Giant, primary, hydatid cyst of the gluteal region

Background: Primary hydatid disease in the muscle is extremely rare, resulting in either the spread of cysts spontaneously or after operations for hydatidosis in distant regions. Methods: Report of an unusual case of primary hydatid cyst in the gluteus muscle, behaving as enlarging soft-tissue tumour, with a review of the literature. Results: Magnetic resonance imaging revealed an intramuscular cyst in the gluteus muscle; and no cyst existed in any other location. The cyst was excised totally, and the diagnosis of muscular cystic hydatidosis was confirmed by histopathologic examination. In follow-up of two years after the operation, there has been no recurrence in either patient. Conclusion: The involvement of the gluteus maximus muscle without the evidence of hepatic or pulmonary disease is rare, characterized by slow development, but a major local extension must be considered in the differential diagnosis of a cystic mass with well-defined margins in the extremities of individuals from endemic regions. Physical examination, serology results and radiological findings should be interpreted with care, especially in hydatid cyst endemic countries. Surgery is still the treatment of choice, with total cyst excision.

Important controversies in lumbar spine surgery: which patients benefit from lumbar spinal fusion and who should be fused?

Considering the rising tendency in the application of lumbar spine devices, a rigorous selection of candidates for lumbar spinal fusion must follow the benefit of the patient in terms of a better outcome than classical techniques or conservatory treatment. We pulled essential information from scientific sources regarding the clinical results of patients who underwent fusion surgery to sift patients who do better from fusion. We found out that imagistic proof of instability such as spondylolisthesis associated with lumbar spinal stenosis and refractory pain takes the most from spinal fusion procedures. Oswestry disability index improvement along with restoring the function and reduction of pain remained the postoperative desires of a successful fusion. Clinical amelioration with bracing test prior to intervention was a predictor of better results after fusion. Exclusion criteria like psychiatric disorders and prior lumbar spine surgery were highlighted since studies demonstrated that they are bad predictors of outcome in spinal fusion surgery. Laminectomy was nowhere implemented in the literature as to be urgently fused since only about 20% of patients manifest instability after this classical procedure. Iatrogenic segmental instability after laminectomy, radiologically proven should be a candidate for spinal fusion. These procedures have high costs and high rates of complications putting the patient’s functional status and quality of life at uncertainty since there is still a lot of debate in this area of spinal neurosurgery.

Active hydrocephalus with aqueduct stenosis to an old woman

Introduction: Aqueduct stenosis (AS) in old people is a rare pathological entity. I report a case of a 66 years old woman with severe ataxia, cognitive deterioration, loss of sphincters control (gatism). Clinical, neuro-radiologic and therapeutic considerations are discussed. Case presentation: A 66 years old woman with a 6 months history of mild cerebral trauma by car accident without losing consciousness, present 2 months before hospitalization severe ataxia, cognitive disorders, gatism. At the time of trauma, brain scanner performed in another institution showed minimal fronto-basal cerebral contusions and blood collection around the brain stem. One month after a new unenhanced brain scan all previous lesions are gone. At admission, an abnormal enlargement of lateral and third ventricles are remarked both on unenhanced CT and MRI scan of the brain explained by cerebral aqueductal stenosis. Ventricular open pressure was 350 mm H2O. A ventriculoperitoneal shunt with a variable pressure valve was installed. The surgery went uneventful and the patient recovered as expected. 6-month follow-up visit the patient was symptom-free, with a fine intellectual recovery.

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

A very rare, purely intradural, spinal, extramedullary cavernous hemangioma was fortunately discovered in a 56 years old woman, presenting with bilateral brachial paresthesia. Using conventional spin-echo T1 proton density, T2-weighted magnetic resonance and gadolinium images an intradural spinal T4-T5, an extramedullary cavernous hemangioma was discovered. The patient underwent surgery, with laminectomy and microsurgical resection followed by an uneventful postoperative clinical course. Similar as in cerebral locations a mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma, rendering a presumptive preoperative diagnosis of the lesion and surgical planning for a good microsurgical resection.

A very rare, petro-clival, neurothekeoma tumor. Case Report

Known as nerve sheath myxoma too, neurothekeoma are benign tumors, usually arise in the skin of the head, neck region and upper extremities, in young females. Cerebral neurothekeoma are very rare, a few cases were already described in the parasellar area, in the middle cranial and posterior fossa. We present a petro-clival neurotekoma. A 78-year-old male was admitted for two years left fronto-temporal headache completed in the last 6 months with left trigeminal V1 neuralgia, left facial hypoesthesia, diplopia, swallowing disorders for liquid foods, balance disorders. From his medical records we noticed: stage 2 chronic kidney disease, hypertension, prostate adenoma, dyslipidemia hypercholesterolemia. The MRI showed a macronodular petroclival mass in hiper T2, hipo T1, flair iso signal; normal cerebral angiography. The patient was operated on using a left retrosigmoid, retromastoidian approach. A 4/3/3 cm tumor, gray, encapsulated, soft consistency, partially cystic, less bleeding, attached to the dura, displacing the basilar artery and brain stem controlateral, encasing the trigeminal nerve. The tumor was totally removed with a good postop evolution. Six months follow up he had no more facial pain, but only persistant left facial hypoesthesia. Histologically the tumor had lobular appearance with spindle or stellate cells embedded in abundant myxoid background. The tumor cells were diffusely positive for S100, PGP9.5’, CD 34” positive in vessels, Ki67’positive in 5%. Cranial MRI performed one month after surgery did not show any residual tumor. Also known as nerve sheath myxomas, neurothekoma are rare benign tumors. For intracranial neurothekoma surgical indication is mandatory

Value of Endorectal MRI in Romanian Men for High Risk of Prostate Cancer: MRI Findings Compared with Saturation Biopsy

PURPOSE

To evaluate the potentials of T2 weighted (T2W)MRI and diffusion weighted (DW) MRI for prostate cancer(PCa) detection, local staging and treatment planning in high-risk group.

MATERIAL AND METHODS

Endorectal MRI was performed in 17 Romanian men (median age: 66 years; range: 58 75 years), prostate specific antigen (PSA) serum levels (median: 20 ng mL; range: 8.6 100 ng mL) with positive findings for PCa(median Gleason score: 8; range: 7 - 9). Imaging findings were compared to standarised 20-core transperineal saturation biopsy. The prostate was divided into 16 standart sectors(10 posterior and 6 anterior).

RESULTS

Overall, prostate cancer was detected in 16 patients(94%) on DW-MRI alone and in all 17 patients (100%) on T2W-MRI alone, and on combined imaging. On T2W-MRI165 sectors out of 272 were suspicious for PCa and 124 (75%)were cancer positive. On DW-MRI 126 sectors out of 272 were suspicious for PCa and 118 (95%) were cancer positive. On the combined imaging approach 134 sectors out of 272 were suspicious for PCa and 126 (94%) were cancer positive. This resulted in diagnostic accuracies per sector of 76% for T2WMRI, 86% for DW-MRI and 89% for combined imaging. Multifocal PCa was confirmed both on MR imaging and by biopsy in 8 of the 17 men (47%) Extra capsular extension(ECE) or seminal vesicles invasion (SVI) was highly suspected in 8 (47%) respectively 7 (41%) of the 17 patients. 6 patients(35%) presented both ECE and SVI. MRI findings were taken into account for treatment planning and none of these patients underwent radical prostatectomy and instead was treated with palliative cryotherapy, radiotherapy and hormone therapy.

CONCLUSIONS

Endorectal MRI is highly accurate in PCa detection in the high-risk group and seems to have an important role in local staging and treatment planning for Romanian population.

Case report. Gelastic seizures in a patient with right gyrus cinguli astrocytoma

OBJECTIVE AND IMPORTANCE

Gelastic seizure (GS) also known as "gelastic epilepsy" is a rare type of seizure associated with several different conditions such as tumors--hypothalamic hamartromas, tuberous sclerosis, hemangiomas, post infectious foci, cortical temporal dysplasia. We report one case of this rare condition generated by a right gyrus cinguli gr. II astrocytoma.

CLINICAL PRESENTATION

A 27 year-old male, right handed, was admitted for a 2 years history of very frequent gelastic seizures accompanied sometimes by simple motor partial seizures in both arms, more often being involved his left arm, without impairment of his consciousness state. His neurological examination was normal. Diagnosis was made on native CT scan: minimal hypodense frontal right paramedian lesion, cerebral MRI showed a small well delimited right, parenchymal, homogeneous lesion (16/22/15 mm), involving gyrus cinguli, without perilesional edema and mass effect, hyperintense both on T1 and T2 MR sequences, non-enhancing after Gadolinium. The cerebral lesion was also documented on EEG and video-EEG recordings. Using an interhemispheric microsurgical approach, above the corpus callosum and the right pericallosal artery, at the level of gyrus cinguli, a yellow-gray, infiltrative tumor, having a moderate vascularisation, has been identified and totally removed. The anatomopathological analysis revealed a grade II astrocytoma. The patient recovered very well, without deficits, no gelastic seizures or epileptic manifestations; three months after operation he is still free of seizures.

CONCLUSION

A case of gelastic seizures accompanied by simple motor partial seizures in both arms, without the impairment of his consciousness state induced by a grade II right gyrus cinguli astrocytoma is described and documented by radiological and electrophysiological studies. Using microsurgical resection, the tumor was totally removed, the patient clinical condition improved. Without an affective connotation as in temporal or hypothalamus topography, gelastic seizures are not patognomonic for hypothalamic hamartomas and in the case of frontal localization of the lesion; they can be associated with motor involvement of the limbs as in our case.

[Blood detoxification using superparamagnetic nanoparticles (magnetic hemodialysis)]

The authors present an experimental study realized in order to simulate blood detoxification with the help of supermagnetic nanoparticles. The particles used are red oxide nanoparticles which are considered to be equivalent from a magnetic susceptibility and dynamic diameter point of view to the complex structures of magnetite nanoparticles.

MATERIAL AND METHOD

Two types of custom HGMS matrices have been used--a threaded one and a micro-spheres one. For testing red oxide particles have been purposefully created to have a lower magnetic susceptibility than magnetite or iron-carbon particles used in other experimental studies. Different concentrations of iron oxide, glycerine and water have been prepared, creating a 3.5 cP viscosity (equivalent to the one of the blood); the concentrations of the prepared solutions varied between 0.16 mg/mL and 2 mg/mL, with the background magnetic field value ranging from 0.25 T to 0.9 T, in order to observer the effectiveness of filtering at different intensities.

RESULTS

The efficiency of HGMS filtering in experimental conditions was almost completely successful (99.99%) in all experimental conditions, both with the threaded and micro-spheres matrices.

CONCLUSIONS

The high gradient magnetic separation system of nanoparticles has maximum efficiency and has the potential of being implemented in a medical blood detoxification device.

Current data and strategy in glioblastoma multiforme

Glioblastoma multiforme (GBM) or astrocytoma grade IV on WHO classification is the most aggressive and the most frequent of all primary brain tumors. Glioblastoma is multiforme, resistant to therapeutic interventions illustrating the heterogeneity exhibited by this tumor in its every aspect, including clinical presentation, pathology, genetic signature. Current data and treatment strategy in GBM are presented focusing on basic science data and key clinical aspects like surgery, including personal experience; adjuvant modalities: radiotherapy, chemotherapy, but also for experimental approaches. Therapeutic attitude in recurrent GBM is also widely discussed.

Atypical ductal adenocarcinoma of the prostate with endometrioid immunohistological features

We present the case of a 52-year-old Caucasian male, admitted to our institution for a verumontanum adenocarcinoma, partially resected endoscopically, a month earlier at another urological clinic. The prior pathological examination wasn't able to give diagnosis. The extensive assessment by clinical workup, ultrasound, flexible cystoscopy, CT scan, and MRI revealed a prostatic tumor extending from the verumontanum to the left lobe and seminal vesicle. The patient underwent radical prostatectomy. The pathological examination revealed a ductal like adenocarcinoma, positive on immunohistochemistry for pan cytokeratin (AE1/AE3), CD10, endomysial antibody EMA and progesterone receptors (PR) and negative for prostate specific antibody (PSA), prostatic specific acid phosphatase (PSAP) and androgen receptors (AR). Ductal like adenocarcinoma of the prostate with endometrioid immunohistological features in the absence of prostate markers is an unusual condition.

[Role of retroperitoneal laparoscopic nephroureterectomy in the current treatment of upper urinary tract urothelial carcinoma]

INTRODUCTION

Nowadays, the standard treatment for upper tract transitional cell carcinoma is open nephroureterectomy, by double lumbar and iliac approach, with peri-meat bladder cuff excision. Since the first laparoscopic nephroureterectomy was performed, several surgical teams were interested by this approach for the treatment of the upper tract transitional cell carcinoma.

OBJECTIVE

To plead for retro-peritoneoscopic nephroureterectomy and to assess the surgical indications.

MATERIAL AND METHOD

Were analyzed the results of the recent published series on nephroureterectomy for upper urinary tract transitional cell carcinoma. Were included studies on conventional, laparoscopic and retro-peritoneoscopic nephroureterectomy, with at least 10 cases, published after 2000.

RESULTS

The advantages of retro-peritoneoscopic nephroureterectomy are: minimum blood loss, reduced analgesic intake, a shorter hospital stay and a faster return to previous activities, lower rate of intra- or postoperative complications compared with trans-peritoneal laparoscopy or conventional surgery. With a proper case selection the oncologic safety of the retro-peritoneoscopy is equivalent with open surgery.

CONCLUSIONS

On short term, retro-peritoneoscopic approach shows similar oncological outcome with other techniques. Retroperitoneal laparoscopic nephroureterectomy is a viable alternative to conventional or trans-peritoneoscopic procedure, with clear cut benefits for the patient. Retro-peritoneoscopy is associated with a low morbidity.

[Advantages of ilio-inguinal extraction of the kidney after retroperitoneoscopic nephroureterectomy]

INTRODUCTION

The manner to extract the specimen after retro-peritoneoscopic nephroureterectomy varies to different surgical teams. The aim of the surgeon is to extract the specimen with minimum parietal injuries, according with oncologic principles. The objective of our study was to evaluate the ilio-inguinal approach to extract the specimen after retro-peritoneoscopic nephroureterectomy.

MATERIAL AND METHOD

Evaluation and follow-up of 71 patients with retroperitoneoscopic nephroureterectomy for urothelial cancer (65 pelvic urothelial carcinoma and 6 urothelial carcinoma of the ureter). Ilio-inguinal incision was used for 68 patients to extract the specimen.

RESULTS

The operating time was 110 +/- 47 min. Blood lost 101 +/- 57 ml. Retroperitoneoscopic approach 10 +/- 4 min. Ilio-inguinal approach 25 +/- 10 min. The weight of the specimen was 601 +/- 127g. Tumor dimension was 5.9 +/- 1.9 cm. No conversion to open surgery was made. No late post surgery complications were registered ( follow-up at 2 and 6 months).

CONCLUSIONS

The enlarged nephroureterectomy can be performed using retroperitoneoscopic approach and the specimen can be extracted through an incision at iliac fossa. This approach can be used to extract large specimens preserving the esthetic laparoscopic benefit as well as the oncologic salty and reducing the risk of post-operative eventration.

Retro-peritoneoscopic assisted cryoablation for small renal tumors: the first cases treated in Romania

Nephron-sparing surgery (NSS), has been demonstrated to be a safe and effective alternative to radical nephrectomy for selected cases. Retro-peritoneoscopic cryoablation (RCA), combine the benefits of minimal invasiveness of the laparoscopy with the advantage of preserving renal function of the nephron sparing surgery. The aim of our study was to assess the initial results with RCA of small renal tumors. Since Jan 2007, twelve consecutive patients, with small renal tumors (mean tumor size 3.89 cm) underwent RCA at our institution. The patients were assessed using: clinical exam, lab exam, ultrasound, contrast enhanced CT scan. For cryoablation, we used the Galil Medical SeedNet with 17 Gauge cryoprobes, under combined retro-peritoneoscopic and ultrasound guidance. Protocol follow-up design includes clinical exam, lab exam and contrast enhanced CT scan at 3,6 and 12 months and annually thereafter. Mean surgical time was 145.42 min. and mean blood loss was 179.17 ml. Two patients presented: bleeding at the extraction of the cryoprobes and urinary fistula which healed with surgical treatment. Histological examination of the core biopsy revealed clear cell carcinoma in 8 patients, papillary carcinoma in 3 patients and angiomyolipoma in 1 patient. Cryosurgical ablation of small renal tumors using multiple ultrathin 17 Gauge cryoprobes is a feasible treatment option. Retro-peritoneoscopic approach allows optimal access to the kidney and endoscopic real-time ultrasound control of the freezing process.

[Prophylactic antibiotics in neurosurgery]

Because of a low risk of infection (around 2-3%), prophylactic use of antibiotics in neurosurgery is a controversial issue. Some neurosurgeons consider that there are strong arguments against the use of antimicrobials (promotion of antibiotic-resistant strains of bacteria, superinfection and adverse drug reactions) and meticulous aseptic techniques could be more usefully than prophylactic antibiotics. On the other hand, despite of being rare, the consequences of a neurosurgical infection can be dramatic and may result in a rapid death, caused by meningitis, cerebritis, abscess formation or sepsis. Clinical studies emphasized that the most important factors influencing the choice of antibiotic prophylaxis in neurosurgery is the patient's immune status, virulence of the pathogens and the type of surgery ("clean contaminated"--procedure that crosses the cranial sinuses, "clean non-implant"--procedure that does not cross the cranial sinuses, CSF shunt surgery, skull fracture). Prophylaxis has become the standard of care for contaminated and clean-contaminated surgery, also for surgery involving insertion of artificial devices. The antibiotic (first/second generation of cephalosporins or vancomycin in allergic patients) should recover only the cutaneous possibly contaminating flora (S. aureus, S. epidermidis) and should be administrated 30' before the surgical incision, intravenously in a single dose. Most studies pointed that identification of the risk factors for infections, correct asepsis and minimal prophylactic antibiotic regimen, help neurosurgeons to improve patient care and to decrease mortality without selecting resistant bacteria.

Technical difficulties in retro-peritoneoscopic radical nephrectomy. Is tumor location important?

Tumor location on the posterior aspect of the kidney or close to the renal hilum could increase the difficulty of the retro-peritoneoscopic radical nephrectomy. The aim of our study was to assess how tumor location influences the difficulty of the retro-peritoneoscopic radical nephrectomy.

PATIENTS AND METHOD

We performed a nonrandomized prospective study in 116 patients with localized renal cell carcinoma who underwent RRN, between Jan. 2000 and Jan. 2005. Twenty-nine patients with a tumor located close to the renal hilum or on the posterior aspect of the kidney (Gr.A) were compared with 87 patients with a tumor at a distance from the renal hilum (Gr.B) in terms of operative time, intraoperative blood loss, and difficulty of the dissection. The difficulty of the dissection was subjectively estimated by the main surgeon using a three degree scale (G1-easy, G2-medium, and G3-difficult). All the operations were finalized by retro-peritoneoscopy and G4-very difficult degree--was not recorded. In the Gr. A, the operative time was longer (117.28 min vs. 94.63 min, p < 0.001) and blood loss was higher (291.86 ml vs. 199.54 ml, p < 0.001). The dissection of the renal pedicle was also more difficult in the Gr. A either for artery dissection (G3 27.59% vs. 11.49%, p = 0.0202) or for vein dissection (G3 20.69% vs. 8.05%, p = 0.0321), while peri-fascial dissection was less frequently difficult (G3 10.34% vs. 28.74%, p = 0.0237). Tumor location close to the renal hilum or on the posterior aspect of the kidney increases the difficulty of renal pedicle dissection.

[Experimental modeling of the blood vessels magnetic embolization]

The embolization of blood vessels is used on a large scale: the method is applied in different diseases, in the ablation of organs, but especially in tumor necrosis. The embolization can be also magnetic, if the embolus is obtained through the deposit in the vessel of magnetic nano or microparticles in the presence of an external magnetic field. The objective of our study was the modeling of the magnetic embolization using amorphous magnetic microspheres that have strong magnetic properties and are biocompatible. Experimental tests were made in order to observe the building of the magnetic embolus inside a thin spiral tube and to determine the influence of some parameters on the efficiency of occlusions: the dimensions of magnetic microspheres (1-300 mm), the debit of the liquid (4.66 - 16.5 ml/min), the viscosity of the carrier liquid (1.007 - 7.34 cSt), the direction and the intensity of the external magnetic field (340 - 600 Gs), the shape of the tube and the linear length of the deposit (5 - 50 mm). Under pre-established experimental conditions the efficiencies of occlusions were between 67% and 100%.

[Preliminary pharmacological study on a "magnetic" drug complex]

Standard therapy requires high amounts of drugs, with subsequent risks of harmful effects on normal tissues. A treatment method that possible can avoid these risks is based on magnetic carriers (the method is designated also as magnetic carrier technique). The method consists in the selective attachment on a micro particle (permanent or reversible bonds), with strong magnetic moment, of an entity with no intrinsic magnetic properties (cells, microorganisms, antibody, antigens or chemicals), followed by external magnetic field targeting of the complexes ("active targeting"). The aims of this study were (1) to evaluate the acute toxicity of two original ferro-fluid (ammonium oleate and sodium oleate-based ferro-fluid) and (2) to assess the diclofenac (non-steroidal antiinflammatory drug, NSAIDS)--sodium oleate-based ferro-fluid efficiency in an acute inflammation model. We founded ammonium oleate-based ferro-fluid to have a strong dose-dependent toxicity, possible trough in vivo ammonium ions release; sodium oleate based-ferro-fluid seems to have a less toxicity. Diclofenac, diclofenac-ferro-fluid complex and ferro-fluid alone, each blocks the 6 hours inflammatory peak and the first two block also the 72 hours inflammatory peak. We conclude that the diclofenac-ferro-fluid complex is probably concentrated in the area of external magnetic field application, leading to a stronger effect of the antiinflammatory drug. Taking in consider our results we cannot exclude a possible summation of the individual effects of diclofenac, ferro-fluid, and external magnetic field on the inflammatory phenomenon.

[Functional characteristics of nucleotide-receptors in human neutrophils]

Nucleotides are important extracellular signaling molecules. It has been established that nucleotides are released from damaged cells, activated platelets and endothelial cells. Thus, at the site of vascular injury, the concentrations of extracellular nucleotides can become elevated. Nucleotides have been shown to cause mobilization of intracellular calcium, upregulation of Mac-1 (CD11b/CD18), degranulation, and chemotaxis in human neutrophils. The goal of this work is to investigate the functional characteristics of nucleotide-receptors in human neutrophils. Nucleotides (ATP and UTP), caused intracellular calcium mobilization in a dose dependent manner. Pharmacological characterization using selective agonists (ATP, UTP), pertussis toxin in human neutrophils and human astrocytoma cells 1321N1 stably expressing P2Y2 or P2Y4 receptors, revealed that human neutrophils express only functional P2Y2 receptors. Treatment of neutrophils with pertussis toxin causes a partial inhibition of nucleotide-induced calcium mobilization. Similarly, by using 1321N astrocytoma cells expressing the P2Y2 receptor we confirmed that calcium mobilization is only partially inhibited by pertussis toxin. The partial resistance of P2Y2-mediated intracellular calcium mobilization suggests that this receptor subtype is coupled not only to a Gi protein, but also to a protein belonging to the Gq-family (most likely G16). In conclusion, we have shown that human neutrophils express functional P2Y2 receptors and all the nucleotide responses are mediated by P2Y2 receptor subtype and that P2Y2 receptors are the functional able to trigger intracellular signaling event in human neutrophils through dual activation of different G proteins.

[Laparoscopic radical cystectomy with enteric urinary diversion. Alternative to open cystectomy?]

Radical cystectomy is the standard therapy for invasive bladder cancer, with best oncological results compared to any other therapeutic alternative. Even if laparoscopic radical cystectomy (LRC) is a well established surgical procedure, performing the urinary diversion completely intracorporeal, is still a challenge due to technical difficulties and associated complications. The aim of our study is to present the first series of LRC with ureterosigmoidostomy. Since May 2004 were performed 7 LRC (5 males and 2 females) (Gr. A). All cases were T2N0 clinical stage. These patients were compared with a retrospective group of 50 patients who underwent open procedure (Gr. B) in term of: operative time, blood loss, analgesic requirements, and hospital stay. LRC has a longer operative time but with statistically significant lower blood loss, less analgesia, and shorter hospital stay. The resection margins of the surgical specimens were tumor free at pathologic examination. Long-term follow-up is pending. On short-term, the results of laparoscopic radical cystectomy are encouraging. When significant experience in laparoscopic surgery is lacking, surgeons should exercise caution with completely intracorporeal urinary diversion.

[Consideration on high gradient magnetic separation of red cells]

The red cells exhibit a proper magnetism due to hemoglobin. In a prototype of high gradient magnetic separator equipped with an ordered ferromagnetic matrix, a set of experiments with blood to determine the influence of the process parameters on the efficiency of the erythrocytes capture was realized. Dependent on the values of the magnetic induction (1.76-2.01 T), average blood flow velocity through the matrix (0.55-1.1 mm/s), and stationary time in the matrix, different values of concentration for the red cells in the matrix were obtained. For tests realized with integral blood, the concentration was approximately 20%, while for tests with diluted blood the concentration fluctuated from 14.51% to 29.90%. A blood recirculation through the matrix led to a concentration of 37.86%. The magnetic separation method permits an acceptable red cells concentration, without apparent destructive effects on the cells.

Ten years of cyclosporine use in renal transplantation: a single-center experience with 479 renal transplants

INTRODUCTION

From 1983 to 1996 therapy with cyclosporine in association with low-dose azathioprine and prednisone has been used for transplantation immunosuppression. The aim of our study was to present 10 years experience with cyclosporine.

MATERIAL AND METHOD

Among 479 renal transplants performed since 1992, 61 were performed with cadaver donor grafts and 58 in pediatric recipients. From 1992 to 1998, the immunosuppressive protocol included CsA, azathioprine, and prednisone. Since 1998, mycophenolate mofetil (MMF) replaced azathioprine. In 2002, tacrolimus and rapamycin were introduced into our protocols. The patients were assessed in terms of serum creatinine, incidence of acute rejection, cyclosporine side effects, and graft and patient survivals.

RESULTS

Five-year patient and graft survivals were higher among recipients receiving CsA-MMF-prednisone when compared with CsA-azathioprine-prednisone. The incidence of acute rejection episodes during the first year after transplantation was less frequent among recipients receiving MMF compared to those treated with azathioprine. The overall 5-year survivals for patients was 86.29% and for grafts 74.04%.

CONCLUSION

Cyclosporine remains a useful immunosuppressive drug, which represents a major step toward efficient renal transplantation. The availability of multiple effective immunosuppressive agents allows individualized protocols to reduce toxic effects. The advent of new induction regimens offers more opportunities to prolong graft life.

Magnetizable needles and wires--modeling an efficient way to target magnetic microspheres in vivo

The in vivo targeting of tumors with magnetic microspheres is currently realized through the application of external non-uniform magnetic fields generated by rare-earth permanent magnets or electromagnets. Our theoretical work suggests a feasible procedure for local delivery of magnetic nano- and microparticles to a target area. In particular, thin magnetizable wires placed throughout or close to the target area and magnetized by a perpendicular external uniform background magnetic field are used to concentrate magnetic microspheres injected into the target organ's natural blood supply. The capture of the magnetic particles and the building of deposits thereof in the blood vessels of the target area were modeled under circumstances similar to the in vivo situation. This technique could be applied to magnetically targeted cancer therapy or magnetic embolization therapy with magnetic particles that contain anticancer agents, such as chemotherapeutic drugs or therapeutic radioisotopes.

[Preclinical assay on a magnetic carrier type ferrofluid]

The aim of the study was to determine the acute toxicity and the antimicrobial actions of an original magnetic carrier, type ferrofluid. The hydrophilic ferrofluid was prepared by covering the Fe3O4 nannoparticles with ammoniumoleate. The absolute amount of iron was of 40 mg/ml ferrofluid.

METHODS

Acute toxicity was evaluated on five groups of Swiss male mice, after a single intraperitoneal administration of 1, 0.75, 0.5, 0.25 and 0.125 ml dose of pure ferrofluid/100 g body weight (b.w.), using step-level toxicity method. The study groups of mice were follow-up for 10 days. We did not use the same volume of solution for all the study groups because we were concerned about not to modify the behavior of the ferrofluid (but for each group we used the same volume of solution). The tasks of this part of the study were: 1) the record of the mice death in the first 10 days after intraperitoneal administration of ferrofluid; 2) the behavior of the animal subjects; 3) the morphopathologic examination of kidney, lung, heart, liver and peritoneum samples from the death mice and from the after ten days survivors which were sacrificed. We also investigated the possible antibacterial actions of the ferrofluid on E. coli spp., Klebsiella spp., Staphylococcus aureus Streptococcus group D., in the second part of the study, using standard lab kit. The validation of the results was performed using controls for E. colli and Staphylococcus aureus.

RESULTS

The death of the mice was registered between 24 and finished after 96 hours. The maximum tolerated dose (MTD), was of 0.25 ml (10 mg iron/100 g b.w.) and the lethal dose hundred percent (LD100) was of 0.75 ml/(30 mg iron/100 b.w.). In our study we did not determined any kind of antibacterial action of the ferrofluid.

CONCLUSIONS

1) LD100, in our study, was of 30 mg iron/100 g b.w., and DMT of 10 mg iron/100 g b.w. 2) The death of the mice may be due to toxic aggression of ammonium ions released, in vivo, from the ammoniumoleate coverage of magnetite nannoparticles. 3) There were no in vitro antibacterial actions for this ferrofluid.

[Magnetic carrier method- an expectation for antitumoral therapy]

In order to enhance antineoplastic agents efficiency new therapy methods were developed one of which being magnetic targeted chemotherapy (MTC). MTC method consists in a permanent or reversible selective binding of highly magnetic particles (carriers) with drugs, antibodies et. al., followed by targeting or adhesion of these complexes to the tumor using an external magnetic field. At this early stage of targeting tumors with magnetic particles, there are reasons to be optimistic.

[Actual modalities of separation by magnetic methods of active biological compounds, cells and pathogenic agents]

The paper presents an overview on magnetic techniques of bio-processing and some of their possible applications. These techniques are in fact direct, or more frequently, indirect magnetic means for separation of particulate substances. A brief presentation of direct and of the most important indirect methods (magnetic carrier and magnetic fluids technologies) is made. There are shown some of the possible applications of magnetic bio-processing in bio-technology and medicine: active biological compounds fixation, isolation and modification, cells and cells organelles separation, removal of xenobiotics, immuno-magnetic testing, pathogen microbes identification.

[The use of high gradient magnetic separation (HGMS) in obtaining red blood cell mass]

This paper presents the "high gradient magnetic separation" (HGMS) and its use in red blood cells separation. A high gradient magnetic field system is described (set up from a filamentary iron-magnetic matrix), that is specially design for red blood cells capture. The configurations and the conditions that are needed for the red blood cells concentration process to allow the red blood cells mass to by obtained are evaluated. Finally, another possible technique of red blood cells concentration based on a type of continual magnetic separation is described.

[The outlook for human blood component separation and the treatment of cancerous tumors by magnetic methods]

This work presents in brief some expectations related to the solution of certain biomedical problems by using a non-conventional physical method: The high-gradient magnetic separation (HGMS). At first a short presentation of the HGMS method is given and then its application in separation of the human blood components is reported. The up to date intensely studied method with magnetic carriers is then described. Among other things, this method enables the cancer tumors treatment by intracavity radiotherapy, drug targeting, and diagnosis exploration.

[Functional dyspepsia in liver cirrhosis]

Many patients with liver cirrhosis have dyspeptic complaints. Peptic ulcer, gallstones and oesophagitis are the most common causes of dyspepsia. Functional dyspepsia is infrequently investigated in liver cirrhosis. Sixty-two patients with liver cirrhosis and dyspepsia were submitted to endoscopic and sonographic investigation. In 28 of them no organic finding was detected. These cases were considered as having functional dyspepsia. 36% were of dysmotility-like type, 28% were ulcer- and reflux-like, each, and 7% were of idiopathic type. Aerophagia could not be taken in consideration as functional dyspepsia, due to portal hypertension. In comparison with a group of 30 patients with functional dyspepsia without liver cirrhosis, functional dyspepsia in liver cirrhosis is more frequent in men than in women and occurs about a decade later. In 12 subjects the gastric emptying of a semifluid meal estimated by sonography was normal. Functional dyspepsia is a reality in liver cirrhosis. Gastric emptying seems not to have a major role in the etiopathogenesis of such complaints.