Ventricular-arterial coupling assessed by PWV/GLS ratio in hypertensive patients

OBJECTIVE

The physiological interaction between the left ventricle (LV) and the arterial system, defined as ventricular-arterial coupling (VAC), facilitates the optimal volume of cardiac work and cardiovascular performance. The aim of this study was to evaluate the benefit of PWV/GLS ratio associated with other vascular and cardiac performance parameters in hypertensive patients compared to age-matched healthy controls.

PATIENTS AND METHODS

We calculated the ratio of pulse wave velocity (PWV), as a marker of arterial stiffness, to global longitudinal strain (GLS), as a marker of left ventricular function in 135 patients divided in 3 groups, as follows: group 1 (HT + CAD) enrolled 54 hypertensive patients with coronary artery disease, group 2 (HT) enrolled 43 hypertensive patients and group 3 (CON) represented the control group consisting of 38 age-matched healthy subjects.

RESULTS

GLS values were significantly reduced in HT+CAD (-17.50±7.2) vs. HT (-17.95±5.3) vs. control (-20.13±4.6) (p-value <0.001). PWV values were higher in HT+CAD (9.90±3.1) and HT (9.70±2.5) vs. control (7.85±3.2) (p-value <0.001). VA coupling measured by the PWV/GLS ratio showed significantly lower values in HT+CAD and HT vs. control (p-value <0.001). The ROC curve identified a threshold of -0.054 of the PWV/GLS ratio to detect altered ventricular-arterial coupling AUROC = 0.836, 95% CI [0.762; 0.909].

CONCLUSIONS

This study demonstrated that assessment of the PWV/GLS ratio represents a useful tool to detect altered ventricular-arterial coupling in hypertensive patients. The perspectives of future use could include monitoring of earlier development of multiple organ damage in hypertensive patients and the efficacy of the different hypertensive medications. Extensive prospective studies are needed to confirm this hypothesis.

Meningioma in shape

Objective: The aim of this study was to evaluate the possible relationship between the appearance of tumour margins of atypical meningiomas and the risk of tumour recurrence, as well as progression-free survival. We also evaluated the correlations between the tumour margins and the neuroimaging characteristics (e.g. brain oedema and contrast enhancement) along with pathological features (e.g. brain invasion and mean value of Ki-67 LI). Material and methods: In our study, we included 81 patients diagnosed with atypical meningioma (grade II meningioma), who have undergone surgery at the "Prof. Dr N. Oblu" Emergency Clinical Hospital Iasi, between January 1, 2010, and December 31, 2019. We followed the MRI imaging characteristics (e.g. tumour margins patterns, contrast enhancement, oedema grading and tumour volume), but also the pathological characteristics such as brain invasion and the mean value of the Ki-67 labelling index. The assessment of tumour recurrence was made using MRI imaging (T1+ contrast), over a follow-up period of 5 years after the surgery. Results: In our study, we observed that 59.3% (n=48) of meningiomas had an irregular appearance. The irregular margins predominated in the male population (65.1%) and were statistically significantly correlated with brain oedema (p<0.001), contrast enhancement (p<0.01), anatomical location (p<0.014) and the mean value of the Ki-67 labelling index (p<0.01). The tumour margins were not correlated with brain invasion or volume of meningiomas. Conclusion: In our series of patients we found that the irregular margin was not a prognostic factor for tumour recurrence over a period of 5 years or for progression-free survival.

Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Introduction. Although in recent years there have been various versions of pancreatic - digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.

Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.

Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico - digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ductomucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).

Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.

Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

Pancreatico-Gastric Anastomosis with and without Sutures – Experimental Swine Model

Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches.

Methods. Our experimental model is based on ten piglets, which were divided into 2 groups. In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas.

Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group.

Conclusions. In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

Left bisegmentectomy for liver cirrhosis associated primary hepatic carcinoma with preoperative chemoembolization

Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.

Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable.

Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver.

Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.

Ileo-ceco-descendento-colic intussusception in adult - a case report

INTRODUCTION

Intestinal intussusception in adult represents a rare cause of intestinal obstruction, therefore the diagnostic and therapeutic methods must be adapted to each case.

MATERIALS AND METHODS

We present the case of a 30 year old female admitted in our service suffering from a subocclusive symptomatology. After preoperative tests were completed in another medical unit, we presumed the possibility of intestinal intussusception. The intraoperative exploration revealed the presence of a terminal ileum tumor (4x5x5 cm) with the invaginated segment progressed on ileo-ceco-transversodescendento-colic trajectory. After partial desinvagination, we performed right hemicolectomy with ileo-transverse end-to-endanastomosis.

RESULTS

The patient was discharged healthy on the 7th postoperative day. The histopathological findings revealed submucosal ileal lipoma.

CONCLUSIONS

Tumors of the terminal ileum, cecum or right colon could have an important role in the etiology of mechanical intestinal obstructions. These tumors can be a starting point for intestinal intussusception, which can advance to the left colon.

Retinoic acid receptor β2 (RARβ2): nonivasive biomarker for distinguishing malignant versus benign prostate lesions from bodily fluids

Alterations in the methylation patterns of promoter CpG islands have been associated with the transcriptional inhibition of genes in many human cancers, including prostate cancer (PCa).

OBJECTIVES

The aim of our study was to evaluate the diagnostic value of aberrant promoter hypermethylation of retinoic acid receptor β2 (RARβ2) gene in serum DNA samples from patients with the diagnosis of PCa and benign prostatic hyperplasia (BPH), as a new epigenetic biomarker in distinguishing between malignant and non-malignant lesions.

MATERIALS AND METHODS

Aberrant promoter hypermethylation was investigated in genomic DNA isolated from the serum of 91 patients diagnosed with of PCa and 94 with BPH (control subjects). In order to evaluate the methylation status of the RARβ2 gene we used the quantitative methylation-specific PCR (QMSP) method.

RESULTS

Promoter hypermethylation of RARβ2 gene was detected in serum samples from 89 of 91 (92.86%) patients with PCa, and in 10 of the 94 (10.7%) patients with BPH.

CONCLUSIONS

RARβ2 represents a promising molecular biomarker which may be used in discriminating between malignant and benign prostatic diseases by noninvasive methods.

Unusual consecutive sacral stress fractures in a female distant runner: a case report

Sacral stress fractures are rare overuse injuries predominantly perceived in female long-distance runners. Our case report describes left-sided sacral wing stress fracture followed by contralateral sacral wing fracture after return to running. A 21-year-old female amateur long-distance runner presented with nonspecific low back and left buttock pain. Plain radiograph at presentation was unremarkable. Magnetic resonance imaging (MRI) revealed extensive bone marrow oedema in the cranial part of the left sacral wing and oblique fracture line. After six weeks of moderate training and two months of tailored running program she felt sharp pain in her right buttock during landing on her right leg. MRI confirmed contralateral sacral wing stress fracture. Additional two-month program to correct lumbar hyperlordotic posture with relaxation techniques and stretching of quadratus lumborum, psoas, multifidus and rectus femoris muscles was carried out. Strengthening of the abovementioned muscles was also done together with abdominal wall muscles and gluteals to stabilize the lumbar spine. She regained full level of training six months after the second fracture. Two years after the second stress fracture of the sacral wing she is free of pain, running about 60 to 70 km per week. Despite rapid rehabilitation program after first sacral stress fracture, contralateral stress fracture occurred. After a few months of additional conditional training and strengthening of lumbar, abdominal and pelvic muscles she regains her long-distance running including four marathons without obstacles. From this case we can assume that following proper rehabilitation program with correction of hyperlordotic posture sacral stress fractures can be avoided.

Perinatal outcome associated with nuchal umbilical cord

INTRODUCTION

Nuchal umbilical cord (NUC) is a possible complication of pregnancy which can be associated with adverse perinatal outcome.

MATERIALS AND METHODS

A retrospective study was done at the County Emergency Hospital Timisoara, Romania, between January 2009 and December 2010 and included cases with NUC at the time of delivery. Outcome variable related to the mothers and newborns were studied.

RESULTS

The incidence of NUC in the studied period was 8%. Most were primiparous. There were no significant statistical differences between vaginal births and cesarean section with one minute Apgar scores higher than 8. Five percent of the studied group presented intrauterine fetal death.

CONCLUSIONS

The presence of NUC implies more attention but are not associated with increased rate of operative vaginal or cesarean delivery. One minute Apgar scores in these cases are comparable. NUC can be a cause of IUFD.

[Clinical and morphological features in a case of recent gastric carcinoma (the signet ring cell carcinoma type)]

The article presents the case of a male patient, hospitalized due to severe pain in the upper abdomen area, nausea, and vomiting. The patient was diagnosed with surgical acute abdomen, for which emergency surgery is performed. Upon penetration into the peritoneal cavity, stomach inspection shows at the medio-gastric level, on the greater curvature, a callous gastric ulcer, with a central perforation. A large excision is decided up to the healthy (normal) gastric tissue, and the resulting pieces are sent to the pathological anatomy laboratory. The histopathological exam reveals signet ring cell recent gastric carcinoma. The biopsy performed 1 month after surgery, prelevated from the antropyloric zone, reveals antropyloric gastritis with moderate activity and Helicobacter pylori positive. Due to the fact that such cases when this gastric cancer type is diagnosed in recent stages are extremely rare, we considered it useful to present it and look into its macroscopic and microscopic aspects, as well as into the differentiating diagnosis.

Three-dimensional reconstruction of statistically optimal unit cells of polydisperse particulate composites from microtomography

In this paper, we present a systematic approach for characterization and reconstruction of statistically optimal representative unit cells of polydisperse particulate composites. Microtomography is used to gather rich three-dimensional data of a packed glass bead system. First-, second-, and third-order probability functions are used to characterize the morphology of the material, and the parallel augmented simulated annealing algorithm is employed for reconstruction of the statistically equivalent medium. Both the fully resolved probability spectrum and the geometrically exact particle shapes are considered in this study, rendering the optimization problem multidimensional with a highly complex objective function. A ten-phase particulate composite composed of packed glass beads in a cylindrical specimen is investigated, and a unit cell is reconstructed on massively parallel computers. Further, rigorous error analysis of the statistical descriptors (probability functions) is presented and a detailed comparison between statistics of the voxel-derived pack and the representative cell is made.

A case of pathological rib fractures: focal osteolysis or osteoporosis?

This paper reports on a unique, previously unreported, successful outcome in the case of a patient with focal osteolytic lesions of the ribs as a first sign of osteoporosis. The lesions were detected by chance after acute cough-induced rib fractures were seen on plain chest radiographs. The diagnosis had to be approached as a diagnosis of exclusion since known causes of the osteolytic process had to be eliminated. The authors describe multiple focal osteolytic lesions with rib fractures appearing in a pattern that could be confused with metastases. Laboratory results were normal. Final diagnosis was based on plain radiography, bone scan and bone densitometry. Pharmacomedical treatments for osteoporosis were applied. The patient was observed between the year 2000 and 2005. Five years later radiological and bone scintigraphy revealed resolution of the lesion. We conclude that osteoporosis should be included in the differential diagnosis of asymptomatic focal osteolysis of the ribs with rib fractures as a complication of acute cough. The case suggests that focal osteolytic lesions of the ribs may regress over time and become scintigraphically inactive.

[Intestinal obstruction caused by abdominal pseudotumoral endometriosis mimicking a peritoneal carcinomatosis--case report]

A 40-year-old woman was admitted in emergency condition with the symptomatology of bowel obstruction. Intraoperative findings consists of a pelvic fixed tumoral mass, and numerous other tumors spread in the whole abdominal cavity mimicking a peritoneal carcinomatosis without liver metastases. Three of the tumors where about 4 cm in diameter producing stenosis of the terminal ileurn and sigma. We considered the case as it was a peritoneal carcinomatosis caused by an uterus or ovarian cancer and we decided for palliative surgery, performing ileo-transversostomy and sigmoidostomy above the obstruction. The histopathologic findings from more pieces of tumors revealed endometriosis without cancerous changes. Postoperative the patient underwent cytostatic and then hormonal therapy. After 3 month the CT scan revealed an important reducing in volume of the pelvic tumoral mass and the barium enema didn't showed any stenosis under the colostomy so, we closed it extraperitonealy. At 16 month after the first operation the patient was reoperated for a parietal defect. At the second look we found no tumors. The pelvic tumoral mass has disappeared, the uterus seemed to be normal but two big ovary cysts were present. We performed bilateral adnexectomy and the repair of the parietal defect. Postoperative evolution was favorable without any complication or complains at 3 month after the last operation.

Differential clinical and motor control function in a pair of monozygotic twins with Huntington's disease

We report a pair of monozygotic Huntington's disease (HD) twins who, although sharing identical CAG repeat lengths, not only present with marked differences in clinical symptoms but also behavioral abilities as measured by our experimental procedures. Both HD twins and two healthy control subjects were tested twice over 2 years. Patient A was generally more impaired at a motor level, whereas Patient B showed greater attentional impairment; Patient B, however, showed more progressive deterioration. The control subjects' performance remained consistent over the 2-year interval. Patient A clinically had the more hyperkinetic hypotonic variant of the disease, whereas Patient B, who was the more impaired, presented with a more hypokinetic hypertonic (rigid) variant. The influences of epigenetic pre- and postnatal environmental factors should not be ignored.

Elevated expression of eIF4E and FGF-2 isoforms during vascularization of breast carcinomas

The translation initiation factor eIF4E is a novel protooncogene found over expressed in most breast carcinomas (Kerekatte et al., 1995), but the pathology where this elevation is initially manifested and its possible role in cancer progression are unknown. We report that eIF4E is markedly increased in vascularized malignant ductules of invasive carcinomas, whereas necrotic and avascular ductal carcinomas in situ display significantly lower levels. eIF4E facilitates the synthesis of FGF-2, a powerful tumor angiogenic factor. Conversely, reducing eIF4E with antisense RNA in MDA-435 cells suppresses their tumorigenic and angiogenic properties, consistent with loss of FGF-2 synthesis. These findings suggest a causal role for eIF4E in tumor vascularization.

Fourier transform-Raman spectroscopy for the qualitative and quantitative characterization of sulfasalazine-containing polymeric microspheres

FT-Raman spectroscopy (FTRS) has been used to characterize microspheres produced from the pharmaceutical polymer Eudragit RS containing a range of concentrations of the drug sulfasalazine. While pure sulfasalazine produced an intense and complex Raman spectrum, the spectrum of drug-free Eudragit RS microspheres was considerably weaker in intensity and contained only a few prominent Raman scattering peaks. In spectra of the drug-polymer microspheres, peaks arising from the individual components could be identified. This enabled a quantitative analysis to be undertaken by calculating the ratio between the area of a sulfasalazine peak and the area of a Eudragit RS peak for each microsphere spectrum. A correlation was shown between the peak area ratio and the microsphere sulfasalazine content. FTRS was then applied to a series of microsphere samples which had been dissoluted into pH 7 buffer for 1, 3, 6, 9, 12, or 24 hr. For each spectrum, the drug-polymer peak area ratio was determined and this in turn enabled calculation of the residual drug content of the microsphere sample. FTRS-calculated data showed good agreement with microsphere drug content values determined spectrophotometrically.

Correlation of serum interferon with some clinical and humoral signs of systemic lupus erythematosus

The serum level of total interferon (IFN) was measured in 15 male patients with systemic lupus erythematosus (SLE) in the active phase and in remission, before and during corticotherapy. The values found were correlated with the clinical and humoral signs of disease. The IFN titer was high in the active phase of disease and was correlated with fever, extension of skin rash, polyarthritis, myositis, autoimmune hemolysis, cardiac and cerebral involvement as well as with ESR, reacting protein C, CIC, ANF and the percentage of LE cells. Isolated LE nephropathy without rapidly progressive or advanced renal failure was not associated with high IFN titer.

Pulmonary involvement in systemic lupus erythematosus

In the course of an ample study of collagen diseases carried out in the "N. Gh. Lupu" Institute of Internal Medicine--Bucharest over a long period, a group of 608 patients with systemic lupus erythematosus (SLE) hospitalized between 1974 and 1986 formed the object of the present study. Of these patients 18% presented pulmonary alterations due to SLE and 3.9% lung diseases of other etiology. The types of pulmonary involvement due to SLE were: pleurisy, interstitial pneumonia, diaphragmatic myopathy. Latent pulmonary damage could also be diagnosed in 8 patients. Most of the patients (94.1%) were females and had been hospitalized several times. Concomitantly with pulmonary damage other organ involvements have also been observed. Complex investigation of respiratory function performed in a selected group of patients revealed: restrictive syndrome, decrease of the gas transfer factor, increase of elastic recoil, hypoxemia on exercise. In most of the cases (92%) the pulmonary diseases had a chronic evolution. The treatment used was corticosteroids in 60% of the cases investigated.

Study of respiratory and immunologic changes in the workers of a poultry farm

The present investigation was designed to the study of respiratory symptoms and immunologic changes in workers of a poultry farm, chronically exposed to various organic allergens (avian, fungi, etc.). The group studied included 202 exposed subjects (109 at the slaughter house, 93 on the farms) and 100 controls. Although the group was chiefly made up of young women, non-smokers, exposure to avian allergens increased the prevalence of respiratory symptoms. Thus, coughing and expectoration was noted in 8.2% of the workers in the slaughter house and 10.7% of those on the farms, wheezing being present especially in the latter (13.9%). An apparently obstructive pulmonary function was observed in 16.10% of the farm hands and 1% of controls. The study of humoral immunity suggested that the presence of precipitation antibodies (76% positive reactions in the farms, 63% in the slaughter house, 44% among the controls) indicated exposure to avian allergens rather than the clinical and radiologic presence of the disease.

[Lumbrical plus syndrome]

A rare case of paradoxical extension of the medius finger - the so-called lumbrical plus finger syndrome-is described. At operation was found a fibrous adherence of the third lumbrical at the sheath of the flexor digitorum profundus. Some of pathological mechanisms are discussed. A satisfactory result was obtained after the resection of the tendon of the second lumbrical.