Effect of dietary chromium supplementation on meat nutritional quality and antioxidant status from broilers fed with Camelina-meal-supplemented diets.

Poultry meat is a valuable source of nutrients and the enrichment with health-promoting substances such as polyunsaturated fatty acids (n-3 PUFA) is an important factor for consumers' choice. Camelina meal (Camelina sativa) is an animal feedstuff used to achieve this goal, but the administration of n-3 PUFA-enriched diets in broiler nutrition can accelerate the oxidative processes in meat leading to a decreased quality of final product. The aim of this study was to investigate the effect of the organic Cr as chromium picolinate (CrPic) on meat quality, fatty acid profile of fat and oxidative stability of meat from broilers fed supplemented dietary Camelina meal. An experiment was conducted on 240 Ross 308 broiler chicken aged 14 days which were assigned to 6 dietary treatments in a randomized complete block design with a 2 × 3 factorial arrangement. Within the treatment arrangement two concentrations of Camelina meal (0% and 3%) and three concentrations of Cr3+ (0, 200 and 400 µg/kg) were used. Dietary treatments were: (1) Control diet (C) containing a corn-soybean diet with no added Camelina meal or Cr3+; (2) a C diet containing an additional 200 µg/kg of Cr3+ as CrPic; (3) a C diet containing an additional 400 µg/kg of Cr3+ as CrPic; (4) a C diet containing an additional 3% Camelina meal; (5) diet 2 containing an additional 3% Camelina meal; (6) diet 3 containing an additional 3% Camelina meal. Chromium supplementation significantly (P<0.05) increased the CP concentrations and significantly (P<0.05) decreased the crude fat concentrations in breast samples. The Camelina meal groups presented higher values of unsaturated fatty acids, particularly n-3 fatty acids (P<0.05). In CrPic groups, increased retention of Zn and Fe (P < 0.05) was observed in breast samples, compared to control group, and thiobarbituric acid reactive substances values were significantly (P<0.05) smaller. Myoglobin fraction (metmyoglobin and oximyoglobin) concentrations differ significantly (P<0.05) from the control group, under the influence of Cr3+ supplements. This study found that broilers fed with CrPic supplements showed improved mineral composition and oxidative stability of breast meat, proving an effective protection of lipid molecules from oxidation in PUFA-enriched meat.

[Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty]. / Incidence, facteurs associés et devenir de l'insuffisance cardiaque hospitalière compliquant l'infarctus antérieur aigu traité avec succès par angioplastie primaire.

UNLABELLED: Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. METHODS: Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. RESULTS: Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. CONCLUSION: In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.

Myasthenia gravis associated with thymoma and toxic multinodular goiter. A case report.

Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.

Acute inflammation with induction of anaphylatoxin C5a and terminal complement complex C5b-9 associated with multiple intra-articular injections of hylan G-F 20: a case report.

OBJECTIVE: The purpose of this case report was to investigate local immune mechanisms present during an acute inflammatory flare initiated by viscosupplementation with hylan G-F 20 in a patient with osteoarthritis (OA) and past meniscectomy. EXPERIMENTAL DESIGN: A patient with a history of bilateral OA and partial left knee meniscectomy, who had received three injections of hylan G-F 20, was diagnosed with an acute flare reaction in the left knee. Her chart was evaluated for clinical, radiological, and laboratory findings and for clinical follow-up. Histopathological synovial examination and real-time polymerase chain reaction (RT-PCR) for genes with major roles in local inflammation and enzyme-linked immunosorbent assays (ELISAs) for markers of complement activation and cytokines were performed. To study the impact of the inflammatory and immune features we compared the case patient with groups of three representative OA and three rheumatoid arthritis (RA) patients. RESULTS: The patient exhibited evidence of highly increased acute phase reactant C-reactive protein (CRP) in the blood. The pathological examination of the synovial membrane identified abundant fibrinous exudate with numerous particles of hyaluronan surrounded by a dense infiltrate of neutrophils and eosinophils. The synovium had moderate hypertrophy and sclerosis as well as an inflammatory infiltrate predominantly composed of T lymphocytes and macrophages with scattered perivascular eosinophils and neutrophils. Immunoperoxidase staining identified numerous deposits of C5b-9 in the fibrinous exudates and the synovial membrane of the patient. Similar findings were observed in the RA patients, whereas deposits were rare in OA synovial samples. In addition, both anaphylatoxin C5a and the terminal complement complex C5b-9 were present at high levels, comparable to those in RA patients. The levels of mRNA for interleukin-1 beta (IL-1ß), IL-6, and the neutrophil marker myeloperoxidase (MPO) were markedly increased compared to those in the RA and OA patients. CONCLUSIONS: This present study is indicative of a pseudo-septic acute inflammatory reaction in response to local accumulation of hylan G-F 20 with the activation of complement and local invasion of pro-inflammatory cells.

[The evaluation of mortality in abdominal surgery of patients aged over 75. A retrospective study on a series of 111 cases]. / Evaluarea mortalitatii în patologia chirurgicala abdominala la pacientii peste 75 de ani. Studiu retrospectiv.

UNLABELLED: Abdominal surgery of patients aged over 75 is a real challenge, regarding the risk-benefit ratio, especially in emergency cases. The aim of the study was to assess the mortality in elderly patients admitted for abdominal surgical conditions. MATERIAL AND METHODS: A retrospective study was carried out on a series of 111 patients aged over 75 that died during hospitalization for abdominal diseases in the 3rd Surgical Unit during the period 2007-2010. Data from the medical files, operating books and pathology reports were collected and analyzed. RESULTS: Of the 61 cases admitted for benign conditions, 11 deceased prior to surgery due to high ASA risk. 50 patients underwent surgery, mainly on emergency basis (42 cases). Most of the patients in this group suffered from intestinal infarction (22), followed by abdominal sepsis (16), intestinal obstruction (12) and digestive bleeding (10). Resection followed by anastomosis was performed in 17 cases; of these, anastomotic fistula with sepsis developed in 7 cases (41%). Malignant abdominal diseases were diagnosed in 50 patients, most frequently colorectal cancer (25) followed by gastric cancer (14), pancreatic cancer (5), billiary duct carcinoma (3), malignant ampuloma (2) and hepatoma (1). In this group, 46 patients were operated on, mainly in emergency (35). Of the 32 cases where resection was performed, anastomostic fistula with sepsis developed in 21 (65,6 %). CONCLUSIONS: the main cause of death was abdominal sepsis due to anastomotic fistula following resections, for both benign and malignant condition.

Identical Mutation in SH3BP2 Gene Causes Clinical Phenotypes with Different Severity in Mother and Daughter - Case Report.

Cherubism is a particular form of fibrous dysplasia of the jaws. Familial occurrence was reported in most cases. The condition is a rare hereditary disorder with autosomal dominant inheritance, with complete penetrance in males and incomplete penetrance in females and variable expressivity. It is known to be caused by mutations in the gene encoding SH3-domain binding protein 2, SH3BP2 gene. Major diagnostic criteria are cherubic facial appearance, painless hard enlargement of the jaws, and frequently associated dental abnormalities. The aim of the study was to analyze clinical and genetic features of cherubism in a family with 3 daughters in which the youngest one was affected. Clinical and radiographic examinations, hematological and biochemical evaluations and biopsy were performed. Molecular genetic analysis consisted of PCR amplification and direct sequencing of selected exons of the SH3BP2 gene. Cherubism was suspected based on clinical and radiographic examinations of the 9-year-old daughter. She presented asymmetrical enlargement of the mandible, speech and swallowing problems and dental abnormalities on the lower jaw. There was no history of similar clinical findings in any of the daughters or the parents of the affected girl. Abnormal results were obtained by genetic analysis. A c.1244G>A mutation was identified in exon 9 of the SH3BP2 gene in the asymptomatic mother and her affected daughter. The identified mutation in the SH3BP2 gene is probably disease-causing. The asymptomatic mother transmitted the gene mutation to her affected daughter. Our results confirm the reduced penetrance and variable expression of the gene mutation.

Meta-analysis of 0 to 8 h post-prandial evolution of ruminal pH.

The objective of this study was to identify relevant descriptors of ruminal pH post-prandial evolution that can replace the mean pH (considered unsatisfactory). These descriptors are to be used in the attempts to predict ruminal pH from dietary characteristics, in order to quantify the potential of a diet to induce subacute ruminal acidosis from its intrinsic characteristics. A total of 219 pH curves, reported as graphics in 48 published articles describing the post-prandial evolution of ruminal pH (first 8 h), were digitized by image analysis then summarized in 15 pH variables. Relationships among pH variables and the principal components (PCs) of pH variability were analyzed in order to identify possible alternatives to mean pH, as the average value of all pH data the curve is composed of. Two groups of pH variables were identified according to their relationship with the most important principal components. A first group, including mean pH, was closely related to PC1, which accounted for 78% of data variability; hence, correlations between variables of this group were generally high. Of these, threshold-related variables were distinct as their within-study correlations with mean pH were rather moderate (0.69 on average). This suggests they might carry supplementary information that could explain the variation in ruminal pH induced by within-study factors, e.g. diet characteristics. However, caution should be taken in their use because of their truncation at 0 h and their non-normal distribution. Variables from the second group were independent of the PC1, and thus of the first group of variables, whereas they were mostly related to PC2 and PC3. This implies they are complementary to mean pH. Of this second group, the rate of pH decreases or the time period when pH reaches its minimum might be useful to better describe the ruminal status, from the point of view of the risk of subacute ruminal acidosis.

[Pancreaticoduodenectomy with or without pylorus preservation: a retrospective analysis of 137 patients]. / Duodenopancreatectomia cefalica cu sau fara prezervarea pilorului: analiza retrospectiva a 137 pacienti.

OBJECTIVE: We performed a retrospective study to assess the postoperative results, long-term survival and quality of life after pylorus preserving pancreaticoduodenectomy (PPPD) versus standard Whipple pancreaticoduodenectomy (WPD). METHODS: A retrospective study was performed in a nonselected series of 137 patients who were operated in the Surgical Clinics of "St. Spiridon" University Hospital Iasi, Romania, from January 1st, 1995 till December 31, 2005. Demographics, preoperative and intraoperative data, as well as postoperative morbidity, mortality and follow-up were analyzed. Quality of life, after to at least six months after discharge, was also studied. RESULTS: There were no significant differences noted in demographics data. Jaundice was more frequent in the PPPD group as for WPD patients (p=0.047). For the most patients the digestive reconstruction after resection were performed as in Child technique: the first anastomosis was pancreaticojejunostomy (end-to-end or end-to-side), the second anastomosis was hepaticojejunostomy (end-to-side) and the last anastomosis was gastrojejunostomy end-to-side (duodenojejunostomy in PPPD group). For 31 cases a pancreatico-gastrostomy were performed. We also noted 14 cases with pancreatico-gastrostomy and duodenojejunostomy end-to-end, and a Roux jejunal loop for 3 patients with previous gastrectomy and gastrojejunostomy (Reichel-Polya). The operating time was shorter in the PPPD group as in WPD (p < 10-3), but the mean blood loss was the same. Postoperative morbidity rate was 46.8% in PPPD group vs 39.2% in WPD (p > 0.05), but the reintervention rate was significant higher in PPPD group (30.6% vs 15%; p = 0.027). We also noted no significant differences of Delayed Gastric Emptying, postoperative mortality rate (14.5% in PPPD group vs 10.1% in WPD group) and mean survival time (42.42 months (24.94 - 59.89; 95% CI) in PPPD group vs 46.78 months (28.07 - 61.50; 95% CI) in WPD group; log rank test p = 0.643). Pathological exam diagnosed a malignancy in 109 cases (54 cases with pancreatic cancer); we noted chronic pancreatitis in 22 cases. Quality of life was also the same in the two groups. CONCLUSIONS: PPPD and WPD were associated with comparable results, but, there is a tendency of increase rate of postoperative morbidity and mortality for PPPD patients. We also noted that postoperative quality of life is the same for both procedures.

[Malignant peritoneal mesothelioma tumours. Evolution, treatment, prognosis]. / Tumorile maligne mezoteliale peritoneale evolutie, tratament, prognostic.

Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.

Invasive amebiasis.

Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.

Features of pathological assessment in rectal cancer.

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

[Necrotizing fasciitis]. / Fasciita necrozanta.

The management of a right foot necrotizing fasciitis and severe sepsis in an old diabetic patient is presented. The early and aggressive surgery, adequate antibiotherapy and correction of organic disfunction (cardio-circulatory, renal, respiratory) eliminated the vital risk and resulted in a satisfactory morpho-functional recovery of the foot.

[Spontaneous esophageal rupture in three patients]. / Ruptura spontana de esofag la trei pacienti.

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.

[Evidence-based colorectal cancer screening]. / Metode de screening in cancerul colorectal.

Colorectal cancer has been identified as an appropriate candidate for early detection and treatment of both asymptomatic individuals and those at risk of the disease. The lifetime incidence of colorectal cancer among persons at average risk is sufficiently high to justify screening the general population. This review presents the latest strategies employed in early detection of the colorectal cancer. An ideal screening test should satisfy some basic criteria: must be simple, secure, accepted by the population with valid and reproductive results. Despite the demonstrated benefits of colorectal cancer screening, incidence and mortality rates of this common cancer remain high. More optimally tailored screening tools are needed that combine the features of a potentially ideal screening test.

[Differentiated thyroid cancer--staging and prognostic systems]. / Cancerul tiroidian diferentiat stadializare si sisteme de scor prognostic.

Differentiated thyroid cancer (DTC), including papillary and follicular carcinoma with histological variants, has an excellent prognosis; nevertheless a subset of these tumours is clinically aggressive and, in some patients, fatal. Treatment of DTC remains controversial, regarding the extent of primary surgical resection, the need for lymph node dissection and the role of postoperative radioactive iodine ablation. In addition to the widely accepted TNM classification, recognition of significant risk factors and developing of staging systems, such as AMES, AGES, MACIS, MSKCC and NTCTCS, has helped to identify the patients with a potential aggressive course of the disease and high risk of recurrence. This has allowed the development of a rational and selective approach to therapy, thus, avoiding excessive treatment and subsequent morbidity without compromising the oncological outcome.

[Surgical initial attitude in epithelial ovarian advanced cancer]. / Conduita chirurgicala în cancerul ovarian epitelial avansat.

UNLABELLED: The purpose of this work is to show the value of aggressive excisional surgery in epithelial ovarian advanced cancer (COEA). MATERIAL AND METHOD: Between May 1993-May 1997, there were 103 obs. with ovarian diseases; 28 obs. (27.1%) with COEA and 75 obs. (72.9%) with benign diseases. All the patients had a subtotal hysterectomy with bilateral anexectomy and omentectomy. The operation was extended to other anatomic elements; in the case of 4 obs., we practiced a segmentary resection of left colon, 2 obs. had an anterior resection of the rectum and a partial resection of the pelvic peritoneum, 15 obs. suffered an excision of tumoral masses from the gastro colic omentum and the right parietocolic space and 7 obs. had a resection of pelvic peritoneum and of the right parietocolic space peritoneum. The optimal cytoreduction with a tumoral residuum less than 2 cm was realized for 23 obs. (82.14%) and for 5 obs., the tumoral residuum was greater than 2 cm (17.76%). The medium survival of the patients with a tumoral residuum inferior to 2 cm was 41 months, at 4 years 54% of the observations being alive, compared to only 14 months for the patients with tumoral residuum superior to 2 cm, at 4 years the survival being only of 15%. All the observations have beneficiated of chemotherapy. The disease reappeared for 23 obs. after a variable period of time. It's treatment consisted of: surgery followed by chemotherapy for 18 obs. and chemotherapy of second line alone for 5 obs. CONCLUSIONS: The ovarian epithelial cancers, famous for an intermediary answer to chemotherapy, lead to an aggressive surgical management with partial extra genital organ sacrifices, to offer a chance of life.

Pycnogenol efficacy in the treatment of systemic lupus erythematosus patients.

A pilot study was performed to evaluate the efficacy of Pycnogenol treatment in systemic lupus erythematosus (SLE) patients. Eleven SLE patients were treated with first line medication according to disease activity and in addition, six of them received Pycnogenol and five a placebo. The SLE disease activity index (SLEDAI), serum anti-dsDNA antibodies, fibrinogen, C-reactive protein levels, erythrocyte sedimentation rate, production of reactive oxygen species (ROS) by neutrophils, spontaneous apoptosis and p56(lck) specific activity in peripheral blood lymphocytes were evaluated. Pycnogenol treatment determined a significant reduction of ROS production, apoptosis, p56(lck) specific activity and erythrocyte sedimentation rate. In addition, the decrease of SLEDAI was significant in the Pycnogenol treated group compared with the placebo group (p = 0.018). The results obtained suggest that Pycnogenol could be useful for second line therapy to reduce the inflammatory feature of SLE.

Dysregulation of p56lck kinase in patients with systemic lupus erythematosus.

In this study we investigated one of the possible mechanisms of p56lck down-regulation in peripheral blood lymphocytes (PBLs) from Systemic Lupus Erythematosus (SLE) patients and we correlated p56lck dysregulation with accelerated apoptosis in SLE PBLs. PBLs from SLE patients and healthy donors were isolated. p56lck protein expression and lck mRNA level were estimated by immunoblotting and RT-PCR, respectively. FACS analysis was used to evaluate the apoptosis and p56lck levels in apoptotic and non-apoptotic PBLs. A non-radioactive Tyrosine Kinase Assay Kit was used to measure p56lck activity. Our results demonstrated that PBLs from SLE patients displayed lower levels of lck mRNA and p56lck protein as compared to healthy donors. The apoptosis of fresh or cultured PBLs was enhanced in SLE patients, especially in anti-DNA negative group. The expression of p56lck was inverse correlated with apoptosis of fresh and cultured SLE PBLs, especially in anti-DNA negative patients. Double staining FACS analysis showed that p56lck expression was lower in apoptotic than in non-apoptotic PBLs. p56lck specific activity was directly correlated to apoptosis in SLE PBLs. While the low expression of p56lck may be the result of lower degree of synthesis, the increased specific activity could directly correlated to the extent of apoptosis in SLE PBLs. Based on our observations, we assume that the p56lck dysregulation could play a role in SLE pathogenesis.