Some considerations concerning cochlear implantation in IFACF-ORL.

The article analyzes the patients who have received a cochlear implant at "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, over a period of 13 years, from the beginning of this program in the year 2000. It presents the types of devices used, the particularities of the patients, the surgical techniques and the outcome, critically analyzing the complications encountered. The authors' comments on the selection of patient protocol, surgical intraoperative challenges and cochlear implant technologies and capabilities are presented.

The association between the timing of valve surgery and 6-month mortality in left-sided infective endocarditis.

OBJECTIVE: The optimal timing of valve surgery in left-sided infective endocarditis (IE) is undefined. We aimed to examine the association between the timing of valve surgery after IE diagnosis and 6-month mortality among patients with left-sided IE. METHODS: We analysed data from a retrospective cohort of patients with left-sided IE who underwent valve surgery within 30 days of diagnosis at a tertiary centre. The association between time from IE diagnosis to surgery and all-cause 6-month mortality was assessed using Cox proportional hazards modelling after adjusting for the propensity score (to undergo surgery 0-11 days vs >11 days, median time, after IE diagnosis). RESULTS: Of 546 left-sided IE cases seen between 1980 and 1998, 129 (23.6%) underwent valve surgery within 30 days of diagnosis. The median time between IE diagnosis and surgery was 11 days (range 1-30). There were 35/129 (27.2%) deaths in the surgical group. Using Cox proportional hazards modelling, propensity score and longer time to surgery (in days) were associated with unadjusted HRs of (1.15, 95% CI 1.04 to 1.28, per 0.10 unit change, p = 0.009) and (0.93; 95% CI 0.88 to 0.99, per day, p = 0.03), respectively. In multivariate analysis, a longer time to surgery was associated with an adjusted HR (0.97; 95% CI 0.90 to 1.03). The propensity score and time from diagnosis to surgery had a correlation coefficient of r = -0.63, making multicollinearity an issue in the multivariable model. CONCLUSION: On univariate analysis, a longer time to surgery showed a significant protective effect for the outcome of mortality. After adjusting for the propensity to undergo surgery early versus late, a longer time to surgery was no longer significant but remained in the protective direction. Multicollinearity between the time to surgery and the propensity score may have hindered our ability to detect the independent effect of time to surgery.

[Morphologic study of cardiac myxomas]. / Studiul morfologic al mixoamelor cardiace.

The aim of the paper was the morphological study of the cardiac myxomas, admitted and operated at CCI, between 2000 and 2004. We evaluated the histology of the tumor, the incidence of the specific lesions, and we analysed the tumoral types on the basis of cardiac myxoma macroscopic appearance in correlation with clinical picture of tumor.

[Acute myocardial infarction--a possible complication in polycythemia vera. Case report]. / Infarctul miocardic acut--o posibila complicatie în policitemia vera. Prezentare de caz.

A 66-year-old woman with Polycythemia Vera suffered an postero-inferior acute myocardial infarction: this is a relative rare association. The association between primary coronary angioplasty with stent implantation and anti-aggregant and myelosuppressive treatment was followed by important clinical benefits for the patient. To our knowledge, there are rare reports in the literature relating the triad of Polycythemia Vera, acute myocardial infarction and primary coronary angioplasty with stent implantation.

[Hypersensitivity myocarditis, a surprising diagnosis. Case report]. / Miocardita de hipersensibilizare--o surpriza diagnostica. Caz clinic.

Hypersensitivity myocarditis is a rare morphoclinical entity that may cause sudden death through arrhythmia and cardiogenic shock. The focus of the paper is the histological evaluation of the cases to identify the death cause of a 50-year-old patient, known to have suffered of hypertrophic cardiomyopathy, infective endocarditis and severe mitral regurgitation, case in which hypersensitivity myocarditis precipitated the evolution of the disease. The basis of the study was a complete cardiac evaluation including the morphological diagnosis on necropsy specimens. The paper shows that hypersensitivity myocarditis is a cause of sudden death through acute cardiac failure, and the setting of a precise morphological diagnosis is very important for an early targeted treatment.

Cytomegalovirus cholangitis presenting with recurrent hemobilia.

Cytomegalovirus (CMV) cholangitis is a rare manifestation of CMV infection that has previously been described only in HIV-infected patients and solid-organ-transplant recipients. Reported here is a case of CMV cholangitis that occurred in a patient on chronic corticosteroid therapy who presented with recurrent hemobilia and biliary obstruction and was successfully treated with ganciclovir and cholecystostomy. A search of the medical literature revealed no previous case of this kind.

[Cardiac amyloidosis. A case report]. / Amiloidoza cardiaca. Prezentare de caz.

The paper presents the morphoclinical picture in cardiac amyloidosis to a 50 years old man admitted at Iasi Cardiology Center with progressive chronic cardiac failure, the patient having recent history of restrictive cardiomyopathy. It was made a complete cardiovascular evaluation including the right cardiac catheterization for endomyocardial biopsy. The biopsy specimens were fixed in buffered 10 % formalin, followed by routine paraffin embedding, and were stained with haematoxylin-eosin, elastic Van Gieson and sulphated blue Alcian for amyloid evaluation. The amyloid deposits were evidentiated in the interstitium and into vascular walls of the biopsy, pointing the importance of the morphological exam for amyloidosis diagnosis.

[Subacute bacterial endocarditis due to Pasteurella pneumotropica. Case Report]. / Endocardita bacteriana subacuta determinata de Pasteurella pneumotropica. Studiu de caz.

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.

[Radiofrequency treatment of cardiac arrhythmias at the Cardiology Center in Iasi ]. / Tratamentul tahicardiilor prin radiofrecventa experienta Centrului de Cardiologie Iasi.

UNLABELLED: It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. OBJECTIVES: The aim of this was to present our experience in the RFCA of cardiac tachycardias. METHODS: Between July 2002 and February 2003, in Iasi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. RESULTS: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. CONCLUSION: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.

[Arrhythmic cardiomyopathy. Case report]. / Cardiomiopatia aritmica. Prezentare de caz.

An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.

Morphological evaluation of the surgically removed aortic and mitral valves.

In 2001, of the 114 valves surgically excised at the Iasi Center of Cardiology from 59 men and 54 women (mean age 51 years; age range: 25 to 78 years), half were aortic and the other half mitral valves. The 57 aortic valves, from 20 women and 37 men (mean age 51.1; age range 25 to 78 years), had been surgically replaced. Functionally, 57.63 percent (30) were stenotic, 21.05 percent (12) were incompetent, and 26.31 percent (15) were both stenotic and incompetent (aortic disease). Pure stenosis was related to calcification of degenerative (73.3 percent), bicuspid (3.33 percent), post-inflammatory (20 percent), and undetermined (3.33 percent) causes. Pure regurgitation was not related to calcification and causes included infective endocarditis (50 percent), bicuspid valve (16.66 percent), postinflammatory (16.66 percent), aortic root dilatation (8.33 percent), and undetermined (8.33 percent). Aortic disease was secondary to postinflammatory etiologies (40 percent), degenerative calcification (33.33 percent), bicuspid and undetermined (13.33 percent each) causes. The reminder of 57 mitral valves, from 35 women and 24 men (mean age 45.5 years; age range 28 to 71 years), were surgically replaced. Functionally, 40.35 percent (23) were purely stenotic, 19.29 percent (11) were purely regurgitant, and 40.35 percent (23) both stenotic and regurgitant (mitral disease). The causes of pure stenosis were postinflammatory (presumably rheumatic) disease in 91.3 percent (21 cases) and degenerative disease in 8.7 percent (3 cases). Pure regurgitation etiology involved floppy valves in 45.45 percent (5 cases), degenerative disease in 27.27 percent (3 cases), postinflammatory disease in 18.18 percent (2 cases) and infective endocarditis 9.1 percent (1 case).

[Primary pulmonary hypertension--morphologic study]. / Hipertensiunea pulmonara primara--studiu morfologic.

Primary pulmonary hypertension is characterized by elevation of pulmonary arterial pressure over 25 mm Hg with increasing of pulmonary vascular resistance. Primary pulmonary hypertension is the result of idiopathic narrowing of pulmonary arteries and extensive remodeling of the pulmonary vasculature in case of lack of the pulmonary interstitial disease, cardiac diseases, and pulmonary thromboembolism. The morphological study revealed the histological vascular elements characteristic in arterial hypertension (intimal proliferation, medial hypertrophy, plexiform and dilatative lesions) associated with recent and organized arterial thrombosis secondary to intimal lesions through a recent infectious process. Our study revealed the necessity of morphological diagnosis in the view of accurate diagnosis and adequate cure. After all, the prognosis of primary pulmonary hypertension remain poor.

Cardiac leiomyosarcoma. Case report.

A case of primary cardiac leiomyosarcoma diagnosed at Iasi Cardiology Center is presented. The study was made on the surgical biopsy specimen, and the diagnosis by routine morphological techniques. The gross examination revealed a large intracavitary left atrial tumor attached by a small sessile base to the left posterior atrial wall, having a smooth, white-gray surface, and a dense consistency. On the cut surface, the tumor had a whirled white appearance, with focal brown areas. The microscopic examination revealed the presence of a spindle cell tumor, forming fascicles orientated at right angles. The study revealed the morphological aspect characteristic to leiomyosarcoma.

[Morphologic and clinical correlations in medullar thymoma]. / Corelatii morfoclinice în timomul medular.

The medullar thymoma is a rare and distinctive epithelial thymoma, a thymic tumor characterized histologically by a mixture of spindle epithelial cells and lymphoid cells. We are presenting this tumor to a 68 years old man, admitted at CCI, for a mediastinal tumor, treated by tumorectomy, for revealing the cytological, histological and immunohistochemical characteristic features. The surgical biopsy was prepared by using usual histological techniques and haematoxilin eosin and Van Gieson stainings. We are discussing the relation between the thymoma clinicopathological and prognostic features, resulting a clear correlation between histological type and clinical study. We also pointed the Muller-Hermelink thymoma histological subtypes and their correspondence with OMS histological types, reflecting realistically the thymoma clinical behavior.

[Permanent cardiac pacing for chronic symptomatic atrioventricular block in uremic hemodialysed patients. A prospective study]. / Cardiostimularea electrica permanenta în insuficienta renala cronica terminala tratata prin hemodializa.

Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, reports concerning advanced A-V block, requiring permanent cardiac pacing in end-stage renal disease (ESRD) hemodialysed (HD) patients are very few. This is the first long term prospective study reporting on systematic permanent pacemaker implantation, in a cohort of ESRD patients from a single HD unit. Between 01/06/1997 and 30/12/2001, 396 pacemakers were inserted for advanced, symptomatic A-V block in our institution, including 5 in ESRD, HD patients (M/F--4/1, age 47-73, M +/- SD--61 +/- 12 years) from a single dialysis center, treating 137 patients during the study period. Thus, the incidence and prevalence of A-V defects treated by permanent pacing in uremic patients was 0.81% and 3.65% respectively. Conversely, the incidence and prevalence of ESRD treated by hemodialysis, among patients with advanced A-V conduction disturbances, requiring permanent pacing were 0.28% and 1.26%. Mitral valve calcifications were present in all patients; 3 subjects also had extensive aortic valve calcifications. Left ventricular hypertrophy (echocardiographic Framingham criteria) was present in 4 patients, but the systolic function (ejection fraction and fractional shortening index) was normal in all cases, although a clinical picture of chronic heart failure was seen in 3 subjects preoperatively. A-V conduction defects were attributed to extensive metastatic calcifications, involving the cardiac squeleton, consecutive to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. No technical difficulties, short or long-term complications related to pacemaker implantation (4 VVI and 1 VVD devices) were encountered. Acute threshold and sensing values were similar with those of non-uremic patients. During follow-up, one patients died from a non cardiac death. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or non uremic patients and pacemaker implantation should be instituted as a prompt life-saving method in all dialysis patients with chronic symptomatic advanced A-V blocks.

Cardiac consequences of the systemic lupus erythematosus therapy with corticosteroids morphological study.

It is presented the case of a fifty years old women, diagnosed 3 years ago with systemic lupus erythematosus, under therapy with prednisone and cyclophosphamid therapy. She was admitted in our hospital for right decompensated heart disease and the presence of an apical right ventricular mass occluding part of the right ventricular cavity. The endomyocardial biopsy was made to clearify the nature of this mass. After processing the specimen, the histological study evidenciated an organizing apical thrombotic mass formed in a large right ventricular cavity in conditions of pulmonary hypertention. There are presented data concerning the adverse effects of the systemic lupus erythematosus drug therapy, as well. In these circumstances, we demonstrated histologically, that both conditions could alter the heart morphology.

Two cases of Marfan syndrome.

The early identification of the Marfan Syndrome should be essential for the prevention of the aortic dilatation and dissection, but the wide phenotypic expression of the disorder makes the clinical diagnosis very difficult. The aim of this study is to emphasise the necessity of a widely applicable method of morpho-clinical diagnosis. The diagnosis was confirmed on surgical biopsies from ascending aortic wall and aortic cusps, using routine morphological techniques. The macroscopical examination revealed a thin ascending aortic wall, presenting a transversal intimal tear, without secondary dissecting hematoma, and an aortic dilated annulus, producing aortic regurgitation. Microscopically, the diagnosis was supported by the identification of cystic medical necrosis, a specific degenerative lesion in the Marfan Syndrome, in patients with or without family history of aortic aneurysms. This study defines the morpho-clinical changes of the disease, emphasising the necessity of a permanent monitorization of the patient after surgery, due to the risk of late complications.

[Weibull regression in the analysis of the aging phenomenon of biological systems]. / Regresia Weibull in analiza fenomenului de imbatrânire a sistemelor biologice.

The processing battery represented by standard regressions is totally insufficient for the primary regression analysis of biomedical observation data. Using only this processing system, it is possible to loose a significant amount of information and especially to obtain false conclusions, seeming to be "statistical justified". This conclusion is sustained by the results obtained in this paper on 8 samples. In this paper it was created a calculation algorithm that allows the automatic, simultaneous effectuation of 16 types of regression, obtained by change of variable. This algorithm finally orders these regressions according to the values of correlation coefficient and emphasizes the regression type that mathematically fits the best the observed data. The choice of the optimal regression type depends basically by the fact that the results supplied by that regression corresponds with the biological characteristics of the studied phenomena. In the specific case of optical nerve, in all the 8 samples and sub-samples analyzed, the regression that supplied the higher correlation coefficients was the Weibull model, with exponent variable as a function of time.

[Insulinemia and its evolution over time in obesity]. / Insulinemia si evolutia în timp a obezitatii.

There is a steady-state metabolism of adipose tissue ("adipose state") with a "metabolic signal" significance. It consists of: seric levels of glucose, insulin, free fatty acids. We studied 45 cases with uncomplicated obesity and we correlated seric level of insulin, basal and reactive, with DAM (mean adipocyte diameter), insulin receptor activity and obesity evolution length (age of obesity). Level of insulin has high influence on insulin receptor function (p < 0.01). Reactive insulin level are higher with obesity age (p < 0.0001). Hyperinsulinemia is a constant, continuous and early reference point of obesity.