ARS Medica Tomitana
vol. XIV - nr. 2 (53) - april - june 2008

Methodology For Mitochondrial DNA Research In Oncology:Goals And Pitfalls
Anna M. Czarnecka, T. Krawczyk, J. S. Czarnecki, W. Kukwa, Anna Ścińska, Anna Ribbene Rosaria Lo Verde, Annalisa Sunseri, Giovanni Peri

ABSTRACT. Mitochondrial DNA has been described as veritable Pandora’s box of pathogenic mutations associated with a wide variety of clinical syndromes including cancer. Nevertheless careful reanalysis of methodological and methodical criteria used in experiments shows that numerous papers could not be used as relevant source of clinically applicative data. It has been shown that much noise has been introduced to the interpretation of the role of mitochondrial DNA in the complex tumorigenesis process and that numerous experiments do not fulfill logical methodological criteria of case-control molecular medical experiment, as originate from technical and conceptual errors that reduce the finding of mitochondrial DNA mutations in tumors to the level of technical and methodological artifacts. Under such circumstances it remains unclear how many of the disease-associated mutations have been determined adequately and the guidelines for reanalysis of previous experiments and design of new trials are needed. This article represents and justify methodological criteria to be used in mitochondrial medicine. Proposed guidelines describe the choice of the sample and patient selection process including patient number, geographical origin and ethnicity; clinicopathological data collection with special care for additional medical factors influencing mitochondrial DNA research as mitochondria influencing diseases. Also the importance of tissue and cell extraction and normal tissue and reference sequence selection are characterized. Finally we describe three – horn dilemma and the significance of avoiding scientific silos in mitochondrial DNA research, including hypothesis formulation and verification.

Radiological Investigation Of Residual Ridge Resorbtion During The Treatment With Immediate Dentures
Corina Ştefănescu, P. Bordei

ABSTRACT. The residual ridge resorbtion in the entire maxilla represents a very important problem, because in the literature no reliable technique for quantifying it could be found. We aimed to develop a suitable method based on planimetry of anatomically defined experimental areas and reference areas derived from stable anatomical landmarks identifiable on a panoramic radiograph. The use of image processing system, opens new vistas for research in dental radiology, and offers a best prosthetic treatment for the dental practitioners. This method can be applicable to a number of clinical situations, and can contribute to a better understanding of residual ridge resorbtion.

The Significance Of Peritoneal Fluid Cytology In Patients With Simultaneous Malignancy
Ana Maria Creţu, Mariana Aşchie, I. Poinăreanu

ABSTRACT. Peritoneal fluid cytology is useful for predicting the prognosis of gynaecological, gastric, pancreatic and colorectal malignancies. However, fluid cytology shows tumour cells only when tumour cells are lining the peritoneum, not when the peritoneum is not involved. In hepatocellular carcinoma, massive liver metastasis or malignant lymphoma causing ascites by lymph node obstruction, ascitic fluid cytology is negative for malignant cells. This study was carried out with the aim to evaluate the significance of peritoneal liquid cytology in detecting malignancy in patients with simultaneous malignancy. Out of 52 cases, 34 (65.38%) peritoneal fluids were tumour cell negative and 18 (34.61%) were tumour cell positive; none (0%) was false positive or true negative. For 9 (50%) patients the peritoneal cytology was positive in of the patients with ovarian carcinomas, 11.11% endometrial carcinomas, and 11.11% with cervical carcinomas. Ovarian cancer was the most common primary site of malignancy associated with peritoneal fluid where as adenocarcinoma was the most common type of malignancy in peritoneal fluid cytology.

Clinical And Therapeutic Aspects In Parkinson’s Disease
Anca Hâncu , M. Kaivanifard , Mirela M. Boju

ABSTRACT. In 1917 James Parkinson describes for the first time, the Parkinson disease under name of “Excited paralysis”. It is a disease of paleostriatal, with a perfidious debut, characterized from clinical point of view by: akynesia, rigidity, bradykinesia, tremor of rest and postural anomalies and from anatomopathological point of view by degeneration of neurons populations, especially the dopaminergic ones from substantia nigra and locus coerulus from mesencephalon. The remained neurons have decrease amount of melanine (the pigment resulted for autooxidation and polymerization of dopamine) and by the presence of Lewy bodies The evolution of disease is of slow progression. Despite the fact that no treatment can stop or regenerate the degenerated neurons that cause the disease, some therapeutic schemes can ameliorate the symptoms significantly.

Urodynamic Findings In Patients With Spinal Cord Injury
S. Osman, Emel Osman, M. Beciu

ABSTRACT. Symptoms of neurogenic bladder range from detrusor underactivity to overactivity, depending on the site of neurologic injury. The urinary sphincter also may be affected, resulting in sphincter underactivity or overactivity and loss of coordination with bladder function. Thirty-nine patients (23 males and 16 females) with traumatic spinal cord injury between 2004-2007 were evaluated for the study of upper tract change at urodynamic test and grouped for classification of neurogenic bladder. All patients were examinees after six months since the accident, this time was necessary for recuperation after spinal shock, each patient was investigate by a neurological exam, general laboratory tests before performing the urodynamic test. All the patients were checked with ultrasonography or intravenous pielography IVP for evaluating upper tract changes. The patients were grouped in cases with hyperreflexive and areflexive bladder. Among them hyperreflexive bladder with detrusor sphincter dyssynergia were 21 and hyperreflexive bladder without dyssynergia were seven. High pressure areflexive bladders were 6 and low pressure areflexive bladders were 5. Vesicoureteral reflux and upper tract dilatation were found in hyperreflexive bladder and high pressure areflexive bladder. High pressure areflexive bladder had the highest incidence of vesicoureteral reflux and upper tract dilatation among all the groups. Low pressure areflexive bladder had no deteriorated upper tract. The urodynamic study classifies neurogenic bladders easily and applied it in making decisions to select treatment modality. The upper tract improved in most of the compliant patients to treatment. In the noncompliant group to treatment a large portion of hyperreflexive bladders with dyssynergia and high pressure areflexive bladder showed deterioration or no improvement in upper tract. The differentiation of neurogenic dyssynergia and physiologic dyssynergia is not easy in these patients. Further study is needed to overcome these problems.

Haematological Manifestations In Liver Cirrhosis
Claudia Mihailov, Irina Tica, Georgiana Vladuceanu, Ioana Ureche

ABSTRACT. After cardiovascular diseases and cancer, liver cirrhosis represents the third cause of mortality in developed countries. The most important of the causes of liver cirrhosis is chronic alcohol abuse, but also hepatic viruses are involved. The new approaches induced the idea that pathological manifestations of liver cirrhosis involve the entire liver, leading to an unorganised hepatic structure and nodule formation, surrounded by fibrous tissue. The study, prospective type, was performed on 148 patients diagnosed with liver cirrhosis, admitted in the IInd Medical Clinic, during 01.01.2006-01.02.2008. Haematological manifestations represent an important element in cirrhosis’ evolution. Patients presented hypersplenism, upper digestive bleeding caused by the bleeding varices, portal hypertension, hemorrhagic gastritis and peptic ulcer.

Hemolytic-Uremic Syndrome In Twins
Adriana Bălaşa,Valeria Stroia, Gh. Chiriac-Babei, Cristina Stoica, Roxana-Cleopatra Penciu, Patricia Scortia

ABSTRACT. Hemolytic-uremic syndrome (HUS) was first described in 1955 and consists of the triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal insufficiency. HUS is classified as diarrhea-associated (D+HUS) and non-diarrhea associated (D-HUS).The clinical course of HUS can vary from subclinical to life threatening. The complications can affect numerous organs or systems: kidneys, central nervous system, endocrine system, gastrointestinal system or heart. The article presents two children of six months old (twins), admitted in Department of Pediatrics of Emergency District Clinical Hospital Constanta. The children were admitted in Department of Peditrics for vomiting, watery and bloody stool and inappetence.Subsequently they developed oligo-anuria and thrombocytopenia. According to clinical exam and investigations, the children were diagnosed with HUS.

Cervical Premalignant Lesions – Immunostaining HPV Antibodies
Dana Iuliana Pleş, Mariana Aşchie

ABSTRACT. The importance of cervical premalignant lesions and human papillomavirus infection for cervical carcinoma has been well established. Nearly 87% of the intraepithelial neoplasia of the cervix occurs in the transformation zone, which is composed of squamous metaplastic cells with unclear origin. Almost 90% of cervical carcinoma have positive immunohistochemical reaction for HPV antibodies, which suggests that the premalignant lesions associated with HPV infection especially HPV 16 and 18, have a major risk for transformation into an invasive carcinoma. Our study tries to demonstrate through immunohistochemical reaction the presence of HPV infection in the preneoplasic lesions and to indicate the differential susceptibility of cervical cells for conversion to cancer considering the type of the HPV infection.

The Chewing Gum - Between Advantages And Disadvantages Epidemiological Study Made In 2007-2008 In The Faculty Of Medicine Constanţa
Beatrice Severin, Floarea Damaschin

ABSTRACT. Starting from the advantages and the disadvantages of chewing gum, we realized a study concerning the attitude of the students and their knowledge’s in matter of chewing-gum! In study they were included students from second semester of academic year 2007-2008, from the specialty general medicine, year IV and medical assistants, year I. Because they were not major differences between the answers of the two lots, we don’t made separate reports. As a method of statistics analyzes we used the percentage method. After this study we found that the majority of the students frequently consume chewing gum and they know which they are the disadvantages of the consumption, but they don’t care about these. The students expose themselves to many risks for health, but without a very serious education, without a healthy attitude, the health is in adrift because the mentality is manipulated easily.

Cornelia De Lange – Phenotypic Diagnostic
Cristina Mihai, F.C. Ionescu

ABSTRACT. We present a boy with Cornelia de Lange Syndrome (CdLS). CdLS is known as a rare syndrome with multiple congenital anomalies, characterized by a specific facial appearance, psychomotor development delay, behavioral problems and organ malformations. There are no biochemical or chromosome markers for the syndrome diagnosis. Cornelia de Lange syndrome is caused by mutations in the NIPBL or SMC3 and SMC1A.Molecular genetic testing is clinically available, but not easily accessible for the developing countries. The clinical diagnosis is very important in these cases. At the time of diagnosis he presents with: facial dimorphism, low body weigh, according to his age, 7400 g, despite being on a special diet with advanced formula milk for the premature infants, rich in proteins, and supplementation with proteins from whey, glucose polymers, rape-seed oil, vitamins and amino-acids. He presents confluent eyebrows (synophrys), long curly eyelashes, low anterior and posterior hairline, anteverted nares, low- set ears, thin lips, nose with triangular shaped tip, phyltrum long and featureless, hypo plastic nipples and umbilicus, cryptorchidrism, small limbs, widely spaced teeth. Gastro-esophageal reflux with nocturnal agitation, recurrent airways infections, and hyperactivity was diagnosed. We discuss the outcome, treatment and interventional therapy strategies in this rare disorder: treatment of gastro esophageal reflux, supplementary formulas and/or gastrostomy tube placement, physical, occupational, and speech therapies, sign language and the picture exchange communication, orchiopexy if cryptorchidrism is present.

Breast MRI For Evaluation Of Response To Neoadjuvant Chemotherapy In Patients With Locally Advanced Breast Cancer
Laura Mazilu, Radu Baz, Andra Suceveanu

ABSTRACT. Assessment of the extent of residual tumor after preoperative (neoadjuvant) chemotherapy by conventional techniques (physical exam, mammography, and sonography) is relatively inaccurate. Breast magnetic resonance (MRI) has been proposed to evaluate the extent of tumor after completion of neoadjuvant chemotherapy to determine which patients have become eligible for breast-conserving therapy. The aim of our study was to determine the accuracy of clinical examination, mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer, as compared with gold standards of pathology. Fifty-one women diagnosed with stage IIB-IIIB palpable breast cancer between 2004 and 2007 and admitted in Oncology Department were prospectively enrolled in a study investigating the effects of neoadjuvant chemotherapy on tumor imaging. Fourty-three patients completed the protocol. Agreement about the rate of response as measured by clinical examination, mammography, sonography, and MRI, compared with pathology was 20.93%, 30.23%, 34.88%, and 86.04%, respectively. Of the four, MRI agreed with pathology significantly more often (P < 0,0001). Our study demonstrates that MRI appears to provide best correlation with pathology, in patients undergoing neoadjuvant chemotherapy, thus establishing which patients have become eligible for breast-conserving therapy.

Relation Between Nutrition And Biological Status At Two Lots Of Military Divers
Cătălina Rudencu, Floarea Damaschin

ABSTRACT. The study is referring to relation between nutrition, physical effort and health quality at two lots of divers with different ways of nutrition (in family and in collectivity) and different level of activity. We searched semblances and differences between the lots members, regarding weight status, biological status (cholesterol, triglycerides and hepatic amines) on one way and calories daily intake on other way. In conclusion, the major over weight is registered in divers that eat in collectivity and the modification of biological tests is registered in over weight divers with medium or light activity.

Rheumatoid Arthritis In Patients With Viral C Hepatitis
Aurora Banţă, Paulina Ciurea

ABSTRACT. Rheumatic complaints can be determinate by viral infection, which can be self limited or can develop destructive arthritis. Hepatitis viral C infection can develop a lot of rheumatic disorders by immune complex deposition. The aim of study is to establish any correlation between serological markers of rheumatoid arthritis and liver serum markers and grade of fibrosis. In the study there were included 330 patients with viral C hepatitis and 5.45% were diagnosed with rheumatoid arthritis. The diagnosis was sustained on the presence of at least 4 of the 7 ARA criteria. Serological markers of rheumatoid arthritis were analyzed at all patients. Rheumatoid factor with titer over 1/80 was observed at 17/18 patients, AAN at 3/18patients, and low level of C3 was observed at 12/18 patients. The level of aminotransaminases was at high level at almost patients. 11/18/ patients with HCV and AR had done liver biopsy, and we noticed that almost of them had grade F3 and F4. Arthritis rheumatoid was observed at 5.45% from patients included in study, and it was associated with female sex, high level of aminotransfersasis, moderate necro-inflammatory activity and moderate fibrosis grade.

Mood Stabilisers In Pharmachological Management Of The Persons With Schizophrenia
Eda Maliche Ciorabai

ABSTRACT. The authors’ goal was to study the main reason for introducing mood stabilisers as adjunctive treatment in patients with schizophrenia, to explore differences in neuropsychological function, symptoms, comorbidity between patients treated with mood stabilisers or not. 175 inpatients with schizophrenia as definite primary diagnosis(DSM-IV-TR) received standardized psychiatrist-administered assessment batteries within 48 hours of admission ( PANSS, MMSE, UKU Side Effect Rating Scale). We study the medication received by these patients, the use of mood stabilisers in the treatment of these pacients.Results:68 percent of the patients with schizophrenia received mood stabilisers during their hospital stays. On admission the dual diagnosis group was more likely to be younger, male, with low social support, more likely to be a danger to self and others. Severity of psychosis was the same at admission for the two groups, but there were differences in hostility item(PANSS) and akatisia item( UKU Side Effect Rating Scale). Several factors are considered in treatment selection. These include evidence of efficacy and safety from clinical study reports, patient characteristics, the presence of comorbidities as substance abuse and the new hypotesis of common endophenotypes for schizophrenia and bipolar disease, an overlap between schizophrenia and bipolar disease. Valproic acid and carbamazepine are the most used mood stabilizers in current practice in our psychiatric clinic.

Fibromyalgia Syndrom

ABSTRACT. Pain can neither be seen, felt, touched, or measured and the most reliable description we have of pain is from the patient. The pain is biological, psychological, and social. Fibromyalgia is not a disease, is a syndrome, a chronic disorder, more common in woman ages of 20 and 50, whose cause is unknown. Studied since the early 1800s , with several hypotheses developed fibromyalgia can be managed, but it needs to be managed.

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