Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment-A New Case Report and Systematic Review

(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient's survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.

Biomechanical Comparison of Conventional Plate and the C-Nail® System for the Treatment of Displaced Intra-Articular Calcaneal Fractures: A Finite Element Analysis

The C-Nail® system is a novel intramedullary fixation method for displaced intra-articular calcaneal fractures. The aim of this study was to evaluate the biomechanical performance of the C-Nail® system and compare it with conventional plate fixation for the treatment of displaced intra-articular calcaneal fractures using finite element analysis. The geometry of a Sanders type-IIB fracture was constructed using the computer-aided design software Ansys SpaceClaim. The C-Nail® system (Medin, Nové Mesto n. Morave, Czech Republic) and the calcaneal locking plate (Auxein Inc., 35 Doral, Florida) and screws were designed according to the manufacturer specifications. Vertical loading of 350 N and 700 N were applied to the subtalar joint surfaces to simulate partial weight bearing and full weight bearing. Construct stiffness, total deformation, and von Mises stress were assessed. The maximum stress on the C-Nail® system was lower compared with the plate (110 MPa vs. 360 MPa). At the bone level the stress was found to have higher values in the case of the plate compared to the C-Nail® system. The study suggests that the C-Nail® system can provide sufficient stability, making it a viable option for the treatment of displaced intra-articular calcaneal fractures.

Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study

BACKGROUND

The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions.

METHODS

In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases.

RESULTS

This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas.

CONCLUSIONS

To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.

Thromboembolic Disease in Haemophilic Patients Undergoing Major Orthopaedic Surgery: Is Thromboprophylaxis Mandatory?

Haemophilia is a rare genetic disorder, that results from various degrees of deficiency of coagulation factor VIII (haemophilia A), or factor IX (haemophilia B), with an X-linked transmission. The patients affected are in the majority of cases males (who inherit the affected X-chromosome from the maternal side), with rare cases of females with haemophilia (FVIII or FIX < 40 IU/dL), situations in which both X-chromosomes are affected, or one is affected, and the other one is inactive (known as carrier). The hypocoagulable state due to the deficiency of clotting factors, manifests as an excessive, recurrent tendency to bleeding, which positively correlates with plasmatic levels. Severe haemophilia results in hemarthrosis, although recent data have shown that moderate or even mild disease can lead to joint bleeding. Recurrent episodes of haemorrhages, usually affecting large joints such as knees, elbows, or ankles, lead to joint remodelling and subsequent haemophilic arthropathy, which may require arthroplasty as a last therapeutic option. Orthopaedic patients have the highest risk among all for deep vein thrombosis (DVT) and venous thromboembolism (VTE) with morbid and potentially fatal consequences. While for the rest of the population thromboprophylaxis in orthopaedic surgery is efficient, relatively safe, and widely used, for patients with haemophilia who are considered to have a low thromboembolic risk, there is great controversy. The great heterogeneity of this particular population, and the lack of clinical trials, with only case reports or observational studies, makes thromboprophylaxis in major orthopaedic surgery a tool to be used by every clinician based on experience and case particularities. This review aims to briefly summarise the latest clinical data and to offer an insight into the current recommendations that readers would find useful in daily practice.

Floating-dislocated elbow in adults: Case reports and literature review

RATIONALE

Floating-dislocated elbow is a severe and extremely rare injury in adults. Reviewing the literature, we found around 6 case reports regarding floating-dislocated elbow in adults.

PATIENT CONCERNS AND DIAGNOSES

We report 2 cases of this unusual injury association. Both patients suffered a high energy trauma - fall from a height. Initial X-rays (radiography) revealed in both cases the fractures above and below the elbow (floating elbow) and associated elbow dislocation (floating-dislocated elbow). One case was a type IIIB Gustilo-Anderson open fracture-dislocation with an intra-articular component (olecranon fracture).

INTERVENTIONS AND OUTCOMES

Each case had his own management problem regarding what to treat first: the dislocation or the associated fractures? Fractures were treated surgically by reduction and internal fixation, and after elbow dislocation reduction, the upper limb was immobilized in a long, well-padded plaster, with the elbow in 90° of flexion, for 3 weeks. Bone union was observed radiographically at 2 months after surgery in both cases. At the 2-year follow-up we recorded full upper limb recovery in terms of muscular trophism and elbow full range of motion.

LESSONS

In addition to adding 2 new cases to a lower number of such lesion associations in adults, we also added a new variant of floating-dislocated elbow which has not been reported until now in the literature. Prompt management of these injuries, with stable fixation of the fractures allowed for early rehabilitation with excellent 2-years functional outcome.

COVID-19 vaccine acceptance among medical students in Romania

Vaccination against COVID-19 is a highly debated subject that brings confusion due to contradictory information coming from the scientific community and the media. Our aim was to focus on a homogeneous group of students in the healthcare field to assess their intention to vaccinate and the drivers behind this decision. A cross-sectional study was performed in the spring of 2021 in a Medical University in Romania. 725 of the undergraduates that completed an online questionnaire regarding their intention to vaccinate against COVID-19 were included in the study. Univariable analysis and logistic regression were performed on several variables to analyze factors affecting the willingness to vaccinate against COVID-19. In our study sample, 93.1% of students presented a strong intention to vaccinate, out of which the highest proportion belonged to subjects studying general medicine (96%). On logistic regression, we identified the following predictor factors: previous infection with coronavirus, prior vaccination refusal, VAX score, scientifically oriented sources of information and preference for RNA-based technology. Medical students have an increased willingness towards vaccination. Even for them, a highly educated and informed group of subjects, the general attitude towards vaccinations has a strong impact on the choice of COVID-19 vaccination.

Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis

Background and objectives: Fragility fractures of the pelvis (FFP) are of increasing interest lately, being associated with a loss of mobility and affecting the quality of life. The aim of our study was to investigate the effect of FFP on disability and pain in patients, after one year since injury. Materials and Methods: In the study, we included 76 patients diagnosed with FFP, who were admitted to our trauma department between January 2016 and January 2019, and were above 65 years of age. The Von Korff pain intensity and disability scores were calculated in the hospital at 6 months and after 1 year. Results: Fifty-four patients were female (71%), with an average age of 75.9 ± 7.19 years. Twenty-two patients were male (29%) and had a mean age of 77.22 ± 7.33 years. We did not record significant differences regarding age between the men and women (p > 0.05). Significant improvements appeared between the baseline and the 6 month follow-up; the average pain intensity score at 6 months was 44.94 (SD 21.20) (p < 0.001), and the disability score was 54.30 (SD 21.62). The following average pain intensity and disability scores after 12 months were similar to the values at6 months: 44.48 (SD 21.74) for pain intensity and 52.36 (SD 24.53) for disability. The Von Korff pain score at 6 months and after 1 year depends on gender and on the initial Von Korff pain score (p = 0.02). The Von Korff disability score at 6 months depends on gender, the baseline pain score and the baseline disability score (p = 0.001). Conclusions: our patients reported long-lasting pain that had a severe effect on their daily routines, and they could not return to their normal status prior to injury.

An original method of simulating the articular cartilage in the context of in vitro biomechanical studies investigating the proximal femur

Biomechanical testing is a necessity given the development of novel implants used in the osteosynthesis of hip fractures. The purpose of biomechanical testing is to recreate realistic conditions similar to the in vivo conditions. Although biomechanical testing of hip arthroplasty has been standardized since the 1970s, there is no consensus at present on testing methodology for osteosynthesis of hip fractures. Most biomechanical studies examining the fractures of the proximal femur in order to optimize implants opt for loading the bone-implant ensemble directly on the femoral head or using a metallic loading part. This loading technique fails to perform a mechanical stress distribution similar to in vivo conditions, which could alter the outcome. The present study aimed to design loading/unloading cups with mechanical properties that resemble those of the cartilage at the hip level. Through the impression and scanning of the cast models obtained, a digital 3D model was created in STL format and this was processed in order to obtain the computer numerical control (CNC) trajectories of the printing head. For prototyping using additive manufacturing technology, a thermoplastic polymer with biochemical properties, such as tensile strength, that resemble those of the adult hip and a Stratasys FORTUS 250 mc CNC machine were used. Loading/unloading cups with similar anatomy and biomechanical forces compared with those of the adult hip were created, which allowed the experimental simulation of the conditions during walking.

Biocompatibility assessment of biomaterials used in orthopedic devices: An overview (Review)

Biocompatibility is one of the mandatory requirements for the clinical use of biomaterials in orthopedics. It refers to the ability of a biomaterial to perform its function without eliciting toxic or injurious effects on biological systems but producing an appropriate host response in a specific case. Today, the biocompatibility concept includes not only bio-inertia, but also biofunctionality and biostability. High biocompatibility and functional properties are highly desirable for new biomaterials. The chemical, mechanical, structural properties of biomaterials, their interaction with biological environment or even the methodology of assessment can influence the biocompatibility. The biological evaluation of biomaterials includes a broad spectrum of in vitro and in vivo tests related to the cytocompatibility, genotoxicity, sensitization, irritation, acute and chronic toxicity, hemocompatibility, reproductive and developmental toxicitity, carcinogenicity, implantation and degradation as specified in different international standards. A brief review of the main assays used in the biocompatibility testing of orthopedic biomaterials is presented. In addition, their main biocompatibility issues are overviewed.

Clinical, histopathological and immunohistochemical features of glomus tumor of the nail bed

Purpose: Glomus tumors account for 1–4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers. Patients, Materials and Methods: We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed. Results: Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1/AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases. Conclusions: Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.

Utility of "reposition-flap" in the reconstruction of the avulsed thumb

Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to "sacrifice" another anatomical region for thumb reconstruction, the "reposition-flap" technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using "reposition-flap" with an O'Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

Omega plate for the treatment of acetabular fractures involving the quadrilateral plate

This retrospective study aimed to assess the outcome of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures. In total, 30 patients (mean age 50.3 years; 25 men and 5 women) with acetabular fractures were treated between January 1, 2018 and December 31, 2019. In all 30 cases, fracture reduction was performed through a modified Stoppa approach and fixed with the omega plate. In specific fracture patterns, additional approaches were needed (lateral window in 4 cases and posterior Kocher-Langenbeck approach in 7 cases). Patients were assessed for restoration of the hip joint congruency, complications, and overall fracture reduction. Quality of reduction was categorized based on Matta's radiological principles and to assess functional outcome the Merle d'Aubigné-Postel and Harris hip score was used. The average anesthesia time was 253.6 min, the mean intraoperative blood lost was 266.6 ml and the mean intraoperative fluoroscopy dose was 3.21 mGy. According to Matta criteria for reduction quality, anatomical reduction was recorded in 22 cases, imperfect reduction in 6 cases and 2 cases had poor reduction. The average follow-up was 22.5 months. Malunion, loss of reduction or implant loosening were not recorded. Late complications included one case of avascular necrosis of the femoral head and post-traumatic arthritis changes in 5 cases. At the final follow-up, a mean Merle d'Aubigné-Postel score of 13.26±4.46 and a mean Harris score of 86.03±13.37 were recorded. The possibility of an anatomically precontoured plate with subsequent lower operative time combined with stable fixation of the primary acetabular fracture fragments and the quadrilateral plate makes the omega plate a viable option for treating acetabular fractures with a very low complication rate and good to excellent results in 89% of the cases.

Daily oral administration of chlorogenic acid prevents the experimental carrageenan-induced oxidative stress

Inflammation and oxidative stress are interrelated processes, during which many pathological processes lead to the reactive oxygen species (ROS) and the cytokines release. The aim of this experimental study was to analyse the effects of chlorogenic acid, in oral daily administration, against the oxidative stress and oedema development in experimental carrageenan-induced rat paw inflammation. The oxidative stress parameters were investigated after a paw inflammation was produced in rats that previoulsy received, for 14 days, either chlorogenic acid (100 mg/day or 150 mg/day) or indomethacin (1 mg/kg/day). The paw oedema was measured through plethysmometry made at 2, 6 and 24 hours after carrageenan injection. The oxidative stress was investigated through spectrophotometry. Blood samples, paw skin and kidneys were collected to investigate malondialdehyde (MDA), glutathione (GSH) and oxidized glutathione (GSSG). The protein expression of oxidative stress-related pathways was analysed in skin and kidneys through Western blot. The present study showed that indomethacin and both doses of chlorogenic acid, after 14 days of oral administration, exerted antioedematous effects during the inflammation development after carrageenan local injection. Compared to the group that received only carrageenan injection, significant decreases of the inflamed paw volume were shown in the treated groups (P < 0.001), in all inflammation phases. The lipid peroxidation was significantly decreased by both doses of chlorogenic acid in inflamed skin (P < 0.0001) and kidney (P < 0.0001). In serum, it was significantly inhibited by indomethacin (P < 0.01) and by 100 mg/day of chlorogenic acid (P < 0.05). The antioxidant protection, evaluated through the ratio GSH/GSSG, was significantly increased by chlorogenic acid in inflamed skin (P < 0.0001) and kidney (100 mg/day, P < 0.01; 150 mg/day, P < 0.0001). In serum, only indomethacin administration produced significant increases of the antioxidant protection (P < 0.05). Western blot analysis showed significant decreases of COX-2 in inflamed skin and kidney in the groups of rats that received indomethacin or 100 mg/day of chlorogenic acid. The effects of chlorogenic acid on NF-κB and pNF-κB were dose-dependent.

Calcium and Vitamin D Involvement in the Fragility Fracture of the Pelvis

The fragility fracture is the widest spread of the bone diseases, in elderly. It particularly affects the vertebrae, the femur, the proximal humerus, the distal radius, the pelvis, thus preventing the patient�s free movement. The most debilitating of all these fractures is the fragility fracture of the pelvis. This type of fracture raises supplementary problems compared to the other fractures due to the difficulties of diagnosis, surgical approach and to the longer recovery period. Choosing the right treatment for FFP is difficult due to health and comorbidities in elderly patients. Both conservative and surgical therapy involve equally large risks: prolonged immobilization or surgical risks. Therefore, pharmacological therapy is an alternative to surgery. Bisphosphonates prove their utility in the fracture-healing outcome, but the influence of calcium and vitamin D were overlooked. The aim of our study was to evaluate the role of calcium and vitamin D in the healing process of patients with pelvic fragility fracture in osteoporotic patients with and without calcium and vitamin D supplementation. Our study shows that calcium and vitamin D exert a positive influence on the healing process of the fragility fractures and strongly emphasizes the need to educate patients to comply with the prescription to supplement calcium and vitamin D in order to improve fracture healing and prevent additional fractures.

Serum Homocysteine and Reactive Species Levels in Fragility Fractures of the Pelvis

Although there are studies showing the link between homocysteine and bone quality, the relationship remains controversial. The purpose of the study was to investigate homocysteine levels in patients with fragility fractures of the pelvis and their association with serum Total Antioxidant Status.The study included a group of 60 patients, aged ]65years, with pelvic fragility fractures and osteoporosis admitted in our trauma department between January 2015 and January 2018 and a control group of 30 patients, aged ]65years without fragility fractures or osteoporosis.The total antioxidant status (TAS) and homocysteine (Hcy) concentrations were determined in serum of all the patients. TAS levels had a significantly lower values in the group with pelvic fragility fractures compared with the control group (p[0.001).We noticed a significant higher mean of Hcy levels (p[0.001) in patients with pelvic fragility fractures compared with the control group. As conclusion this study shows that patients with fragility fractures of the pelvis have moderately elevated levels of homocysteine and reduced serum Total Antioxidant Status.

Bisphosphonates Influence and Pain Assessment in Mobilization of Patients with Fragility Fracture of the Pelvis

Fragility fractures of the pelvis have lately gained interest due to the increased incidence caused by aging populations. The aim of the study was to evaluate the results of the therapy in patients with pelvic fragility fracture admitted between January 2015 and September 2018 St. Spiridon Emergency Hospital in Iasi in order to improve the therapeutic approach. We assessed the correlation between pain and the early mobilization under the weight bearing condition in patients with and without osteoporotic therapy in history. The study emphasizes the role of pain in recovery process and underline the serious consequences of the late detection of bone fragility. Our study had revealed that previous osteoporotic treatment has benefits in the event of a fracture. As a result of this analysis, we consider that the age for the prophylactic measures in bone fragility should go below 60 years.

Number of Langerhans cells is decreased in premalignant keratosis and skin cancers

BACKGROUND

It was shown earlier that a number of CD207 positive Langerhans cells was lower in basal cell carcinomas than in the normal epidermis. Moreover, benign skin lesions presented a higher number of Langerhans cells when they were compared to malignant tumors.

AIM

To count Langerhans cells, assessing expression levels of CD1A and CD207 markers in actinic keratosis, basal and squamous cell carcinomas, compared with the normal skin. Comparison of Langerhans cells might give a valuable prognostic marker for skin cancer.

METHODS

Immunohistochemistry and methods of statistics were used.

RESULTS

Expression of CD1A and CD207 markers was assessed in tumor samples of actinic keratosis, cutaneous basal and squamous cell carcinomas, in comparison with the normal skin. In each cohort there were 40 patients (and 11 healthy individuals). We have shown that the number of Langerhans cells is considerably lower in cutaneous basal and squamous cell carcinomas, compared with their number in the normal skin (p < 0.0001).

CONCLUSIONS

CD1A expression correlated with CD207 expression only in the control group. There was no correlation in actinic keratosis, basal and squamous cell carcinoma. This may suggest an alteration of Langerhans cells phenotype in skin neoplastic diseases, making the number of Langerhans cells a valuable prognostic factor for skin tumors.

Why we use AT.Lisa multifocals?

In this paper, the authors try to motivate their preference for implanting AT.Lisa Multifocals from all other premium IOL's from the market. It is emphasized, through clinical examples, that their choice comes after a long experience with this type of mul- tifocals IOL's. We make a short presentation of this particular type of MIOL's with their good but also weak points and try to motivate our decision to change from other types. We present the steps that each patient has to follow in our clinic prior to surgery itself, stressing out the idea that the discussion with the patient is very important in taking a decision regarding the implantation of a Premium IOL.

[Pseudoexfoliative glaucoma]

Secondary open-angle glaucoma, characterized by the deposition of whitish, fibrillar material within the structures of the anterior segment of the eye.

Hepatic and systemic effects of rosuvastatin on an experimental model of bile duct ligation in rats

In the early stages of cholestasis, a plethora of mechanisms are considered to contribute to the liver injury: oxidative stress, inflammation, cholangiocytes proliferation and fibrosis. Our study aims to investigate the effects of different doses of rosuvastatin (Ro) on experimental bile duct ligation-induced cholestasis. 40 female Wistar rats were randomly divided into 4 groups (n=10): Sham group (laparotomy); BDL group (subjected to bile duct ligation); BDL group treated with Ro (5 mg/bw daily); BDL group treated with Ro (10 mg/bw daily). After 6 days of treatment, in the day 7 after BDL, the animals were sacrificed and we explored hepato-cytolysis, the seric parameters for cholestasis and oxidative stress in plasma, liver, brain and kidneys. Proliferation was investigated by expression of proliferating cell nuclear antigen (PCNA), while inflammation by liver histology, TNFR2 expression and NF-κB induction and activation. To assess fibrosis, we performed Tricrom-Masson staining, transforming growth factor beta-1 (TGF-β1) expression, and for myofibroblast activation, we analyzed α-SMA expression. The administration of Ro in early stages of cholestasis proved to have a beneficial effect by decreasing α-SMA. Ro didn't exert systemic oxidative stress effects, but increased hepatocytolysis, oxidative stress and inflammation in the liver and sustained increased levels of pro-fibrotic cytokine TGF-β1 as well as the number of proliferating cells in ducts and parenchyma. Ro inhibited the induction and the activation of NF-κB, which could be considered a beneficial effect. Further studies must be carried out in order to clearly investigate the balance between risks and benefits for Ro administration in early stages of cholestasis.

Non-invasive oxidative stress markers for liver fibrosis development in the evolution of toxic hepatitis

Oxidative stress is related to the liver fibrosis, anticipating the hepatic stellate cells' (HSC) activation. Our aim was to correlate oxidative stress markers with the histological liver alterations in order to identify predictive, noninvasive parameters of fibrosis progression in the evolution of toxic hepatitis.CCl4 in sunflower oil was administered to rats intragastrically, twice a week. After 2, 3, 4 and 8 weeks of treatment, plasma levels of malondialdehyde (MDA), protein carbonyls (PC), hydrogen donor capacity (HD), sulfhydryl groups (SH), and glutathione (GSH) were measured and histological examination of the liver slides was performed. Dynamics of histological disorders was assessed by The Knodell score. Significant elevation of inflammation grade was obtained after the second week of the experiment only (p=0.001), while fibrosis started to become significant (p=0.001) after 1 month of CCl4 administration. Between plasma MDA and liver fibrosis development a good correlation was obtained (r=0.877, p=0.05). Correlation between PC dynamics and liver alterations was marginally significant for inflammation grade (r=0.756, p=0.138). HD evolution revealed a marginally inverse correlation with inflammation grade (r=-0.794, p=0.108). No correlations could be established for other parameters with either inflammation grade or fibrosis stage.Our study shows that MDA elevation offers the best prediction potential for fibrosis, while marginal prediction fiability could be attributed to high levels of plasma PC and low levels of HD.

Chemopreventive effects of Calluna vulgaris and Vitis vinifera extracts on UVB-induced skin damage in SKH-1 hairless mice

Solar ultraviolet radiation (UV) is a major cause of non-melanoma skin cancer in humans. Photochemoprevention with natural products represents a simple but very effective strategy in the management of cutaneous neoplasia. The study investigated the protective activity of Calluna vulgaris (Cv) and red grape seeds (Vitis vinifera L, Burgund Mare variety) (BM) extracts in vivo on UVB-induced deleterious effects in SKH-1 mice skin. Forty SKH-1 mice were randomly divided into 4 groups (n=10): control, UVB irradiated, Cv + UVB irradiated, BM+UVB irradiated. Both extracts were applied topically on the skin in a dose of 4 mg/40 μl/cm(2) before UVB exposure - single dose. The effects were evaluated in skin 24 hours after irradiation through the presence of cyclobutane pyrimidine dimers (CPDs) and sunburn cells, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 levels. The antioxidant activity of BM extract was higher than those of Cv extract as determined using stable free radical DPPH assay and ABTS test. One single dose of UVB generated formation of CPDs (p<0.0001) and sunburn cells (p<0.0002) and increased the cytokine levels in skin (p<0.0001). Twenty hours following irradiation BM extract inhibited UVB-induced sunburn cells (p<0.02) and CPDs formation (p<0.0001). Pretreatment with Cv and BM extracts resulted in significantly reduced levels of IL-6 and TNF-α compared with UVB alone (p<0.0001). Our results suggest that BM extracts might be a potential candidate in preventing the damages induced by UV in skin.

Oxidative photodamage induced by photodynamic therapy with methoxyphenyl porphyrin derivatives in tumour-bearing rats

The oxidative effects of photodynamic therapy with 5,10,15,20-tetrakis(4-methoxyphenyl) porphyrin (TMP) and Zn-5,10,15,20-tetrakis(4-methoxyphenyl) porphyrin (ZnTMP) were evaluated in Wistar rats subcutaneously inoculated with Walker 256 carcinoma. The animals were irradiated with red light (λ = 685 nm; D = 50 J/cm2; 15 min) 3 h after intra-peritoneal administration of 10 mg/kg body weight of porphyrins. The presence of free radicals in tumours after photodynamic therapy with TMP and ZnTMP revealed by chemiluminescence of luminol attained the highest level at 18 h after irradiation. Lipid peroxides measured as thiobarbituric-reactive substances and protein carbonyls, which are indices of oxidative effects produced on susceptible biomolecules, were significantly increased in tumour tissues of animals 24 h after photodynamic therapy. The levels of thiol groups and total antioxidant capacity in the tumours were decreased. The activities of antioxidant enzymes superoxide dismutase and glutathione peroxidase were also increased in tumour tissues after photodynamic therapy. Increased levels of plasma lipid peroxides as well as changes in the levels of erythrocyte antioxidant enzyme activities suggest possible systemic effects of photodynamic therapy with TMP and ZnTMP.

Photochemoprevention of cutaneous neoplasia through natural products

Non-melanoma skin cancers such as squamous cell carcinoma and basal cell carcinoma are the most common types of human tumors, representing 30% of the new cases of malignancies diagnosed each year. Ultraviolet radiation (UV) from the sun is a major cause of non-melanoma skin cancer in humans. The prevention and mainly the photochemoprevention with natural products represent a simple but very effective strategy in the management of cutaneous neoplasia. Here we review the progress in the research of new and existing agents developed to protect the skin exposed to UV. We also discuss the current state of knowledge on their photosuppression mechanism in humans as well as in animal models, and efficiency in cancer prevention.

Effects of PDT with 5-aminolevulinic acid and chitosan on Walker carcinosarcoma

Porphyrins and new chitosan hydrogels based composites with porphyrins are used as active cytotoxic antitumor agents in photodynamic therapy (PDT).

AIM

The present study evaluates the effects of photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) and 5-ALA associated with chitosan (CS) using Walker carcinosarcoma in rats as experimental model.

METHODS

The animals were irradiated with red light ( lambda = 685 nm, D = 50 J/cm(2), 15 min) 3 h after i.p. administration of 5-ALA (250 mg/kg b.w.) or a mixture of 5-ALA (250 mg/kg b.w.) and CS (1.5 mg/kg b.w.). The animals were sacrificed at 1, 3, 6, 24 h and 14 days after the treatment. The effects of PDT were investigated by morphological studies, monitoring the 5-ALA induced protoporphyrin IX (Pp IX) level in tumor tissue and serum, MMP 2 and 9 (gelatinases) activity in tumor and malondialdehyde level (MDA), marker of the lipoperoxidation process, in tumor and serum.

RESULTS

Zymography revealed an increased activity of MMP 2 in tumors from animals treated with 5-ALA PDT. PDT with 5-ALA induced a higher lipid peroxidation in tumor tissue compared with 5-ALA-CS. CS associated to 5 ALA PDT enhanced the accumulation of PS in tumors inducing earlier necrotic changes. In the same time CS reduced MMP 2 activity.

CONCLUSION

Our results suggest that MMPs activation and oxygen reactive species are involved in PDT effects.

Iodide excess exerts oxidative stress in some target tissues of the thyroid hormones

Environmental iodine deficiency continues to be a significant public health problem worldwide. On the other hand, iodide excess results principally from the use of iodine-containing medicinal preparations or radiographic contrast media. For this reason we intended to explore iodide excess impairment on prooxidant/antioxidant balance of the thyroid gland, hepatic tissue and in blood and the effect of selenium administration on oxidative stress markers under the same circumstances. Experiments were performed for 10 days with white, male, Wistar rats, as follows: group 1: control-normal iodine supply group; 2: high iodine diet, group; 3: high iodine diet and selenium; group 4: high iodine diet and Carbimasole. Oxidative stress markers such as lipid peroxides were determined in thyroid gland, hepatic tissue and in blood. Measuring H+ donor ability of the sera and catalase activity in thyroid gland and in hepatic tissue assessed antioxidant defense. Iodide excess had prooxidant effects, leading to an increased lipid peroxides level and catalase activity in target tissues and in blood and to a decreased H+ donor ability of the sera. Selenium supplementation had opposite effects. Present data allow us to conclude that the alterations due to iodide excess in thyroid gland, hepatic tissue and in blood are mediated through oxidative stress.

Biochemical researches in age related cataract

PURPOSE

To comparatively evaluate the biochemical profile in normal human lenses with capsule and in stages of age related opaque lenses without capsule.

MATERIALS AND METHODS

The study included 3 groups of lenses with transparent structure, mature and incipient cataract.

RESULTS

The results were for 25 biochemical investigations.

CONCLUSIONS

Multiple biochemical mechanisms contribute to the progressive loss of transparency of the lens.

[Toxic anterior segment syndrome]

The authors present two cases of TASS which occurred consequent upon anterior chamber administration of cefuroxime(Axetin). The ESCRS guidelines on prevention, investigation and management of postoperative endophthalmitis recommends intracameral injection of an antibiotic agent (cephalosporin) at the conclusion of surgery. In our group of patients TASS occurred. Elements of diagnosis and treatment in TASS are discussed. As a conclusion to our study we decided to discontinue cefuroxime administration.

A lymphoid conjunctival tumor--clinical aspects; therapeutical options

A female woman, 34 years old, having a history of 10 years of conjunctival allergy, came to our Clinic for a pale pink mass lesion, occupying both the upper and the lower fornices. The therapeutical and also investigational approach was to excise all suspected tissue and to biopsy to determine if benign or malignant (clinically indistinguishable). The conjunctival biopsy revealed a non-Hodgkin malignant conjunctival MALT lymphoma. A complete medical check-up performed by a hematologist-oncologist confirmed that the disease was localized. In this case, of ocular adnexal MALT lymphoma with localised disease, we took into account local treatment: external beam radiation therapy, topical use of chemotherapy agents and biologic therapy (subconjunctival injections with interferon-alpha). Systemic chemotherapy was avoided. Interesting results were obtained with

[Histological studies in cataract--effect of USIOL IOL's in posterior capsule of rabbits]

Cataract represents a degenerative process of lens structures with multifactor causes.

STUDY OBJECTIVES

are to present histopathological modificatios at different types of cataract and to demonstrate the USIOL lens effects at rabbit posterior capsule, after extracapsular surgery.

MATERIAL AND METHOD

It was performed a comparative histological study at different types of cataract. It was implanted PMMA and acrylic USIOL lens at 2 rabbits. Follow-up was for 3 months and after ECCE it was performed histopathological examination of posterior lens capsules.

RESULTS AND CONCLUSIONS

There are few histological observations which can suggests the cataract cause. USIOL implants are well tolerated and the posterior lens capsule modifications after IOL implantation are not important.

Survivin antiapoptotic gene expression as a prognostic factor in non-small cell lung cancer: in situ hybridization study

Survivin is an inhibitor of apoptosis that plays a significant role in cell cycle regulation and is important for survival prognosis in many neoplasms. Survivin expression was assessed by in situ hybridization (ISH) in 60 consecutive patients (54 males and 4 females) with NSCLC treated between 1993 and 1997. The examined patients had IIB and IIIA stage according to TNM system. In all cases the chemotherapy with cisplatin and etoposide (2 cycles) was administered prior the surgery; in patients responding to the therapy one more cycle was applied. Survivin gene overexpression was observed in 35 patients (58.3%). There was no correlation between survivin mRNA level and histological type of tumor, stage of cell differentiation, stage of disease according to TNM classification, performance status according to WHO and number of chemotherapy regimens administered (p > 0.05). However, the correlation between survivin gene expression and response to the chemotherapy was statistically significant (p = 0.04). Statistical analysis showed that median survival in patients with survivin gene overexpression was shorter (14.0 months) as compared to patients with no expression (60.0 months; p = 0.00002). In survival assessment by means of Kaplan-Meier test, 14.3% of five-year survival was achieved in the former group versus 60% in the latter (p = 0.00003). Univariate analysis (log-rank test) showed that significant independent prognostic factors in NSCLC included: stage of the disease according to TNM classification (p = 0.006), response to chemotherapy (p = 0.005) and pattern of survivin gene expression (p = 0.00003). Multivariate analysis utilizing Cox's model showed that for survival assessment the stage according to TNM, response to the chemotherapy and survivin expression estimated by means of ISH are of statistical significance (p=0.00001). The calculated predictive values showed that ISH technique was quite accurate in assessment of five-year survival. Our data show that survivin expression may be used as a prognostic factor and a target for therapy.

Assessment of prognostic significance of cytoplasmic survivin expression in advanced oesophageal cancer

Survivin is a member of the family of proteins, which inhibit apoptosis (inhibitor of apoptosis proteins - IAP). Expression of survivin was found in colorectal cancer, neuroblastoma, bladder cancer, non-small cell lung cancer, and breast cancer. There is some recent data indicating the correlation of poor prognosis and worse response to chemotherapy in patients with oesophageal squamous cell carcinoma (OSCC) expressing survivin. The aim of the present study was to assess survivin expression in cancerous tissue of patients with advanced OSCC and to test the potential correlation between survivin expression and clinicopathological data. Forty two patients (mean age 58.36+/-8.97 yrs), who were oesophagectomised due to squamous cell carcinoma of the thoracic oesophagus between 1998 and 2000, were retrospectively analysed. Cytoplasmic survivin expression, examined immunohistochemically, was found in 35 (83.33%) cases. No statistically significant correlation between survivin expression in the tumour and patients' gender, TNM stage, or vascular involvement was noted. The mean survival of patients with cytoplasmic survivin expression (17.81+/-5.51 months) was not statistically different to those with negative survivin staining (16+/-6.28 months) as assessed by Mantel-Cox test (p=0.49). Univariate regression analysis revealed UICC staging as the only predictor of survival in the analysed group (p<0.05). These results indicate that the cytoplasmic survivin expression does not seem to be the prognostic factor in advanced cases of OSCC.

Dry eye syndrome. Etiological and therapeutic aspects

"Dry eye syndrome" is a common disorder of the tear film that results from inadequate tear production, excessive tear evaporation or abnormality in mucin or lipid components of the tear film. A number of 53 patients suffering from dry eye syndrome were followed up for a period of 18 months. The study group was heterogeneous, including a lot of conditions accompanied by dry eye syndrome: Syogren's syndrome, lupus erythematous, ocular rosacea, patients with systemic treatments with antidepressants, betablockers, diuretics, oral contraceptives, glaucomatous patients with topical beta-blockers, postmenopausal women, aging people, computer users and long-term contact lens wearers. The therapeutical options were dictated by the severity of the syndrome: substitution therapy, treatment of the underlying eyelid diseases, modifying of the environmental conditions and treatment of the complications in the most severe cases. The new pathological approach is innovative and it may provide a real therapeutical measure for this condition: topical A Cyclosporine and androgen drops.

[Eosinophilic pleurisy (a study of 27 cases)]

After reviewing the specific literature mainly on cytokines role in eosinophilic pleural chemotaxis, the study on 27 cases of eosinophilic pleurisy is presented. Only 3 cases were malignant pleurisies. The ratio between blood and pleural fluid eosinophils has no semiologic significance. Tuberculosis and parasitoses have no special significance. Autonomous eosinophilic pleurisies are regarded as a distinct nosologic entity. Their prognosis is favourable. The glucocorticoids are the choice treatment.

Studies on bcl-2 protein in cultured lymphoid cells

Bcl-2 protein was analysed in cell cultures derived from non-Hodgkin lymphomas and chronic lymphocytic leukaemia patients. The presence of bcl-2 proto-oncogene protein product has been demonstrated on cytospin preparations utilising immunochemical methods. The correlation between the expression of the bcl-2 protein and the appearance of proliferation- or differentiation related figures was studied. The reported bcl-2 up regulation in malignant lymphoid cells was confirmed in haemo- and lymphopoietic progenitor cells as well as in TPA/PHA activated peripheral blood lymphocytes. In comparison to neoplastic cells lower intensity of bcl-2 positive staining in freshly isolated cells from non-leukaemic tissue was observed.

[Early results of the treatment of Hodgkin's disease in adults using the seven-drug cytostatic protocol]

65 adult patients with Hodgkin's disease were treated acc. to multidrug protocol proposed by I. Koza et al. including doxorubicin, vincristine, vinblastine, bleomycin, procarbazine, lomustine and prednisone. 4 drugs (3 cytostatics and prednisone) including cycles were given repeatedly every 4 weeks. In the group of first line therapy (39 persons) 61.5% CR and 23% PR was obtained i.e. 84.5% therapeutic responses. The protocol used as salvage therapy resulted in 30% CR and 23% PR. Undesirable gastrointestinal effects were observed less commonly than after ABVD and CVPP schemes but myelosuppressive effect was more often seen and required attenuation of cytostatic drugs doses in the further cycles of therapy. The considered protocol seems to be a valuable one approaching to -but not achieving- the results of MOPP and ABVD schemes: is better tolerated because of elimination of strong emetic cytostatics (chlormethine and decarbazine) but late toxicity could be evaluable only after several years.