Osteopontin - a biomarker of disease, but also of stage stratification of the functional myocardial contractile deficit by chronic ischaemic heart disease

The study analyses the significance of the plasmatic values of the OPN dosed to 91 people suffering from diastolic cardiac dysfunction with preserved ejection fraction, thus revealing significant growths of its level compared to the normal value. Despite being a clinical research, its conclusions are a breakthrough, differing from the results of other studies published in the relevant medical literature. We can make this assertion because this study analyses the clinical information given by the circulating values of the OPN, based on experimental models (animals), or on patients with congestive heart failure, which can be identified with the existence of a low systolic flow. The results of our study allow us to assert that the plasmatic values of this glycoprotein lead to its acceptance in the medical practice as a new biomarker that provides indicators regarding the stratification of risk with the patients suffering from heart failure of the diastolic dysfunction type, but whose systolic flow is preserved.

Using the galactomannan antigen assay in the diagnosis of invasive aspergillosis after hematopoietic stem cell transplantation

Invasive aspergillosis (IA) is the most common life-threatening infections after hematopoietic stem cell transplant (HSCT). The serum galactomannan (GM) is recognized as an indirect mycological criteria for an early diagnosis of IA. Starting January 2011, we implementing in Fundeni Clinical Institute, Bucharest, for the first time in Romania, the detection of GM antigen (Platelia Aspergillus EIA, Bio-Rad). In 2011, patients undergoing HSCT were screened with the galactomannan ELISA; we performed a retrospective chart review of 162 SCT patients who underwent galactomannan testing. Thirteen of the patients (8.02%) had at least one positive galactomannan ELISA, and four had multiple positive tests. When calculated in reference to a proved or probable diagnosis of aspergillosis, the galactomannan ELISA had a sensitivity of 0.857 and a specificity of 0.913. The positive predictive value was 0.46, and the negative predictive value was 0.993. The Platelia Aspergillus galactomannan antigenemia assay may assist physicians in making an early diagnosis of IA, in correlation with clinical and radiological criteria. The test has a high sensitivity and specificity and a very good negative predictive value. We found the screening of GM ELISA to be a highly specific diagnostic tool in detecting IA manifested in patients undergoing HSCT.

[Alternatives to allogenous blood transfusion]

Blood transfusion is usually meant to lower morbidity and mortality rates. Allogenous blood transfusion implies certain risks that can be avoided by autologous blood transfusions techniques including: preoperatory autologous blood donation, acute normovolemic hemodilution, intraoperatory and postoperatory blood salvage. Preoperatory blood donation and acute normovolemic hemodilution are used for planned interventions with an estimated blood loss higher than 20% of blood volume. These methods imply Erythropoietin and iron treatment. Intraoperatory and postoperatory blood salvage is performed by personnel trained in blood donation, handling and storage. Autologous blood transfusions are used for certain surgical procedures that commonly require transfusions: orthopedic surgery, radical prostatectomy, cardiovascular surgery, organ transplantation. An alternative to allogenous blood transfusion is the use of artificial oxygen transporters: human or animal hemoglobin solutions or pefluorocarbonate solutions. These solutions do not require cross reactions, do not carry diseases and are generally well tolerated and easily stored in the operating room, ambulance and other transport means. They have however a slight degree of toxicity.

[Retinopathy in severe acute pancreatitis]

Retina examination performed in patients with severe acute pancreatitis showed intra and peri-retinal hemorrhages. They were associated with cottonwool exsudates induced by micro-infarction of the retina and the optic nerve similary to the Purtscher retinopathy. This feature of the retina examination indicates a severe outcome due to the multiple organ failure syndromes. This condition mainly developed in young male patients between 36 and 56 years of age. In 2 patients with septic shock, acute hemorrhagic retinopathy was identified within the first 24 hours and the patients died after a few days, while for other 3 patients with septic shock the outcome was also death after a few weeks. For 9 patients with severe sepsis, examination of retina showed perivascular exudates and vascular occlusion subsequently leading to partial optic atrophy; examination of other 6 mild sepsis patients did not show any retinal abnormalities. Ophthalmoscopy performed within the first 24 hours for patients with severe acute pancreatitis is a predictor of disease evolution and outcome.

Complete blindness after optic neuropathy induced by short-term linezolid treatment in a patient suffering from muscle dystrophy

We present a case of severe optic neuropathy following linezolid treatment, which led to complete irreversible blindness, in a patient with progressive muscular dystrophy, treated with linezolid for 16 days for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Interruption of antibiotic therapy did not lead to remission of ocular symptoms. Administration of linezolid may lead to severe neuropathy even in the case of short-term treatment.

[Effects of sudden abdominal decompression on the cardio-pulmonary function]

The authors present certain observations on a female patient with large uterine fibroma, HTA and obesity who underwent a cardiac stop in the moment of excising fibroma out of the peritoneal cavity ; she was resuscitated but the cardiac stop repeated for two times and finally she survived. Four months later, total hysterectomy with bilateral adnexectomy was performed with no incidences. We discuss on the intraabdominal pressure increase effect (IAP) more than 10-15 mmHg determining an intraabdominal hypertension (IAH) with negative effects on the tissular and cell perfusions and producing an "abdominal compartment syndrome" (ACS). Intraabdominal hypertension has a significant consequence on the cardio-vascular system by reducing the cardiac pre-charge, cardiac contractility decrease, cardiac flow decrease and post-charge increase. All these changes reduce the heart ability to fit to sudden abdominal decompression and producing a vacuum into the abdominal vessels and stopping the heart by a more significant reducing of the pre-charge and cardiac flow.

[Intra-abdominal pressure on the functions of abdominal and thoracic organs]

A certain pressure exists within closed cavities such as the skull, the abdomen, the thorax, therefore allowing a good supplying to the organs inside. Variations of intraabdominal pressure (IAP) over 10 mmHg will cause an intraabdominal hypertension (IAH) altering both the tissue and cell blood pressure and having an impact on some organs, thus achieving the co-called "abdominal compartment syndrome" (ACS). Intraabdominal pressure increase can lead to some negative effects on both the intra- and extra-abdominal organs such as: cardiovascular, renal, respiratory and digestive systems. ACS is defined as a pathologic status originating from the intraabdominal pressure increase over 20-25 mmHg, values determining a perfusion pressure decrease within the abdominal organs (APP). IAP followed by IAH occurs in ileus, abdominal tumors, intraabdominal hemorrhage and in some morbid conditions: obesity, hepatic cirrhosis with ascites, pregnancy. Central nervous system is affected as an IAP increase will cause an intracranial pressure increase (ICI) with cell perfusion decrease; it occurred by means of the jugular vein compression and the central venous flow reducing. As a conclusion, IAP increase is associated by clinical manifestations with local and general effect finally producing organic failure, too.