ARS Medica Tomitana
vol. XVI - nr. 1 (60) - january - march 2010

Pathologic And Immunohistochemical Features Of Digestive Neuroendocrine Tumors
Mariana Aşchie, Anca Crăciun, Anca Mitroi, Anca Chisoi, I. Poinăreanu, Andreea Ilieşiu

ABSTRACT. Neuroendocrine tumors are rare tumors of the interface between the endocrine and nervous system. Digestive tract neuroendocrine tumors account for 95% of all neuroendocrine tumors. In our study we investigated 17 cases of neuroendocrine digestive tumors hospitalized in Emergency Clinical County Hospital of Constanta. In these patients we determined pathologic and immnuohistochemical profiles of neuroendocrine tumors. Our data suggested that neuroendocrine digestive tumors present variable localization with large intestine predominance. Grading of neuroendocrine tumors correlate with loco-regional and vascular invasion and positive diagnosis of neuroendocrine tumors was emphasized by immunohistochemical profile of these tumors.

Morphological Aspects Of Non-Hodgkin Malignant Lymphomas In Constanta County
– Retrospective Study

Anca Chisoi, Mariana Aşchie, Anca Antonela Crăciun, I. Poinăreanu, Anca Florentina Mitroi, Andreea Ilieşiu

ABSTRACT. Lymphoma is a type of cancer that originates in lymphocytes of the immune system. Non-Hodgkin lymphoma are malignant proliferation of lymphocytes originated in lymph nodes. There are 40.000 new cases in every year for non-Hodgkin lymphoma. In Romania, non-Hodgkin lymphoma incidence is 5,1/100.000. We chose to study patients with malignant non-hodgkin lymphoma from 2004-2008, hospitalized in County Hospital Constanta. The diagnosis was established on the basis of histopathological exams. There were identified 65 non-Hodgkin lymphoma patients. Microscopical study of the specimens showed that the predominant tumoral type was Diffuse Small Cell Lymphocytic Lymphoma, followed by Lymphoblastic Lymphoma and Diffuse mixed lymphoma. Sex distribution for each lymphoma form showed no sex preference in Diffuse small cell lymphocytic lymphoma, Mixt follicular lymphoma, Histiocitic lymphoma. In case of Large cell anaplastic lymphoma Hodgkin-like, Mixt follicular and difuse lymphoma, Burkitt lymphoma, Diffuse mixed lymphoma, Lymphoblastic lymphoma there was evidentiated some degree of sex determinism. Burkitt lymphoma was diagnosed in younger ages and other lymphomas were diagnosed in older ages. Median diagnosis age in Constanta, Romania is 60-70 years old, showing a belay diagnosis age than in USA, Australia or developed European countries. Sex ratio on studied cases was M/F = 3/2.

Epidemiology Features Of Autoimmune Thyroid Disease In Dobrogea
Alina Martinescu, E. Circo

ABSTRACT. Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder. The autoimmune thyroid diseases (AITD) are caused by an interaction between susceptibility genes and environmental triggers, leading to loss of immune tolerance and initiate the cellular and/or humoral immune response which produces autoreactive cells and antibodies against thyroid autoantigens. Abundant epidemiological data, including family and twin studies, point to a strong genetic influence on the development of AITD. Some of these genes/loci are unique to Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) and some are common to both the diseases, indicating that there is a shared genetic susceptibility to GD and HT. To date, significant progress has been made towards the identification and functional characterization of autoimmune susceptibility genes. In this review, we summarize the epidemiology features of AITD patients from an iodine-replete area, like Dobrogea.

Food Poisoning A Major Problem Of Public Health
B. Tofan, Floarea Damaschin, Beatrice Severin

ABSTRACT. Food poisoning is a disease conditioned by environmental factors, especially one to which we all are in direct dependency – food – and, shamelessly, by human negligence. Although significant progress has been made in food production, packaging and storage, the morbidity and the mortality caused by this kind of pathology still stands at worryingly levels, affecting a large number of people worldwide. Food poisonings are a group of uneradicated diseases, spread all around the world, with a high frequency, despite all progress made concerning the hygienic standards, the people’s knowledge about the sanitary domain and the ways to stop or at least lower the evolving of the germs. Therefore, we realized an epidemiological study regarding the cases of food poisoning among the Galati County’s citizens, between 2005 and 2008. We used data gathered from The Direction of Public Health of Galati, regarding the epidemiologic surveys made in 2005 - 2008, in Galati County. As a method
of statistical analysis we used the percentage method. Analyzing the results of our study, we have found a total number of 215 cases. It can be said that food poisoning, in the period under review, had determined an important morbidity in Galati County, with epidemiological, social and economic implications. The health education, the compliance to the hygienic standards keeping food safe, the compliance to the public health legislation – are just a few ways to decrease the number of cases, whereas food poisoning is a disease that could be eradicated through proper diet and an efficient hygiene.

Le Ligament Latéral Interne Du Genou
Carmen Ciufu, Loredana Pazara, N. Ciufu, Cristina Farcaş, Ninela Rădulescu, Cecilia Adumitresi

RÉSUMÉ. Les lésions ligamentaires internes isolées du genou sont facilement diagnostiquées cliniquement. Elles ne requièrent pas de traitement chirurgical. Hormis les radiographies standard, un bilan d’imagerie est rarement nécessaire. En revanche, en cas d’entorse grave pluriligamentaire, le diagnostic clinique est parfois impossible et le traitement chirurgical des formations périphériques internes est parfois indiqué. Dans ce cas, le bilan d’imagerie complémentaire a un réel intérêt. Après un rappel anatomique, les auteurs font le point sur l’apport de chaque technique d’imagerie (radiographie standard et dynamique, échographie, arthrographie et IRM) dans le diagnostic des lésions ligamentaires Ninternes et pour la différenciation entre une rupture sans et avec instabilité du genou.

Use Of Simvastatin In The Treatment Of Rheumatoid Arthritis
Lucia Cojocaru, A. Rusali, Ana-Maria Ramazan, Elvira Craiu, Maria Şuţa

ABSTRACT. The pleiotropic effects of statins, especially the anti-inflammatory and immunomodulatory ones, indicate that their therapeutic potential might extend to other disorders such as rheumatoid arthritis. Therefore, we undertook a prospective cohort study to evaluate the efficacy and safety of simvastatin used for inflammation control in patients with rheumatoid arthritis. 100 patients with active rheumatoid arthritis divided into two equalgroups (the study one received 20 mg/day of simvastatin in addition to prior DMARDs and the control one) were followed up over 3 months and during this time there were two study visits. At each visit we measured all clinical variables and we harvested blood samples. Also, we recorded all adverse events throughout the study. After 3 months, EULAR response was achieved in 32% patients allocated simvastatin compared with 14% in the control group (p=0.037). In the statin group there was a semnificative improvement in DAS28 ESR, DAS28 PCR, SDAI, CDAI, evaluator global assessment of disease activity and tender joint count. Also, swollen joint count, visual analogue scale for pain, patient global assessment of disease activity and eritrocite sedimentation rate declined more in the statin group, but without achieving statistical significance. Adverse events were mild and occured with similar frequency in both groups. In conclusion, simvastatin has modest, but clinically apparent anti-inflammatory effects in patients with rheumatoid arthritis. These effects in adition to their good safety profile and known cardiovascular protective effects promote statins as attractive therapeutic agents in combination with DMARDs, especially in patients with other cardiovascular risk factors.

Age And Sex As Risk Factors In Upper Gastrointestinal Bleeding Due To Gastric And/Or Duodenal Ulcers
C. Kapetanos, Andra Suceveanu, A. Suceveanu, Laura Mazilu, Fl. Voinea

ABSTRACT. The Upper Gastrointestinal Bleeding (UIB) has a high incidence (1/o/oo) and mortality rate (12% – 25%) that impose the continuous study of the risk factors. The authors’ aim is to identify the importance of the age and sex as risk factors of the UIB, to establish
possible correlations among them. The study concerned 344 patients diagnosed as UIB and gastric ulcer (GU), duodenal ulcer (DU) or gastro-duodenal ulcer (GDU), hospitalized at the Constanţa Clinical County Hospital in the Surgery Department between the years 1991- 1995, 1999-2003. the method uses the anamnesis study, clinical and Para clinical exams including endoscopic examination. Statistical comparison were performed by student’s unpaired t-test; the level of significance chosen for all results was t<0.05. Risk factor found common ground through personal study is the age. The results reveal that main age of the UIB debut is 59.8 years of age. The increase in the percentage of patients younger than 60 years at the debut of the UIB may be correlated with higher levels of stress as 76% of the patients from the studied group live in the city, 90% of these patients are employed and 65% hold management positions. Male gender (71%), history of gastric ulcer / duodenalulcer, chronic treatments with NSAIDs (66.92%) and alcohol intake (66.86%) are other risk factors. Digestive bleeding in GU and DU, expose the patient to a life threatening high (11.34%).

Functional Status Of Patients With Juvenile Idiopathic Arthritis After 20 Years Of Evolution
Ana-Maria Ramazan, Maria Şuţa

ABSTRACT. To estimate functional abilities of adult patients with juvenile idiopathic arthritis (JIA) after 20 years, as well as to identified the clinical and biological factors which can influence the limited disability. The study is observational with a retrospective part and a prospective observational part. The patients were shared in two groups: the study group (53 patients) and a control group (52 patients). Pacients was assesed on subjective manner (pain score, global patient well-being, activity like BASDAI score), objective manner (tender joints, swolen joints, joints with limited movements, joints with ankylosis), functional (with HAQ, BASFI, Steinbroker) and assesment of quality of life. There were no significant differences between study and control group. 15% of patients were without disability, but 69% of them had severe disability. With analise of HAQ score on ILAR classification it seems that systemic forms were smaller. 83% of patients with entesitic onset were without disability, but the oligoarthritis and the systemic arthritis produces severe disability. Disability is influenced by the pain score, global patient wellbeing, tender joints, joints damage scores , ESR and by quality of life. 69% of patients with JIA (especially polyarthritis and systemic arthritis) present severe disability, but the results are discordant to Steinbroker functional classes.

The Imagistic Diagnosis Of Peritoneal Carcinomatosis
Sirma Tomoş, Fl. Voinea, Elena Chiriac

ABSTRACT. Peritoneal carcinomatosis is the dissemination and implantation of tumor cells throughout the peritoneal cavity and often results in significant morbidity with or without systemic metastases. Tumors may originate from a local or distant site. Frequently, a diagnosis is not established until after the vague signs and symptoms of early disease have given way to debilitating effects of local or regional metastases. Therefore, an early diagnose is very important. This study was carried out with the aim to evaluate which non-invazive investigation, such as ultrasonography, computed tomography or magnetic resonance imaging can be used as a diagnostic tool. This study was based on 53 cases of peritoneal disseminations from different origins who were investigated imagistically. Most of patients were diagnosed by means of CT scan, 31 patients (58,5%), followed by ultrasonography (34% of the cases).

Epidemiological Features Of Crc In Constanta County
Maria Gălan, Laura Mazilu, Andra Suceveanu, A.P. Suceveanu, Tzortzana Loisiou, Fl. Voinea

ABSTRACT. CRC is the 3rd cancer in frequency in both men and women. Its mortality, although declining in the past two decades due to the introduction of screening programs, is still high, constituting 9% of the global causes of death. Our study has proposed to characterize the main epidemiological aspects and mortality rates of CRC in Constanta and to make a comparison of data obtained with data obtained from the whole country. Data on the epidemiology of CRC in the Constanta county were obtained from registers of ambulatory oncology of Constanta County Emergency Hospital. Data on the epidemiology of CRC in Romania were obtained by acccesarea (GLOBOCAN 2002). Statistical analysis of data from our study was carried out with GraphPad soft StatMate (1.01), GraphPad Prism 4 (4.03) and GraphPad Instat (3.05).In males, CRC was maintained 3rd place in the period 2006-2008 as covered, while the in female sex, incidence advanced CRC from 4th to 3rd place in the range. The average age of diagnosis was not significantly changed during the study, being over 60 years. Rates of death from CRC in both sexes was maintained as the 2nd cause of death in the study period. In Constanta county, CRC is present in the overall trend of evolution in the whole country, regarding the incidence and the death rates. CRC although a neoplasia with curative potential, yet presents directly proportional incidence and mortality rates, again arguing the implementation of a screening program in Constanta County, as well as in the whole country.

Arterial Flow Establishment: Leveled Endarterectomies – A Technique To Choose In Atherosclerotic Obstructions In Femoro-Popliteal Segment
Marta Budu, Madalina Fanaru, E. Oclei, D. Bajan

ABSTRACT. In the last five years, in the 2nd Surgery Clinique from Emergency Clinical County Hospital Constanta, has been performed in order to establish the arterial flow in the lower limbs, a new and lesser used technique. The technique consists in discovering the femoral tripod, the superficial and the deeper femoral artery. At this level one can make 2, 3or 4 arteriotomies, where after administrating heparin i.v. can be performed endarterectomies or thrombendarterecomies which have as result good flows and, especially good reflows from deeper femoral artery and from above the arteriotomy. The election place for arteriotomy was chosen after analyzing the arteriography before the intervention. Postoperatory was always administered sodium heparin continuously (by injection), then fractionated at each 4 hours, the doses being adjusted depending on the clotting markers. After 6 days begins the association of the sodium heparin with an oral anticlotting drug (Trombostop or Sintrom). Analyzing the statistics we have drawn a few conclusions, regarding the advantages and disadvantages of this technique.

Difficulties Related To Lymph Node Evaluation In Colorectal Cancer
C. Ghiţă, I.D. Vilcea, I. Vasile, C. Mirea, C. Mesina, D. Enache

ABSTRACT. The lymph node invasion is one of the most important prognostic parameter in colorectal cancer: the many lymph nodes are involved, the worse the prognosis will be. In order to assess accurately the lymphatic invasion in colorectal cancer a minimum of 12 lymph nodes must be identified and pathologically evaluated. To accomplish this goal a number of adverse factors must be taken into consideration. This study purpose was to evaluate some of the factors influencing lymph node retrieval in a general surgical and pathological department (IInd Surgical Clinic and Pathology Department of Emergency Hospital of Craiova).
The most important factors that influence the lymph nodes evaluation was emergency surgery and segmental resection. Even though the nodal evaluation improved over time, there is place for N stage evaluation amendment.

Postnatal Pancreatic Β Cell Growth – Modern Overview
Raluca Pasăre, I. Iordache, Cristina Lazar

ABSTRACT. Even 15 years ago , the accepted concept was the one that had born with all the pancreatic β cells one ever had. Many thought that insulin resistance would lead to diabetes without changes in the β cells. However, now the concept that diabetes only results when there is an inadequate functional mass of β cells had gained general acceptance. The most obvious lack of β cell is seen in type 1 diabetes as the result of autoimmune destruction of β cells. The lack in type 2 diabetes with its hallmark of peripheral insulin resistance has been less obvious to many . The evidence over the past decade has been compelling that in most cases the β cells can, and also do compensate for added demand , resulting from pregnancy , obesity , or insulin resistance. It’s very important to keep in mind the fact that only 15-20% of people with obesity or severe insulin resistance become diabetic ; the others maintain their normoglycemia due to β cell compensation. The new concept support the theory which says that β cell mass is dynamic and increases and decreases both in function and mass to maintain the glycemic level within a very narrow physiological range. The changes in mass can be in both number ( hyperplasia ) and individual volume of β cells ( hypertrophy ) . When the mass cannot increase adequately , diabetes ensues

Entheseal Damage To The Patients With Psoriatic Arthritis
Camelia Pană

ABSTRACT. Psoriatic arthritis is an inflammatory systemic disease, of unknown cause, characterized by the association between chronic, progressive inflammatory arthritis, and skin psoriasis. The disorder is currently framed in spondyloarthropathy group, with ankilosing spondylitis, reactive arthritis, inflammatory bowel disease associated arthritis and undifferentiated spondyloarthropathy. A special feature of this group of diseases is the presence of inflammation at the insertion of tendons and ligaments to bone, called enthesitis. Unlike rheumatoid arthritis, where synovitis is the primary lesion, in psoriatic arthropathy things are less clear. In the last decade, been shown by studies of magnetic resonance (MRI), as entheseal changes occur before any other joints manifestations and may have an important role in clinical disease expression. Furthermore, there is a correlation between disease activity and number of painful enthesis, suggesting the existence of clinically silent entheseal damage in patients with psoriatic arthritis clinical and/or biological inactive. This paper aims to define the link between distribution and severity of entheseal damage and clinical patterns of psoriatic arthritis. Conclusion: The clinical expression of psoriatic artropathy is in direct relationship with the distribution of entheseal damage, clinically evaluated, is consistent with ultrasound studies performed for these enthesis

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