ARS Medica Tomitana
vol. XIII - nr. 1 (48) - january - march 2007

Isolation And Cultivation Of Human Mesenchymal Stem Cells
M. Gavrila, D. Ulmeanu, Mitran Valentina

ABSTRACT. Mesenchymal stem cells (MSC) are multipotent stem cells that can differentiate into a variety of cell types. We plated Histopaque-purified bone marrow monocytes directly into cell culture plates. Cells cultures were maintained at 37oC with water saturated atmosphere and 5% CO2. Medium was replaced one to two times every week. Approximately 3-4 week later, there were some colony that contained fibroblast-like cells. We examined these cells for morphology and compared them with data existing in literature. We suggest that these marrow derived cells are the mesenchymal stem cells described in literature.

Angiogenesis And Estrogen Receptor Status In Primary Breast Cancer Patients: An Analysis Of 158 Needle Core Biopsies
S. Vamesu

ABSTRACT. Angiogenesis, formation of new blood vessels from a preexisting vascular bed is a complex multistep process, which may also permit metastasis. Estrogens enhance growth and proliferation of certain target cells such as breast epithelial cells and estrogen dependent mammary carcinoma cells. To investigate how tumor angiogenesis correlates with estrogen receptor (ER) status in breast carcinoma diagnosed on core biopsy, microvessels were counted (and graded the density of microvessels) within the initial invasive carcinomas of 158 patients. Using light microscopy, the number of microvessels was counted manually in a subjectively selected hot spot (in the most active areas of neovascularization per 400x field), and their values were separated as above or below median (low and high), without knowledge of the outcome in the patient or any other pertinent variable. When the mean values of MVD of the various groups defined by ER status were compared, significant difference was noted (P = 2,39307E-05). When tumours were classified as high or low MVD, based on a cut-off value (30,70175 microvessels / mm2), cases with high MVD were significantly more numerous. MVD did show a relationship with groups defined by ER status (P = 0,000649). The correlation of angiogenesis with ER status may be a potential therapeutic target for the treatment and prevention of breast cancer, using antiangiogenic molecules.

Morphometric Assessment Of Epithelial Nuclei In Usual Fibrocystic Disease
Mariana Deacu, Mariana Aschie, Madalina Bosoteanu, Liliana Mocanu, D. Ulmeanu

ABSTRACT. The large majority of displastic and tumoral mammary lesions arise from epithelial organ component. Benign or malignant cells phenotype is concerned by nuclear appearance: size, shape, chromatics, nuclei number, chromatin aspect, mitosis type. Morphometric analysis could provide quantitative information about nuclear profile in several lesions. In this study we proposed to assess nuclear morphometric features of mammary epithelial cells in fibrocystic disease compared to normal mammary resting tissue. The different values of nuclear area among various publications may be due to factors related to individual variations and application of different morphometric methods. Our nuclear morphometric measurements of typical fibrocystic breast disease showed no statistically differences from normal resting mammary gland. In usual fibrocystic breast disease the results of hormonal imbalance consist primarily in stromal changes that induce cystic transformation of mammary ducts.

The Pediatric HIV/AIDS Pandemic: On the Cusp of Hope
M. W. Kline

ABSTRACT. To date, the world’s reaction to HIV/AIDS in Africa and the developing world largely has consisted of despair and a sense of hopelessness and inevitable devastation. Nevertheless, as HIV/AIDS care and treatment programs have been developed, and successes have been achieved, hope has returned. Today, we are for the first time on the cusp of an era in which huge numbers of HIV-infected children and families will gain access to health-restoring, life-prolonging treatment. Pediatric health professionals in the developed and developing worlds have the unique challenge and opportunity to change forever the way pediatric HIV/AIDS is perceived and managed globally.

Listeria Monocytogenes Infection In Pregnant Women
Irina Magdalena Dumitru, S. Rugina, Elena Gorun

ABSTRACT. Retrospective study on 280 women with abortive disease serologically investigated for Listeria monocytogenes (serotype 1a) in the last five years (2001-2006). The most affected age group proved to be that in the range of 20-30 years: 206 (73.9%) cases. 112 (40%) female had the diagnostic titer (>/= 1/320); among these, 64 (22.85%) had miscarriages in the IVth-VIIIth month and 38 (13.57%) gave birth to dead foetuses. During pregnancy, only 10 female (3.57%) was diagnosed with listeriosis and received treatment with Ampicillin. The rest of female (168 cases) was diagnosed later to abortion and the titer was low. All Ampicillin treated female gave birth healthy newborn.

Fungal Infections In Patients With Intestinal Parasites
S. Rugina, Irina Magdalena Dumitru, Elena Gorun

ABSTRACT. Study on 112 patients with intestinal parasites and fungi, diagnosed in department of parasitology between Jan the 1st 2000 – Jan the 1st 2001. From 112 patients, 92 (82.14%) had protozoa and 20 (17.85%) had helminthes. From these patients, 48 (42.85%) had intestinal fungal infection, 44 (39.28%) in association with protozoa and 4 (3.57%) in association with helminthes. From these, 36 patients had poliparasitic burden. From all Candida species, 86% was susceptible to fluconazole; only Cryptococcus was susceptible to Amfotericine B.

Lisotyping In The Follow-Up Of High Nosocomial Potential Bacteria (Klebsiella spp.) In Emergency Clinic Hospital Constanta
Victoria Braga, Mihaela Botnarciuc, Victoria Badea, Maria Cosman, Adina Barbu, Lavinia Voineagu, Ramona Stoicescu

ABSTRACT. Klebsiellae are conditioned pathogens. reported as responsible for nosocomial infections. Multidrug resistant strain, eventually extended-spectrum-beta-lactamase-producers (ESBL). are higly virulent and may become a major problem in hospitals. Our study is based on the remark made at the beginning of 2005 year, that in Emergency Clinic Hospital Constanta bacteria belonging to Klebsiella genus appear more and more frequently in various specimens. In the laboratory of the Hospital during the first eight months of 2005 were isolated from various specimens 148 strains, biochemically identified as Klebsiella spp. In the first four months, we isolated 72 Klebsiella strains in various specimens. Klebsiella appear as predominant bacteria in 46 feces specimens, 38 collected from hospitalized children, and only 8 collected from other departaments. In the middle o April four new - born babies died. In these children Klebsiella was isolated in cultures from feces, throat swabs and blood cultures. Our study continued on the next four months: May – September, when there were isolated 86 Klebsiella strains, 58 strains being from pediatrics. Sensitivity tests to antibacterial drugs showed for the Klebsiella strains isolated from children the presence of an antibiotype with high resistance. From 24 strains of Klebsiella isolated from various departments 16 strains were lisotype IVA1 and 10 strains were ESBL productive. All the strains with this lisotype were from neonatology, except one strain from urology.

L’IRM Dans Les Lesions Traumatiques Du Tendon Distal Bicipital
Carmen Ciufu, Loredana Pazara Hanzu, Maryse Moinard

RESUME. Si les ruptures proximales du tendon du biceps sont assez fréquentes, l’avulsion de l’insertion distale du biceps sur la tubérosité radiale est un accident rare. Sur 100 ruptures tendineuses du biceps 96 concernent la longue portion, 1 la courte et seulement 3 le tendon distal. Les causes de la lésion sont: accident sportif (différentes types de sport), accident domestique ou accident du travail. Le tableau clinique de ces ruptures est stéréotype. Il s’agit essentiellement de sujets de sexe masculine, de plus de 45 ans, effectuant des travaux manuels. Le diagnostic clinique de la rupture complète est aisé à la phase aiguë sur les données de l’examen associées à l’anamnèse. A la phase subaiguë le diagnostic clinique est moins aisé du fait de l’apparition d’un empâtement du pli du coude qui gêne la palpation des éléments anatomiques et d’un amendement des déficits musculaires. Le diagnostic est aussi malaise en cas de rupture partielle, puisque le tendon est palpé en place, ou lorsque le tableau clinique est inhabituel. Les examens complémentaires qui contribuent au diagnostic sont: radiographie standard, échographie, tomodensitométrie, l’IRM. Le traitement choisi peut être soit conservateur (immobilisation puis rééducation), soit chirurgical. Les complications éventuelles sont: les lésions de la branche postérieure du nerf radial, l’apparition des calcifications, la perte de l’extension du coude.

Methods Of Early Lung Cancer Diagnosis In Constantza County
Doina Tofolean, Laura Mazilu, Fl. Voinea

ABSTRACT. Lung cancer is one of the most important and common malignancy, with a dramatic and continuous increase in the incidence for the last half of the past century. In Romania, the incidence of this malignancy continues to increase in both men and women, with 8% estimated prevalence and 17% incidence. Constantza County is situated on the 3-rd place in Romania regarding the prevalence of lung cancer, and on the second place regarding its mortality rates. The purpose of this study is to identify and evaluate the most accurate diagnostic methods available in Constantza County for the early detection of lung cancer. It is a transversal epidemiological study, including 1,556 patients diagnosed with lung cancer over a 5-year period (01 January 2000 – 31 December 2005).

Clinical-Therapeutical Correlations In Rheumatoid Arthritis
Claudia Mihailov, Irina Tica, Tatiana Mandru

ABSTRACT. The new approaches of the pathological mechanisms involved in Rheumatoid Arthritis (RA) induce the idea that the irreversible destruction of the joints starts late enough to allow the introduction of specific therapies, in order to avoid articular deterioration. Our paper wants to determine the correlation between the clinical manifestations and the optimal therapy. The study, prospective type, was performed on 61 patients diagnosed with RA, admitted in the IInd Medical Clinic and examined in the Ambulatory of Rheumatology of the Emergency Clinical Hospital of Constanţa from 01.01.2005 to 01.01.2006. The diagnosis of RA was made upon ARA criteria (revised in 1987). Each patient’s data were introduced in a chart; they were analyzed and presented as graphics and tables. The drugs used were: non-steroidal anti-inflammatory drugs (NSAIDs); steroid therapy, sulphasalazine, methotrexate; Remicade; etanercept; Arava. Extra-articular manifestations of RA represent a factor of poor prognosis and they require associated double or triple therapy. The onset with asymmetrical oligoarthritis was registered in 67% of patients and they had a good response to treatment with sulphasalazine alone or in association with methotrexate. Patients with extra-articular manifestations and associated elevated CRP levels and low serum complement and the patients in the IV stage of illness.required complex remissive therapy, usually double or triple therapy or Remicade / etanercept administration

Radioanatomical And Semiological Aspects In Pituitary Adenomas Investigated By Magnetic Resonance Nucleare
Steliana Popescu, Elena Sapte, M. Onciu

ABSTRACT. Magnetic resonance imaging has an important role in the diagnosis, description and pre-therapeutically evaluation of the patients with benign pituitary tumors. The present study represents a retrospective analysis which comprises 23 patients, ages between 15 to 63 years, who presented to the Radiology and Medical Imaging Department of the Constanta County Clinical Emergency Hospital during September 2005 - December 2006, with clinical and biological signs suspicious for a secretor hypophyseal tumor. MRI examinations have been performed with a 1T GE Signa Horizon machine, using a standardized protocol, before and after intravenous contrast substance administration. All cases with clinical symptoms suggestive for a prolactinoma or for hypercorticism, have presented on MRI investigation a tumor lesion located at the level of the anterior hypophysis, of which the most common were the microadenomas.

Morbidity Determined By Uterine Fibroids - Retrospective Study Of 6356 Cases
L. Irimiea, R. Stanca, H. Riad, A. Spyrou

ABSTRACT. The authors analyzed a group of 6356 patients with uterine fibroids, hospitalized and treated in the clinic of gynecology at the university hospital of Constanta in a period of 10 years. Incidence of affliction were categorized according to there functional signs at admission. Cases were divided according to their age, degenerative modifications and complications due to surgery. In this study the incidence of uterine fibroids is very high, and the clinical signs of abnormal uterine bleeding is frequent. The majority of the cases were patients that were in menopause. Confirming thus the Hormal theory, indirectly, in the pathogenicity of uterine fibroids, in which the ratio between estrogen/progesterone levels play a role. There is also a rare localization of fibroids in the cervical istmic region evident, and in this there is a higher frequency of single tumors at this level. A clinical argument can now be stated in favor of the muscular origin of these tumors. Most of the complications due to surgery were found to be negligibly small except the manifestation of depression in younger patients. We can compare this to other refined studies in the field that had a significant decrease in depression, in which the use of conservative techniques and eventually imploring laparoscopic techniques to embolise the fibroid vascularization. Radical techniques are reserved for older patients.

Etiological Risk Factors In Placental Abruption
L. Serbanescu, V.I. Tica

ABSTRACT. This study analyzed the main etiological factors involved in produced placental abruption. It was done in Constanta Clinical Hospital between 1996 and 2006 and the data were collected from the birth files. The primary cause of placental abruption is usually unknown, but multiple risk factors have been identified. Some of them are: arterial hypertension, prolonged rupture of membranes, maternal trauma, maternal age, parity, alcohol abuse, smoking, drugs consume. The incidence of placental abruption was 5.6 per 1,000 births, the incidence of prolonged rupture of membranes was 15% and incidence of arterial hypertension was 18% (60% hypertension induced by pregnancy and 40% in essential form). There were 58 dead babies (58.62% males and 41.37% females) and 199 alive babies (54.77% males and 45.22% females). The incidence of uterine fibroma was 5%. The recurrence of placental abruption was 1.58%. Arterial hypertension and prolonged rupture of membranes are the most important etiological factors in placental abruption. Placental abruption is more frequent in pregnancies with male babies.

The Utility Of Prediction Methods In Gynecology
V. I. Tica, S. Bafani, Irina Tica, O. Teren, Monica Vasile, M. Zaher

ABSTRACT. Obstetrics and gynecology is a specialty where prevision is constantly resulting in new hypothesis and beneficial clinical strategies. Gynecology takes great benefit from the possibility of predicting epidemiological phenomena or the course of a specific pathology. The assertion is relevant, as these benefits influence the course of most of the physiological situations a woman can be in or that of health or disease in some of the most frequent and dangerous diseases in this more than half of the planet population. If we also take into the consideration the couples (involved in the subfertility problems) or the newborns, the numbers increase. We present below (without any exhaustive claim) the use of items like intermediate-risk, specificity and high sensitivity, connection between risk factors and the prevalence, prognostic factors of overall survival in some of the gynecologic sub-specialties: reproductive endocrinology, gynecologic oncology or general gynecology and prevention. Prediction processes and models are successfully used in scientific and clinical activities, improve the bringing the gynecologists in unison with respect to treatment resolutions and constitute a solid basis for individual, professional and social decisions, in gynecology.

Nephrotic Syndrome Secondary To Renal Vein Thrombosis In A Newborn
Mihai Larisia, Elena Leu

ABSTRACT. Renal vein thrombosis (RVT) develops when a blood clot forms in the renal vein, which carries blood from the kidneys back to the heart. The disorder is not common. Renal vein thrombosis occurs in both infants and adults. In children, renal vein thrombosis almost always occurs rapidly after an episode of severe dehydration or during a septicemic status. Neonatal renal vein thrombosis is a well-recognized clinical entity which is associated with serious morbidity. In infancy, nephrotic syndrome can be a risk factor for renal vein thrombosis, but, in the same time, can be secondary to RVT. The authors report a case of nephrotic syndrome secondary to renal vein thrombosis, described in a 21-day-old neonate addmited in intensive care unit for a combination of signs and symptoms suggesting sepsis and shock. The evolution was gradual towards renal vein thrombosis manifested by a characteristic clinical association of macroscopic hematuria, oliguria, nephromegalia and trombocytopenia and confirmed by ecografic examination, followed, 10 days after, by the occurrence of an edematous syndrome with marked proteinuria, hypoproteinemia, hypoalbuminemia, hyperlipidemia which is correlated with the clinical picture of secondary nephrotic syndrome.The authors focused on this case presentation and discussed about the succesion of these conditions in this newborn.

Therapeutical Management in Locally Advanced Colon Cancer
R. Popescu, V. Sarbu, T. Iusuf, Manuela Minca, Cristina Dan

ABSTRACT. Locally advanced colon cancer is defined as a tumour which invades the neighbouring structures and organs, having a distinctive surgical approach and evolution. On a trial of 169 patients with locally advanced colon cancer, authors present personal experience in comparison with literature data, regarding therapeutical strategy: the operability at the moment of intervention, the types of operations, the postoperative attitude, especially the chemotherapy for residual tumoral tissue and the overall survival.

The First Breast Reconstructions After Radical Mastectomy for Breast Cancer Performed in Constanta
O. D. Unc, V. Sarbu, I. Iordache, Marta Budu, Lizica Itu, Diana Nicolaescu

ABSTRACT. The current treatment for breast cancer is the surgical one. After radical mastectomy the following techniques are used for immediate or delayed reconstruction of the breast: placement of prostethic devices and autologous reconstruction. For the first time in Constantza, in the Second Surgery Clinic of Departmental Hospital, our general surgery team performed a breast reconstruction after the patient has been operated for a breast cancer. We report practically the first two cases of breast reconstruction with latissimus dorsi miocutaneous flap made in 2005.This technique used the reconstruction with latissimus dorsi miocutaneous flap and we prefer it better than the other ones not only because of physiological reasons but also for oncological and psychological ones. We consider that this technique is quite simple and needs an increasement in its usage, even though we have to cross some psychological obstacles for the patients and for the doctors who are taking care of breast cancer patients.

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