ARS Medica Tomitana
vol. X - nr. 1 (36) january - march 2004

Limfoame maligne gastrointestinale - aspecte anatomoclinice, morfologice si imunohistochimice
Mariana Aschie, Mariana Deacu, Madalina Bosoteanu, Liliana Mocanu

REZUMAT. Limfoamele primitive gastro-intestinale formeaza o categorie de aproximativ 3% din totalitatea cazurilor de limfoame, reprezentând cea mai frecventa localizare a determinarilor extraganglionare. Originea lor se crede a fi in tesutul MALT submucos. Majoritatea sunt non-Hodgkin cu grad inalt de malignitate. Studiile aprofundate demonstreaza o asociere certa intre infectia cu Helicobacter pylori si limfoamele de tip MALT, infectie ce nu pare a se asocia cu alte localizari ale limfoamelor extraganglionare. Se prezinta ca tumori uni- sau multifocale (20% din cazuri) pe unul sau mai multe segmente ale tractului gastro-intestinal, frecvente la nivelul stomacului (in medie 53%); in 29% din cazuri intereseaza intestinul subtire, in 11% din cazuri colonul. Localizarile ileocecale sunt de 10-20%, fiind observate mai ales la copii. Localizarile apendiculare sunt rare, iar cele esofagiene sunt exceptionale.

Cercetari clinice si citologice cu fundamentare biochimica in cancerul ovarian
Natalia Rosoiu, Aneta Tomescu, Mariana Aschie, Adriana Ovezea, Irinel Verman, Marian Jecu

ABSTRACT. In the present paper we refer to an interdisciplinary research with correlation between biochemical data (biochemical parameters of the serum and ascitis fluid), nuclear medicine (tumor markers ACE, CA-125), cytologic (microscopic examination of ascitis fluid) and morphopathology (microscopic study of biopsy samples), to find out the significance of these investigations for the diagnosis, prognostic and efficient monitoring of the therapy. The study group was of 10 patients hospitalized in Gynecology Department of the Constanta County Hospital, diagnosed with ovary neoplasm, with surgical indication.. Biochemical investigations revealed the following results: Serum ALP activity was increased 2 times than reference values. Testing the transaminases activity and the AST/ALT ratio showed decreased values of the ratio orienting the diagnosis to a degree of liver disturbances possibly due to the presence of metastases. In 1 case GGT was increased to 159 IU/L and GGT/AST ratio was 8.83 as a sign for the intrahepatic cholestasis. Dosing the fibrinogen offered varied results, indicating an increase 2-3 times the normal values. Hemoglobin, ESR and glycemia did not offer information with diagnostic significance. Tumor markers ACE and CA-125 presented initial increased values; the decrease of the values after surgery allows a favorable prognosis. The dosing was repeated to monitor the appearance of relapse or metastases. Biochemical analysis of ascitis fluid revealed higher activity of acidic phosphatase than the serum activity. The parallel increase with serum alkaline phosphatase activity may suggest the presence of bone metastases. The cytological examination of the ascitis fluid offered suggestive data for neoplasm diagnosis. Monitoring all these parameters allows an early diagnosis, more accurate, adoption of a corresponding therapy and monitoring the patients’ evolution.

Particularitati de diagnostic in diabetul zaharat la copil si adolescent
Valeria Stroia, Cristina Mihai, Doina Catrinoiu

ABSTRACT. Alstrom Syndrome is a very rare, life-threatening, genetic disease that attacks in very early childhood with autosomal recessive transmission. An individual must carry two copies of the mutated gene (one from the mother and one from the father), in order to be affected with Alstrom Syndrome. Researches located the gene for alstrom Syndrome on chromosome 2. There are 255 cases identified at Jackson Laboratory, Maine, USA and 79 published in the literature. Clinical features of Alstrom Syndrome: nystagmus and photophobia in early infancy, progressive retinopathy leading to blindness, childhood obesity, sensorineural hearing loss, hyperinsulinemia and insulin resistance, diabetes mellitus type 2, heart failure in infancy or early adulthood, liver dysfunction, heart disease, normal intelligence with some reports of delay. The authors present 2 clinical cases of Alstrom Syndrome ; one of the patients was initially diagnosed as Laurence-Moon-Biedl-Bardet syndrome ; in the other-the insulin resistance was the main feature that led to the diagnosis.

Are fertilizarea in vitro efecte semnifictive hepatice? Studiu de preemtiune pentru urmarirea variatiei plasmatice a unor enzime hepatice
V. Tica, O.Teren, Irina Tica, A. A. Tica, P. Mares, C. Gouzes, S. Ripart-Neveu, C. Courtieux

ABSTRACT. In order to compute the provisional number of patients corresponding to a significant statistic variation of hepatic transaminases during In Vitro Fertilization (IVF), Lactic Dehidrogenase (LDH), Alcaline Phosphatase (AP) and g-Glutarat Trasferase (g GT) were determined in patients included in 23 IVF cycles (University of Montpellier-Nimes, France), the first day (D1) - before beginning treatment with Busereline, for ovarian suppression, D14 (before beginning hMG, for ovarian stimulation), D19, D24, the day before triggering the ovulation, the day of oocyte retrieval, 15 days after the embryo transfer, and after a month (in nonpregnant women). The statistical analysis (Medical Computing Departments of Constanta and Montpellier) calculated the necessary number of probes at 18-24 for AP (48 for a 5% difference from the control value), 15-41 for LDH (36 for a 5% difference from the control value) and 29-38 for g GT (46 for a 5% difference). Considered suppositions represent a correct estimate for sizing a future study group.

Reactii adverse ale tratamentului cu Remicade
Suta Maria, Draghici Catalina

REZUMAT. Remicade (Infliximab) este un anticorp monoclonal chimeric IgG1 care inhiba activitatea functionala a TNFα. Este indicat pacientilor cu forme moderate/severe de artrita reumatoida, in doze de 3mg/kg corp si celor cu boala Crohn forma moderata/severa sau cu fistule, in doze de 5mg/kg corp. Obiectiv: evidentierea reactiilor adverse pe un lot de 12 de pacienti care au urmat tratament cu remicade. A fost selectionat un lot de 12 de pacienti cu artrita reumatoida in tratament cu Metotrexat 7,5- 15 mg/zi, care a urmat tratament cu remicade timp de 1-3 ani; s-au urmarit reactiile adverse aparute dupa remicade, atât reactiile infuzionale cât si cele aparute ulterior in cursul tratamentului. Durata tratamentului a fost de 1 an la 29% din pacienti, 2 ani la 29% si 3 ani la 42%. Au fost semanalate reactii infuzionale acute (dispnee, transpiratii, reactii anafilactice) in 3 cazuri si tardive (rash) la alti 2 pacienti. O pacienta a intre-rupt la cerere tratamentul datorita reactiilor alergice aparute. Dintre reactiile frecvent intâlnite semnalam prezenta anticorpilor antinucleari - ANA (8 pacienti), fatigabilitatii (5 pacienti), infectiilor (2 pacienti). Cele rar intâlnite au fost reprezentate de sindromul de citoliza hepatica (7 pacienti), sindromul lupus-like (1 pacient), dureri cervicale (1 pacient), proteinurie (1 pacient) si hematurie (1 pacient). Tratamentul cu Remicade este in general bine tolerat. Reactiile adverse apar destul de rar, iar severitatea acestora este moderata, punerea in pericol a vietii fiind intâlnita exceptional, infectiile si reactiile anafilactice prezentând cel mai ridicat risc vital.

Colangiopancreatografia dinamica prin rezonanta magnetica dupa stimulare cu secretina
Carmen Ciufu, Cristina Farcas, Ileana Ion, Ninela Radulescu, Cecilia Adumitresi

REZUMAT. Obiectiv: sa se specifice daca stimularea secretiei pancreasului exocrin cu secretina imbunatateste vizualizarea ductelor pancreatice la efectuarea colangiopancreatografiei (MRCP) prin rezonanta magnetica (RM) la pacientii cu pancreatita cronica severa. La un numar de 7 pacienti cu date clinice si de laborator sugestive pentru pancreatita cronica, ce nu prezentau modificari ale ductelor excretoare la explorarea ultrasonografica (US) si computer tomografica (CT), s-a efectuat MRCP in primele 10 minute dupa administrarea secretinei. S-a masurat diametrul ductului pancreatic principal la nivelul portiunii cefalice, corporeale si caudale si s-a apreciat gradul de umplere duodenala inainte si dupa administrarea de secretina. S-a analizat si numarul de canale excretoare secundare evindentiate. La toti cei sapte pacienti s-a observat cresterea semnificativa in dimensiuni a canalului pancreatic principal la 3 minute dupa administrarea secretinei. La pacientii cu forme severe de pancreatita cronica s-a observat un grad redus de umplere duodenala. Ramurile secundare ale ductelor excretoare au fost evidentiate la 5 dintre pacienti. Administrarea secretinei imbunatateste vizualizarea ductelor excretoare pancreatice si ajuta la evaluarea rezervei exocrine.

Durerea abdominala recurenta la copil. Studiu clinico - etiologic
Valeria Stroia, Larisia Mihai, Ioana Cristina Alexe

ABSTRACT. Recurrent Abdominal Pain is one of the most frequent simptoms in children and adolescence determining medical presentation. Controversies about patterns, etiology, terapeutical options, evolution and prognosis focuses on the importance and difficulties of diagnosis in pediatric practice. The authors report a retrospective clinico-etiological study of children presenting recurrent abdominal pain, admitted in Pediatric Department during a 3 years period. Despite of normal clinical course and good prognosis,there is necessary complete investigation of any child presenting Recurrent Abdominal Pain, correct diagnosis and optimal treatment.

Evolutia incidentei ulcerelor chirurgicale in Clinica Chirurgie II a Spitalului Clinic Judetean de Urgenta Constanta
T. Iusuf, Cristina Cristache, F. Botea, R. Popescu, Raluca Pasare, Aylin Iusuf

REZUMAT. Lucrarea isi propune evidentierea evolutiei incidentei ulcerelor chirurgicale in epoca tratamentelor complexe in care s-au impus blocantii rece ptorilor H2, inhibitorii specifici ai pompei gastrice de protoni ori protectorii mucoasei gastrice. S-au studiat comparativ doua perioade de câte 5 ani, 1991-1995 si 1999-2003, inregistrându-se toate cazurile de interventii chirurgicale pentru ulcer gastric sau duodenal efectuate in Clinica Chirurgie II a Spitalului Clinic Judetean de Urgenta Constanta in aceste intervale.

Artele si medicina - Honoré Daumier
Petru Bordei

REZUMAT. Medicul si arta medicala au constituit dintotdeauna subiecte de inspiratie pentru artisti, prin pictura fiind redate atât aspecte laudative, cât si aspecte critice, satirice, uneori exagerate, dar si de multe ori mai mult sau mai putin reale. Putini sunt pictorii care in opera lor sa nu aiba referire si la lumea atât de complexa, cea a medicinii. Printre artistii care au avut in obiectiv “slujitorii lui Esculap” a fost si pictorul francez Honoré Daumier (1808-1879). Reprezentant al picturii realiste, Daumier foloseste in special litografia pentru a ironiza toate defectele timpului sau, aratându-si in acelasi timp dragostea fata de cei umili. Dupa votarea in Franta (1835) a legii care interzicea satira politica, el se ocupa de satira sociala.

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Constanta

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Ovidius University
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