ARS Medica Tomitana
vol. XV - nr. 1 (56) - january - march 2009

Les Profiles Immunohistochimiques Des Tumeurs Malignes Non-Seminomateuses Testiculaires Le Carcinome Embryonnaire Et La Tumeur De Sac Vitellin
I. Poinăreanu, Mariana Aşchie, Anca Florentina Papuc, Anca Dobre, Antonela Anca Crăciun, Andreea Ilieşiu, Mariana Deacu, Mădălina Boşoteanu, Ghiulendan Iacub, Jadranka Stanisici, Ana Maria Creţu, Diana Badiu, Gabriela Bălţătescu, Manuela Enciu, Valentina Lăcurezeanu

RESUME. Les tumeurs de cellules germinales sont les tumeurs le plus fréquentes et importantes au niveau testiculaire. Ils touchent principalement les jeunes hommes et leur incidence augmente régulièrement dans les sociétés riches. Dans plusieurs régions, notamment en Amérique du Nord et en Europe du Nord, ils sont devenus les plus courantes formes de cancer chez les hommes âgés de 15 – 44 ans. Il existe des preuves épidémiologiques circonstancielles que le taux de l’incidence d’apparition de nouveaux cas est associé au mode de vie occidental, caractérisé par un régime alimentaire fort calorique et le manque d’exercice physique. En dépit de l’augmentation de l’incidence, le taux de mortalité de cancer des testicules a baissé en raison d’une chimiothérapie très efficace qui comprend le cisplatinum. Dans la plupart des pays avec une excellente infrastructure d’oncologie clinique, le taux de survie de 5 ans s’approche de 95%.

A Pathological Study Of Malt Lymphomas Of Gastrointestinal Tract
Anca Dobre, Mariana Aşchie, Anca Antonela Crăciun, I. Poinăreanu, Anca Florentina Papuc, Andreea Ilieşiu, Mariana Deacu, Mădălina Boşoteanu

ABSTRACT. We chose to realise a statistical study of MALT lymphoma cases new diagnosed between 2000–2007, in Morphopathology Department of County Hospital, Constanta, following a few parameters: sex, age, tumor localization, immunohistochemistry pattern in order to morphologically characterize the MALT lymphomas in Constanta, Romania. There were 73 cases of MALT lymphoma. The diagnosis was established on the basis of case history, paraclinical investigations, histopathological exams. From our study resulted an increasing in number of new diagnosed MALT lymphoma between 2000 - 2007 (5 cases in 2000 to 16 cases in 2006). From all MALT cases the most frequent localization was stomach with 57% off all MALT cases (41 cases), followed by intestinal localization (23% meaning 17 cases) and colo-rectal localization (10% meaning 7 cases). Sex ratio didn’t show any preference for a sex determinism excepting gastric localization with a slighted predisposition for mans patients. Age analysis showed a large amount of cases between 41-70 years of age. For male patients the vast majority of cases were between 51-70 years. For female patients a lot of cases were in 41-60 years. Immunohistocemical analysis showed that MALT lymphomas are negative for CD43 (97,2% meaning 71 cases), CD5 and CD10 (100%), Ki67 (98,6% meaning 72 cases) and positive for CD11c (60,2% meaning 44 cases), CD20 (94,5% meaning 69 cases).

A Potential Diagnostic Tool For Distinguishing Between Malignant Cells And Reactive Mesothelial Cells In Peritoneal Effusions
Ana Maria Creţu, Mariana Aşchie, N. Ioncică, Natalia Roşoiu, I. Poinăreanu, Anca Crăciun, Andreea Ilieşiu, Anca Dobre, Gabriela Preda, Jadranka Stanisici, Anca Papuc, Ghiulendan Iacub, Diana Badiu

ABSTRACT. One of the main challenges of diagnostic cytology is finding an unequivocal and reliable method for discriminating between nenign reactive mesothelial cells and malignant cells exfoliating into peritoneal effusions. Cells from reactive or hyperplastic mesothelium shed from body cavity surface in various biological settings may present a wide range of deviation from normal cellular morphology, majing it difficult, or even impossible, to distinguish them from malignant cells by mean of purely cytological criteria.The cytomorphological evaluation of effusion is a challenging aspect of non-gynecology cytology. Computerised image analysis can rapidly digitise the image of the cells and thereby can estimate various morphometric parameters of the cell. This study was carried out with the aim to evaluate if cytology and cytomorphometry can be used as a potential diagnostic tool for distinguishing between malignant cells and reactive mesothelial cells in peritoneal effusions. The previous study showed that existed significant differences between morphometric variables derived from nuclear and cytoplasmic outlines in benign and malignant effusions. This study was based on 67 available cases with a histological diagnosis known, we have examined the peritoneal effusions from routine morphologic features. Cytologically, 38 (56,71%) peritoneal fluids smears were classified as benign (negative cytology), 22 (32,83%) were malignant (positive cytology) and 7 (10,44%) were cosidered suspicious. The various cellular parameters that were measured by cytomorphometry included nuclear as well as cytoplasmic diameter, area, ratio of nucleus to cytoplasmic area. Cytomorphometry hepls in better and quicker sorting for malignant cells. Finally, 34 cases were found to be benign, 22 malignant and 4 in the category of atypical cases.

Morphologic And Immunohistochemical Differential Diagnosis Of Dysplastic Nevus And Malignant Melanoma
Antonela-Anca Crăciun, Mariana Aşchie, Mariana Deacu, Mădălina Boşoteanu, Anca Papuc, I. Poinăreanu, Andreea Ilieşiu, Anca Dobre, Ghiulendan Iacub, Jadranka Stanisici, Gabriela Bălţătescu, Ana Maria Creţu, Diana Badiu, Valentina Lacurezeanu, Manuela Enciu

ABSTRACT. Dysplastic nevus and malignant melanoma represent a very important pathology of our times because of their difficult differential diagnosis, the increased incidence in young individuals and high mortality of the latter. This paper tries to point out aspects of differential diagnosis between these two entities. We chose to study patients diagnosed in the Pathology Department of Emmergency County Clinical Hospital Constanta with benign and malignant melanocytic tumors from 2007 to 2008 (244 cases). The microscopic aspects of dysplastic nevus encountered consisted of junctional or compound nevi with mild/moderate cyto-architectural atypia, atypical melanocytes mainly in the basal layer, accompanied by a dermal or junctional inflammatory infiltrate. The microscopic features of malignant melanoma group includes epithelioid cell form, spidle cell form, pigmanetated forms, nonpigmentated forms and acral lentiginous melanoma, mostly associated, accompanied by epidermal ulceration and inflammatory infiltrate. The incidence of melanocytic tumors is higher in females, regardless the type of tumour (common nevus, dysplastic nevus or malignant melanoma) and prefer younger people. The clinical diagnostic criteria between dysplastic nevus and malignant melanoma are not concluded because these lesions can have similar macroscopic aspects (irregular borders, uneven pigmentation and variate sizes). The thorough examination of microscopic slides is the best method for establishing the diagnosis of dysplastic nevus or malignant melanoma. Immunohistochemical examination is useful when the morphology is uncertain, assessing the proliferation markers that can indicate the malignant transformation or the malignant potential of a dysplastic nevus.

Rare Etiological Factors Isolated From Normally Sterile Products
Victoria Braga, Lavinia Voineagu, Adina Honcea, Andreea Taşu, Monica Telehoiu

ABSTRACT. The normal sterile liquids do not contain live microorganisms. The objective of this paperwork it was constitute by antropozoonosis with Erysipelothrix rhusiopathiae, isolated from normally sterile liquids of hospitalized patients in the Emer-gency Clinical Hospital of Constanta, between 1.08.2008- 1.04.2009. During this period, were sent to laboratory 7134 samples of normal sterile pathological products; 1270 were positive culture.Only 4 cultures were with Erysipelothrix rhusiopathiae. The Erysipelothrix rhusiopathiae identification an antibiogram was made with Vitek 2.Patients affected by infection with this bacteria are generally patients with low immunity, with multiple associated diseases.Using the latest technology offered by Vitek2 enabled identification of the gram positive bacillus.Bacillus Erysipelothryx rhusiopathiae proved sensitive to a wide range of antibiotics.

Cornelia De Lange Syndrome
Alina Martinescu, Anca Popescu

ABSTRACT. Cornelia de Lange syndrome (CdLS) is a developmental disorder characterized by prenatal and postnatal growth deficiency, intellectual disability that is usually moderate to profound, abnormalities involving the arms and hands, and distinctive facial features. Facial characteristics consisting of synophrys, long eyelasheses, long philtrum, thin upper lip and downturned mouth. It is a multisystemic disease that most often affects the gastrointestinal tract and the heart. Brachmann first described a severe form of this syndrome, also known as Brachmann de Lange syndrome. Mutations in the NIPBL, SMC1A, and SMC3 genes have been identified with current molecular screening techniques. Phenocopys of the syndrome are related to chromosomal aneuplodies or teratogenic factors. The correlation between genotype and phenotype is not clear cut. Diagnosis is made subjectively from the characteristic symptoms although CdLS has no set criteria that can indicate with absolute certainty whether or not a person is affected. We present a 24 years old female proband with characteristic facial features, mental retardation (IQ = 51), speech delay and behavioral problems, but without malformations or growth deficiency caused by an interstitial deletion on short arm of X chromosom.

The Babies Health And Nitrate-Contaminated Well-Water
Beatrice Severin, Floarea Damaschin

ABSTRACT. The consumption of water with high nitrate concentrations produce acute nitrate poisoning in infants, methemoglobinemia, or blue baby syndrome. Those most affected are infants fed artificially with powder milk, in the preparation of which it uses such of water. At these it was found a decrease in immunity or deficiencies in intellectual and physical development. But chronic consumption of water polluted by nitrates has many negative effects. The study aims to estimate the incidence and analysis of features of evolution of the cases of poisoning by nitrates, due to consumption of polluted water. The study is based on cases of nitrate poisoning in infants and small children, diagnosed at the County Hospital Emergency Constanta, in the period 1997-2007. The study used data from hospital archives. As a method of statistics analyzes we used the percentage method. Diagnosis and treatment of methemoglobinemia are not enough, preventive strategies should include identifying and eliminating the sources of exposure.Nitrate poisoning of infants could be an extremely rare disease that we would make campaigns for greater promotion of natural food, so it should not be abandoned so easily.

Symptomatic Pericarditis In Tumor Necrosis Factor (Tnf)-Alpha Inhibitors Treated Rheumatoid Arthritis Patients - 3 Case Presentations
Maria Şuţa, Luminiţa Matei, Cristina Duminica, Doiniţa Oprea, Ana-Maria Ramazan, R. Şuţa

ABSTRACT. Pericardial effusion is found during their evolution in less than 30% of rheumatoid arthritis (RA) patients, one third of them are symptomatic, and pericardial tamponade is a rare event. Extraarticular manifestations are more frequent in patients with severe, active forms of RA, but only a few cases of clinical apparent pericarditis have been reported during biological treatment. We present 3 cases of symptomatic pericarditis, one of them complicated by pericardial tamponade, in tumor necrosis factor (TNF)-alpha inhibitors treated RA patients. In our Rheumatology Clinic, 45 RA patients are currently being treated with TNF-alpha inhibitors (17 infliximab, 25 etanercept, 3 adalimumab), out of which, in the last year, we have diagnosed 3 cases of symptomatic pericarditis. All of these 3 patients have been diagnosed at least 10 years ago, with severe, seropositive RA. Conclusion: In some of the RA patients, the TNF-alpha inhibitor therapy did not prevent pericarditis, which was complicated by pericardial tamponade in one case.

Short-Term Cardiovascular Risks Of Glucocorticoid Pulse-Therapy In Rheumatoid Arthritis Patients
Luminiţa Matei, Maria Şuţa, Cristina Duminica, Doiniţa Oprea, Ana-Maria Ramazan, R. Şuţa

ABSTRACT. Rheumatoid arthritis patients have important clinical benefits from glucocorticoid therapy. Pulse-therapy represents an alternative to high-dose daily therapy, as an intention to minimize side effects. Severe cardiovascular events, including sudden cardiac death have been described after pulse-therapy, but there is no clear evidence regarding the frequency of such events, particularly in rheumatoid arthritis patients. This is a prospective observational study that evaluates the short-term cardiovascular risks of glucocorticoid pulse-therapy (125 mg methylprednisolone infusions for 3 consecutive days) in 20 rheumatoid arthritis patients, using clinical, biochemical, conventional electrocardiography and continuous 24-hour cardiac rhythm monitoring parameters. The adverse events recorded were: asymptomatic significant blood pressure raise (2 patients, previously hypertensive), angina (1 patient, with known coronary heart disease) and asymptomatic unsustained ventricular and supra-ventricular tachycardia (3 patients, all with known previous heart disease). Cardiovascular adverse effects of glucocorticoid pulse-therapy seem to be closely related to underlying cardiovascular comorbidities. Low risk patients allow just clinical supervision during infusions, including blood pressure measurement and can probably be managed as day-hospitalization. Patients with known cardiovascular disease need closer follow-up, at least clinically, if not cardiac rhythm monitoring.

A Case Of Pulmonary Toxocariasis Associated With Progressive Eosinophilia In A 60 Year-Old Man Mimicking Alveolar Cell Carcinoma: Case Report And Literature Review
Elena Danteş, Oana-Cristina Arghir, Emilia Tabacu, Petronela Ariadna Fildan

ABSTRACT. Human toxocariasis is caused by Toxocara canis, which is an intestinal nematodes found in dogs and cats. We report a case of progressive eosinophilic pulmonary multifocal infiltrates in a 60 year-old man with only a history of bronchial asthma for 13 years. He lost 15 kg in weight in the last three months before hospitalization and complained of fatigue, malaise, asthenia, rare vague abdominal symptoms, worsening progressive shortness of breath and chronic productive cough, mostly daily expectoration of 250 ml of watery sputum (bronchorrhea). The initial standard chest x-ray examination revealed basal bilateral hypertranslucery due to hyperinflation and multiple poorly circumscribed alveolar-filling lesions disseminated. The computed tomography scans of the thorax revealed mediastinal adenopathy, extensive ill-shaped bilateral opacities and consolidations associated with small bilateral pleural effusions. The cytologic study of bronchial aspiration revealed diskariotic cells and alveolar cell carcinoma was the first presumptive diagnosis. Later analysis of bronchoalveolar lavage fluid with 66.8% eosinophils correlated with a progressive high degree of peripheral blood eosinophilia (from 6% to 45%) induced the diagnosis of toxocariasis and a positive enzyme-linked immunosorbent assay for Toxocara canis represented the clue. The general and respiratory symptoms respond to treatment with albendazole 800 mg 2 times a day for 1 month after completing a course of steroids. The antibody titer also normalized.

Specific Aspects Of After Burns Sequelae In Children
I. Bordeian, Virginia Matei, Adriana Enache, Iuliana Stănescu

ABSTRACT. A burn represents a surgical condition with a great potential for disability both anatomical and functional, and esthetic. Developing after burns sequelae is much more frequent in children than in adults and especially in little children (under 5-6 years old). The presence of sequalae that produce disabilities after burns in children represents a very important cause of lack of integration in the society especially when these sequalae are “in sight”. Preventing these after burns sequalae in children starts at the moment of the accident and ends when the child stops growing up (at the age of 19 in girls and 21 in boys). If neglected, after burns sequalae that concern functional areas need the use of intricate surgical procedures for the doctor and hard to bear for the child.

Monstrous (Unusual) Keloid – Case Presentation
Adriana Enache, Virginia Matei, I. Bordeianu, I.V. Iordache

ABSTRACT. The development of hypertrophic scars and especially of the keloid certainly is influenced by age; extreme ages develop more rarely keloid. The clinical, biological, and physiopathological arguments are strict regarding the fact that old people meet all the conditions to develop easier an atrophic scar (that is young for a longer period of time). The authors of this paper present the case of an old man – 82 years old – who develops a monstrous keloid on his shoulder after a small surgical intervention (the excision of a sebaceous cyst), measuring: 42/19/8 cm and with a weight of 1900 grams. The therapeutic intervention was the excision of the keloid (invasive in the surrounding tissues according to the classic definition of the keloid) and covering the resulting fault with skin autograft.

Laparoscopic Treatment Of Inguinal Hernia
R. Popescu, V. Sârbu, Iulia Cândea, Cristina Dan, Raluca Pasăre

ABSTRACT. In this study we evaluate our experience in laparoscopic inguinal herniorrhaphy performed in the last two years on 14 pacients (12 men and 2 women). In all patients we used the most common laparoscopic technique for inguinal hernia repair which is transabdominal preperitoneal (TAPP) approach. Our results were similar with those in the literature regarding the complications, recurrence rate, time to full recovery and return to work. We consider that laparoscopic herniorrhaphy is a feasible alternative to open hernia repair, also very safe and effective procedure for the patients with minimal postoperative pain, short hospital stay and shorter time to return normal activities as compared to open procedures.

Osteosynthesis Methods And Surgical Approaches In The Distal Epiphyses Humerus Fractures
B. Obadă, N. Obadă, M. Enescu, S. Ureche

ABSTRACT. Distal epiphyses humerus fractures are articular fractures and the aim of the treatment are the remake of the articular congruency to obtain full recovery biomechanic. The only ways to achieve this important target are the surgical treatment and the osteosynthesis method must be stable to start the recovery early. Distal extremity humerus fractures modify the elbow biomechanic with ulterior functional consequences, depending on the fracture type and the treatment quality. The fracture instability and the cominution impose surgical approach, but the higher the cominution, the more difficult the osteosynthesis. The therapeutic attitude is analysed in relation with the fracture type. The paper evaluates the surgical approaches for each type of osteosynthesis method for these kinds of fractures. The decision to offer operative intervention for distal humerus fractures is based on many factors, including fracture type, intra-articular involvement, fragment displacement, bone quality, joint stability, and soft-tissue quality and coverage. The goal of treatment is anatomic articular reduction and restoration of alignment. Non-displaced fractures may be treated with splints, casting, and early range of motion. Internal fixation may be necessary to achieve a stable articular reduction. The articular segment must also be stably fixed to the metaphysis and diaphysis. Regardless of treatment selected, early elbow range of motion is critical to avoid long-term stiffness.

Bacterial Meningoencephalitis With Double Aetiology In Children
Simona Claudia Cambrea, Maria Margareta Ilie, Claudia Nina Rugină, E. Vasiliu, R. Baz, C. Urjan, O. Carp, S. Rugină

ABSTRACT. Bacterial meningitis is an important serious illness worldwide. Tuberculous involvement of the central nervous system (CNS) is an important and serious type of extra-pulmonary involvement. It has been estimated that approximately 10% of all patients with TB have CNS involvement. In developing countries CNS tuberculosis is a disease of younger age group, usually childhood. The high morbidity and mortality of tuberculous meningoencephalitis (TBM) warrants an early diagnosis and treatment. On the other hand acute bacterial meningitis in children is a relatively frequent disease. Bacterial meningitis with double aetiology Mycobacterium tuberculosis and other bacteria were disease very rare in clinic. In Constanta County in first 3 months of year 2007 we noticed presence of 5 cases of TBM in children with age between 6 months and 6 years. In this article we report two cases of children aged less than 3 years with double aetiology bacterial meningitis: tuberculous and other bacteria. One child was vaccinated BCG and other wasn’t. We analyze aspect of cerebrospinal fluids, electroencephalography (EEG), hemogram and inflammatory tests from blood and cerebral CT/MRI examination. Diagnosis of TBM was delayed in both cases. Internal hydrocephalus was present in both cases since first days of hospitalization. In both cases we registered important neurologic deficits; in one case neurologic deficits recovered, and in second case neurologic sequellae were severe and definitive invalidate.

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