone increasing criticism among the international urological community due to its’ inability to achieve a complete tumor ablation [1].

This substantial oncologic drawback has been mainly related to the limited sensitivity of the classical white light cystoscopy (WLC) [2]. In other words, the standard endoscopic assessment of the bladder was often outlined as insufficiently capable of accurately identifying all of the existing tumor formations [3].

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