Embryological, clinical and anatomopathological considerations on a very rare case of a bicephalous fetus (dicephalus dipus dibrachius)

In this paper, we present the very rare case of a 21 weeks pregnant woman, examined clinically and by ultrasound. We could observe the present of two heads and a common trunk and therefore we proceeded to the small caesarian of necessity. We examined the fetus from the clinical and pathological point of view and we could observe a rare case of pregnancy with a bicephalous malformed fetus. During the autopsy, we could reveal the common elements and the devised ones, which are described as it follows. The case is a very rare one and that probably explains the fact that until the 21 weeks examination, even if she was clinically and ultrasound examined there was the appreciation that it was a twin pregnancy with a normal evolution. In this case, it is necessary to underline that the difficulties concerning the diagnosis and the medical behavior are also because the patient was a primipara 34-year-old woman without any pathological or specific family history. This case analysis shows the necessity of a preconception genetic advice together with the extension of the analysis of the genetic risk in all mothers under 35-year-old, mandatory and supported by the medical system. At the same time, an ultrasound examination of great performance proves to be necessary in order not to prolong the development of a pathological pregnancy.

Arbuscular mycorrhizal fungi in terms of symbiosis-parasitism continuum

Arbuscular mycorrhizal fungi are forming the most wide-spread mycorrhizal relationships on Earth. Mycorrhiza contributes to phosphorous acquisition, water absorption and resistance to diseases. The fungus promotes the absorption of nutrients and water from soil, meanwhile the host plant offers photosynthetic assimilates in exchange, like carbohydrates, as energy source. The plant benefits from the contribution of symbiotic partner only when nutrients are in low concentrations in soil and the root system would not be able to absorb sufficiently the minerals. When the help of mycorrhizal fungi is not necessarily needed, the host plant is making an economy of energy, suppressing the development of fungi in the internal radicular space. In this moment, the nature of relationship turns from symbiotic to parasitic, triggering a series of defensive reactions from the plant. Also, there were several cases reported when the presence of arbuscular mycorrhizal fungi negatively influenced the host plant. For example, in adverse environmental conditions, like very high temperatures, instead of determining a higher plant biomass and flowering, the mycorrhiza reduces the growth of the host plant. We conducted a pot experiment with hydroponic culture to examine the effect of arbuscular mycorrhiza on development of French marigold as a host plant. As experimental variants, the phosphorous content in nutrient medium and temperature varied. Plants were artificially infected with arbuscular mycorrhizal fungi using a commercial inoculum containing three fungal species, as following: Glomus intraradices, Glomus etunicatum and Glomus claroideum. Colonization intensity and arbuscular richness were checked using root staining with aniline blue and estimation with the Trouvelot method. To observe the differences between plants from the experimental variants, we examined the number of side shoots, flower buds and fully developed flowers, fresh biomass and total leaf area. Results show that adverse climatic conditions, like temperature shock at the beginning of growing period modified the nature of symbiosis. In this case, the physiological parameters were reduced at colonized plants, while usual, constant growing conditions permitted the normal, efficient and beneficial development of symbiosis.

Sonoelastography of breast lesions: a prospective study of 215 cases with histopathological correlation

BACKGROUND

Elastography is an imaging technique, which displays the hardness of soft tissue, by showing the behavior of tissue when subjected to mechanical stress. The purpose of this study was to assess the role of ultrasound elastography in differential diagnosis of breast lesions.

MATERIALS AND METHODS

A prospective study was conducted in our Research Centre, University of Medicine and Pharmacy of Craiova. We introduced in this prospective study 215 patients diagnosed with breast lesions between January 2009 and January 2011. The patients were examined in the supine position and a ductal exploration was made over the breast. The final diagnose was cytology (FNA - fine needle aspiration), histology after excision or follow-up for six months. For obtaining the elastography images, we used a EUS Hitachi EUB 8500 and Siemens ultrasound systems with elastography modules incorporated. For assessment of ultrasound elastography role in differential diagnosis of breast lesions, we performed ROC analysis.

RESULTS

The elasticity score for benign lesions was on average 1.95±1.1, and for malignant lesions was 4.21±0.9. The mean diameter of malignant lesions was 27.3 mm, which was higher than the average diameter of benign lesions (19.9 mm). The most common histology of the benign nodules was fibroadenomas, cysts, and fibrocystic change. Of the malignant nodules, the most common lesion was infiltrative ductal carcinoma. We obtained a sensitivity of 85.3%, and a specificity of 90% (area under the ROC curve=0.908, 95%CI=0.856-0.945 and p=0.0001) when a cut-off point of 3 was used.

CONCLUSIONS

Elastography is a method which can complement conventional ultrasound by improving the diagnostic performance. The introduction of ductal ultrasound combined with elastography increased the sensitivity and specificity, the radial technique allowing the precise localization of lesions regarding the breast gland.

Primary varices pathogenesis. The appealing unitary model

Primary varices pathogenesis is still unclear about the trigger event and the disease progression. Throughout time, a lot of hypotheses were created, each with a certain degree of veracity, to explain the aforementioned dilemmas. Present day investigation technologies allowed the undeniable progress in deciphering venous mechanics and biochemistry. Objectifying venous hemodynamic and valvular-parietal changes, their dynamic progression as well, lead to important clarifications in primary varicose disease physiopathogenesis. The importance of establishing a complete, unitary pathogenic model implies the practical possibility of immediately applying the right therapy addressing the pathogenic mechanism of this disease (i.e. correcting the "pressure escape" gateway) correlated with the progression stage (reflux degree) and the type of primary varices (gravitational, non-gravitational, or "suspended" varices). Initially, our study produces a critical evaluation of the classic pathogenic hypotheses and, later on, based on our long time experience in this field, it presents a complete and unitary, evolutive and pathogenic model in primary varices. The proposed model details a pathogenesis and a progression far more nuanced in primary varices, based on solid evidence, having obvious therapeutic implications and predictable results.

The valvular segment of the lower limbs venous system: anatomical, physiological and physiopathological aspects

The valvular segment is a distinct venous structure, which, from a morphological point of view, is comprised of the following components: the valvular insertion, the valvular gorge entrance orifice, the valvular defile, the valvular gorge exit orifice, the valvular sinus. Endoscopic and echo Doppler examinations are used to identify the normal and the pathological morphology of the valvular segment, and the hemodynamic phenomena occurring at this level. Cusps' integrity and size as well as valvular dynamics are key elements directly involved in shaping the valvular segment in general, and the valvular sinus in particular. The valvular sinus shows an obvious hemodynamic determinism. Valvular segment pathology is the outcome either of a progressively long evolving process initialized by gravitational venous pressure overcharges, or of a rapidly evolving process such as the hemodynamic shock following intense physical efforts. Valvular defunctionalisation implies a different mechanism and a different type of cusp lesion.

Changes in chlorophyll fluorescence parameters and oxidative stress responses of bush bean genotypes for selecting contrasting acclimation strategies under water stress

Drought resistance of bean landraces was compared in order to select genotypes with either high morphological or high biochemical-physiological plasticity. The lines in the former group exhibited fast reduction in fresh and dry mass, decreased the water potential in primary leaves after irrigation withdrawal and the biomass mobilized from the senescent primary leaves was allocated into the roots. These genotypes had high frequency of primary leaf abscission under water stress. The genotypes with plasticity at the biochemical level maintained high water potential and photochemical efficiency, i.e. effective quantum yield, high photochemical (qP) and low non-photochemical (NPQ) quenching in primary leaves under drought stress. While superoxide dismutase activity was not influenced by the drought and the genotype, catalase activity increased significantly in the primary leaves of the genotypes with efficient biochemical adaptation. Lines with high morphological plasticity exhibited higher quaiacol peroxidase activity under drought. Proline may accumulate in both cases, thus it may be a symptom of protein degradation or a successful osmotic adaptation. On the basis of contrasting responses, the genetic material cannot be screened for a large-scale breeding program by a single physiological parameter but by a set of the methods presented in this work.

[Dextrocardia of post right pneumonectomy]

The negative pressure achieved in the hemi thorax in the case of lung pneumonectomy has consequences on the mediastinum organ statics. This condition results through the other lung expansion. These changes are common, but rare in adult lung pneumonectomy. In the case of right lung pneumonectomy, the mediastinum moves to the operated part and disturbs the function of the vessels and cavities with thin wall or low pressure (vena cava, right atrium). These aspects are not observed in the case of left lung pneumonectomy. Taking this into consideration the authors present the case of a young woman with right lung pneumonectomy, an intervention made in childhood, at ten years old. After sixteen years of evolution a serious mediastinum re-shuffle was discovered, the heart was moved in the right hemi thorax, with a dextrocardia like aspect. This case is interesting because it raises positive and differential diagnosis problems--dextrocardia, associated disorders, serious complications.

[Color Doppler ultrasonography of the orbit in the treatment and evolution of the open angle glaucoma with normalized pressure]

The purpose of the paper consists to evaluate the vascular component that it takes part to ethiopatogenie of certain forms of primary open angle glaucomas, as well as to suggest a specific treatment.

MATERIAL AND METHOD

14 patients (28 eyes) with primary open angle glaucomas with average of 64 years were investigated by Color Doppler Imaging. All patients present deteriorations papilo-perimetric or/and visual acuity, in spite of normalized pressure by medical or surgical treatment.

RESULTS

The calculus of the velocimetric indices allowed us to measure the vascular resistance index that is increased at 6 patients in ophthalmic circulation, 4 patients in central retinal artery and 2 patients in whole shaft carotid-ophthalmic. We are found a correlation between papilo-perimetric deteriorations and the value of the vascular resistance index, too. Giving vasodilatative drugs that grow the ocular blood flow by improving the microcirculation at the level of the optic nerve's head, such as calcium channel blockers, could benefit effects for this type of patients.

CONCLUSIONS

Orbitar Color Doppler Imaging allows to evaluate the vascular lesions that have a negative influence in the evolution of primary open angle glaucomas, and, therefore, suggesting a specific treatment.