ALZHEIMER'S DISEASE - ESTROGENS AND SELECTIVE ESTROGEN RECEPTOR MODULATORS, FRIENDS OR FOES?

Alzheimer's disease(AD) is the leading cause of dementia and is characterized by the presence of extensive plaque deposition and neurofibrillary pathology. The aim of the present study was to make an update regarding the influence of estrogens and SERMs on inflammation and on the resolution of inflammation, respectively, focusing on these most important features implicated in the pathophysiology of AD. Several hypothesised mechanisms of action of estrogens and SERM are exposed and also some relevant clinical studies on this subject are analysed. The analyzed studies have a high heterogeneity of preparations used, of administration routes, of the female population included and of the periods of time from the appearance/induction of menopause to the therapeutic intervention and also of follow-up periods of patients and of the means of evaluating their cognitive decline. One can say that all the ways of pharmacological influence on the membrane or intracellular signalling system associated to estrogens that may have clinical importance in the prevention and possibly in the treatment of AD have not been exhausted. Estrogens with selective ERα or G protein-coupled estrogen receptors (GPER1 or GqMER) effects could be used to influence the resolution of inflammation process, with positive effects on AD evolution.

Conservative surgery for borderline ovarian tumors--emphasis on fertility preservation. A review.

BACKGROUND: Borderline ovarian tumors account for 15-20% of all ovarian epithelial tumors. Since their original description in 1929, our knowledge of their natural history and molecular pathology has advanced most dramatically over the last two decades. This improved knowledge of BOT has permitted to drastically decrease the therapeutics of these tumors, which remains mostly surgical. METHOD: We studied the available literature on surgical management of BOT accentuating the most important aspects on this topic: radical vs. conservative treatment, fertility preservation. RESULTS: Although there are conflicting reports about some of the aspects of surgical management of these tumors, since BOTs commonly affect women of reproductive age, who have not completed childbearing, have an excellent overall prognosis and the majority of them (approximately 50% to 85%) are stage I at diagnosis, conservative surgery (unilateral salpingo-oophorectomy or cystectomy) can be safely performed after comprehensive surgical staging, in order to preserve fertility. CONCLUSION: Conservative surgery could be safely performed in young patients treated for BOT, provided that they are carefully followed-up.

[Umbilical hernia in adults: laparoscopic approach with prolene mesh--is it a safe procedure?]. / Hernia ombilicala (HO) la adult: plasa de prolene montata laparoscopic este un procedeu eficace?

INTRODUCTION: The laparoscopic approach for umbilical hernia is more and more used, but few results are reported. The aim is to evaluate the efficacy and safety of using the Prolene mesh placed laparoscopically in umbilical hernia treatment. MATERIAL AND METHOD: Between 2004-2006, 21 patients with umbilical hernia, aged of 34 to 77 years, were submitted to intraperitoneal application of a Prolene mesh to cover the umbilical ring. The mesh was sewed by Protack staples or transfascial stitches. Before deflating the patients, the greater omentum was interposed between the mesh and the bowel. It is notice that 8 patients were obese, 6 patients had omental or bowel adhesions to the peritoneal sac and 5 patients had ascites due to liver cirrhosis. The patients were discharged 24 to 48 hours after the operation and followed up for 6 to 12 months. RESULTS: All patients were alive at the end of follow-up, without hernia recurrence or complications due to the Prolene mesh in the abdominal cavity. In 3 patients we registered subcutaneous seromas for 1 to 3 weeks (imposing evacuation by punction) and 5 patients kept a mildly deformed umbilical scar after the cure of large hernias. DISCUSSIONS: In the literature are mentioned the techniques using composite or two-layers meshes. Prolene meshes are not agreed by some authors, for the supposed risk of bowel lesions. In our trial were no such complications. CONCLUSION: Laparoscopic repair using Prolene intraperitoneal mesh in umbilical hernia is a safe, efficient and rapid method, avoiding infections complications in obese or cirrhotic patients.

Impact of chronic administration of anabolic androgenic steroids and taurine on blood pressure in rats.

Supraphysiological administration of anabolic androgenic steroids has been linked to increased blood pressure. The widely distributed amino acid taurine seems to be an effective depressor agent in drug-induced hypertension. The purpose of this study was to assess the impact of chronic high dose administration of nandrolone decanoate (DECA) and taurine on blood pressure in rats and to verify the potentially involved mechanisms. The study was conducted in 4 groups of 8 adult male Wistar rats, aged 14 weeks, treated for 12 weeks with: DECA (A group); vehicle (C group); taurine (T group), or with both drugs (AT group). Systolic blood pressure (SBP) was measured at the beginning of the study (SBP1), 2 (SBP2) and 3 months (SBP3) later. Plasma angiotensin-converting enzyme (ACE) activity and plasma end products of nitric oxide metabolism (NOx) were also determined. SBP3 and SBP2 were significantly increased compared to SBP1 only in the A group (P<0.002 for both). SBP2, SBP3 and ACE activity showed a statistically significant increase in the A vs C (P<0.005), andvs AT groups (P<0.05), while NOx was significantly decreased in the A and AT groups vs controls (P=0.01). ACE activity was strongly correlated with SBP3 in the A group (r=0.71, P=0.04). These findings suggest that oral supplementation of taurine may prevent the increase in SBP induced by DECA, an effect potentially mediated by angiotensin-converting enzyme.

Impact of maternal melatonin suppression on forced swim and tail suspension behavioral despair tests in adult offspring.

Melatonin is an essential hormone, which regulates circadian rhythms and has antioxidative and anticarcinogenic effects. As melatonin secretion is suppressed by light, this effect was examined on the offspring of the Wistar rat females exposed to continuous light (500 lux) during the second half of the pregnancy (day 12 to 21). Control rats were kept under a 12:12 light-dark cycle. The resulted male offspring have been behaviorally assessed for depression after postnatal day 60 by using Forced Swim Test (FST) and Tail Suspension Test (TST). Animals resulted from the melatonin deprived pregnancies have developed an abnormal response in the TST, but a normal FST behavior. Also, TST active movement was different in the melatonin suppression group compared to the control group. These findings suggest that intrauterine melatonin deprivation might be linked to the depressive like behavior in adult male offspring.

Meckel's diverticulum--a rare cause of intestinal obstruction in adults.

Although many people have Meckel's diverticulum, only some experience any symptoms, most under the age of 10. In adults it is usually asymptomatic but approximately 4% develop complications. Meckel's diverticulum is usually diagnosed in the first years of life and after that the risk of the complications decreases with increasing age, with no predictive factors for the development of complications. We describe the case of a 34-year-old man admitted in the emergency department with diffuse abdominal pain, nausea, flatulence and lack of transit for feces and gas. The patient had been previously operated for peritonitis due to a perforated ulcer. Clinical examination and paraclinical investigations (abdominal radiography and ultrasound) suggested the diagnosis of intestinal obstruction, probably produced by adhesions due to previous abdominal intervention. The diverticulum was resected using a linear stapler and the patient recovered without any complications. Small bowel obstruction due to Meckel's diverticulitis may be caused by entangled loop of small bowel around a fibrous cord, intussusception, volvulus, or incarceration within a hernia sac. The discovery of a Meckel's diverticulum complication in a mid thirties patient represented an intra-operatory surprise and is the peculiarity of the case.

[Incidents, accidents and complications in laparoscopic surgery]. / Incidente, accidente si complicatii în chirurgia laparoscopica.

Between 1995-1999 in Coltea Surgical Clinic were performed 2498 laparoscopic operations (1957 cholecystectomies, 541 other procedures). The laparoscopic approach consisted in 1 to 6 ports of 5 to 12 mm. Conversional rate was, 176% and reintervention was required in 0.76% of cases. In 4 cases (0.10%) parietal bleeding imposed conversion or early reintervention. Parietal emphysema was not significant in our trial. Wound infection or chondritis occurred in 0.72% of cases; only one patient had to be reoperated. Post-incisional hernia developed in 0.08% of patients. We don't treat patients with cancer by laparoscopic approach, but the 4 patients with unknown neoplasia in our trial didn't develop port metastases. Our trial suggests the real benefit of the laparoscopic approach also concerning parietal morbidity.

[Nonparasitic serous cysts of the liver]. / Chisturi seroase neparazitare ale ficatului.

On the occasion of the presentation of four cases of serous hepatic cysts, of non parasitic origin, the authors comment on the rarity of this affection, although in the last time, asymptomatic cases can have a frequency of 1% after screening with ultrasounds and CT Scan. Is presented a series of data concerning the etiopathogenesis, the clinic and the treatment of such cases.

[Diagnostic and treatment problems in primary malignant tumors of the small intestine]. / Probleme de diagnostic si tratament în tumorile primitive maligne ale intestinului subtire.

Between 1984-1994, 8 cases of MTSI (7 males and one female, between 24-53 years age) have been operated in our Department, representing 2% from all malignant gastrointestinal tumours. The pain as a result of the obstruction, followed by chronic blood loss with anemia and perforation, (4 patients operated in emergency) were the most frequent symptoms, the tumors being localised on jejunum (3) and ileum (5) with a diameter to 3-15 cm. Lymphatic (4), hepatic (2) and peritoneal (I) metastases were present. We performed a wide resection of the bowel and mesentery, including lymph nodes (in 4 cases with radical intention). Histopathological findings: 4 adenocarcinoma, 3 leiomyosarcoma and a lymphoma. Postoperative treatment was selective and consisted in polychemotherapy (PCT) and cobalt therapy (60Co). There was no postoperative mortality, two local recurrences in 6 month. Survival rate at 5 patients was 32 month. At 5 years were in life 2 leiomyosarcoma and 1 adenocarcinoma and at 7 yrs, 1 leiomyosarcoma and 1 adenocarcinoma.

[Considerations on 988 breast cancers]. / Consideratii pe 988 cancere de sân.

AIM: Therapy schedule improvement. MATERIAL & METHOD: The study includes 988 patients (which 16 men) with breast cancer who underwent surgery between 1984-1998. Out of them 63.2% were in advanced stages. The patients were divided in 2 homogenous groups: trial A = 520 patients treated between 1984-1991 (in stade: I = 2, II = 240, III = 246, IV = 32) studied retrospectively, and trial B = 468 patients treated between 1992-1998 (in stade I = 3, II = 212, III = 235, IV = 18) studied prospectively. In trial B the complex therapy schedule was improved according to disease's stade, local breast aspect and patient's biological status, straining on neoadjuvant therapy. To the entire group 945 radical mastectomies (95.6%) were performed. Only 628 (63.5%) could be properly followed up. RESULTS: Global 5 years survival rate was 72% (improved from 69% in trial A to 72% in trial B). The survival rate varied according the stage from 100% (stade I), 88% (stade II), to 22% (stade III) and 2% (stade IV). In the advanced states, the local recurrencies at 5 years were of 22% and the methastases of 17%. CONCLUSIONS: The neoadjuvant therapy, selectively applied upon stade and patient improves the 5 year survival rate. Every patient with an advanced breast cancer can benefit of a complex, differentiated and well guided treatment. The adequate operation earn the important role in powering the neoadjuvant and adjuvant therapies. Further results improvement requires restarting the collectivities and high risk persons screening.

[Preliminary results after the transperitoneal laparoscopic treatment of the first 50 inguinal hernias]. / Rezultate preliminare dupa cura laparoscopica pe cale transperitoneala a primelor 50 hernii inghinale.

The authors are presenting the results of first 50 inguinal hernias treated laparoscopically trough the transperitoneal approach (39 men, 11 women, mean age--42,5 years, 44 uncomplicated and 6 epiploon's incarceration). After the dissection of the hernia's pouch, the parietal defect was covered with Prolène meche in 15 cases, with Marlex in 10 cases and Plastex prosthesis in 25 cases, all of them without fixation. The prosthesis itself was covered with the parietal peritoneum in running suture. The immediate postoperative evolution was good, the patients being able to walk soon after being awake, and without any urinary problems (even in elder patients). The patients left the hospital 24-48 hours after surgery. They were followed-up 2 to 10 months, periodically. The results were good, except 4 patients: 1 case with port-site hematoma (in the right lower quadrant, necessitating open surgery). 2 patients with seromas (vulvar and scrotal) in case of section and abandoning the hernial pouch. 1 patient with prosthesis migration with precocious recidive (24 hours after the operation). We consider the transperitoneal approach as very good in the treatment of uncomplicated and not very large hernias. The easiest and safest technic is that using Prolène prosthesis.

[High obstruction in strangulated diaphragmatic hernia]. / Ocluzie înalta prin hernie diafragmatica strangulata.

Case report of a 57-year-old man, admitted in emergency, because of high occlusion and severe dyspnea. The physical examination and the imagistics explorations established the diagnostic of strangulated left diaphragmatic hernia. After a short re-equilibration, the surgical approach was made by left thoracophrenolaparotomy and on realize the visceral reduction, the treatment of visceral injuries and the plasty of the pretty high diaphragmatic defect with a nylon mesh. The postoperative evolution was difficult, with hemorrhagic gastropathy, blocked evisceration, pneumonia and left pleural empyema. The control at 10 months show a patient appearing very well, with a voluminous eventration (who need surgical treatment) with normal image on the chest radiography, left hemidiaphragm in normal position and immobile, the gastrointestinal tract sitting intraabdominal, without parietal injuries.

[Left lumbar sympathectomy via the retro-pneumoscopic approach. The technical considerations]. / Simpatectomia lombara stânga pe cale retropneumoscopica. Consideratii tehnice.

Retropneumoscopic lumbar sympathectomy is performed with an increasing frequency as a treatment of chronic obstructive arteriopathies; though the method has limited indications. We present the operative technique as it was performed în the Coltea Surgical Department in 2 patients. We highlights on difficulties advantages and disadvantages of the method.

[Acute nonbiliary and nontraumatic pancreatitis. The diagnostic and treatment characteristics]. / Pancreatite acute nonbiliare si netraumatice. Particularitati de diagnostic si tratament.

Deeper knowledge of the etiopathogenesis of acute pancreatitis and the possibility to estimate the extend and gravity of pancreatic and peripancreatic lesions determined essential fluctuations in treatment evolution. Etiology of nonbiliary and nontraumatic A.P. recognises in the first place alcoholism (20-25% of A.P.) and in the second place less common causes such as: hypercalcemic states, hyperlipidemia (about 5-10% of A.P.). Diagnosis of nonbiliary A.P. leans upon: antecedents of chronic alcoholism, alteration on liver function tests and serum put levels and the results of cholecystocholangiography, abdominal ultrasonography and duodenum tubing. These reveal the absence of gallstones, cholesterolosis or anomalies of papilla of Vater (sphincter of Oddi). A number of 128 patients with acute pancreatitis were admitted to the clinic in the period 1984-1994 from which 48 with a non-biliary and non-traumatic. A complex medical treatment was applied to all patients but only 25 responded favourably, the remaining 23 necessitating surgical intervention, which was effected on de-shocked and re-equilibrated patients, diminishing thus the number or repeat interventions in the complications which may appear in such cases. Thus postoperative mortality fell from 58, 33 to 30, 76.

[Vulvar cancer. The therapeutic aspects]. / Cancerul vulvar. aspecte terapeutice.

Even though it has a low frequency (4 - 5%) compared to genital cancers, it has certain biological features represented by the possibility of multicentric localisation what performs on the dystrophic lesions, the presence of the inguinal nodes, the sensibility of the irradiation of the cancer and nodes and the efficacity of the treatment of the treatment of the bleomicine which request many therapeutical problems. Between 1985-1994, in Coltea Surgery Clinic there were operated 13 vulvar carcinoma, in women between 45-69 years old, in stages II (6), III (4) and IV b (3). Primary lesion was on labia major (11), labia minor (1) and posterior fourchette (1). Preoperative radiotherapy was made in 9 patients. At 3 patients, valvar lesion represents the second cancer--in all cases were syndrome neoplasia, after cervix neoplasia (2) or ano-rectal neoplasia (1) which were operated. At histopathological exam all cancers were spinocellular epithelium keratosis in 10, non-keratosis in 2 or trabecular in 1. The surgical treatment was selective and consisted in total vulvectomy (9), vulvectomy with inguinal lymphadenectomy (3) and left colostomy (1) after ano-rectal invasions and intestinal obstruction. The postoperative mortality and complications were zero. Postoperative treatment consisted in radiotherapy in association with chemotherapy 93) or only chemotherapy (8). The survival rates at 3 years (2), 5 years (30, 7 years) (3) and 10 years (2), justify the complex treatment. In conclusion, vulvectomy represents the specific treatment associated with inguinal lymphadenectomy in case of lymph nodes metastasis. Postoperative radiotherapy and postoperative chemotherapy seem to increase the survival rate.

[Laparoscopic appendectomy in obese patients. A comparative study with open appendectomy]. / Apendicectomia laparoscopica la obezi. Studiu comparativ cu apendicectomia deschisa.

The aim of this study is to show the advantages of laparoscopic versus classic appendectomy in obese patients. The trial includes 32 obese patients which underwent laparoscopic surgery for appendicitis in our clinic, compared to a similar trial of patients with open surgery. In both o trials we followed-up the operating time, postoperative pain, hospitalization and social and professional reintegration. We noticed that in laparoscopic appendicectomy patients postoperative pain and hospitalization are reduced, the bowel transit restants rapidly and spontaneously, there are no wound complications and patients recover faster. The disadvantages consisted in longer operative time and higher cost of the laparoscopic operation versus classic appendectomy.

[The different indications for the Roux-en-Y jejunal loop]. / Indicatii deosebite ale ansei jejunale în Y "à la Roux".

On an unitary series of 64 patients with a gastro-jejunal anastomosis, en Y "à la Roux", 24 had the special indications: reconversion of a anastomotic gastro-duodenal or gastro-jejunal fistula, large gastric resection for cancer, postbulbar ulcers, hemorrhage duodenal ulcer associated with diverticula, stump duodenal fistula, desinsertion of Vater papilla, giant pancreatic pseudocysts, inextirpable principal duct tumors, complexes biliary fistula, and central hepatic hydatic cysts. The results were good. On discuss the general and special advantages and the disadvantages of this method.

[The surgical possibilities in locally advanced gastric cancer (LAGC)]. / Posibilitati chirurgicale în cancerul gastric avansat local (C.G.A.L.).

Most frequently the diagnostic of gastric cancer is established in advanced stages. Practically, was noticed that local evolution advances the appearance of metastases. The authors are presenting 159 cases of locally advanced gastric cancer (LAGC) out of 211 gastric cancers submitted to surgery between 1984-1995. The surgical possibilities in such situation specifically adapted to each case, are discussed. The operation has an important role in appreciating local and regional extension, solving complications and even performing radical resections.

[The classical or laparoscopic operation in inguinal hernias]. / Operatie clasica sau laparoscopica în herniile inghinale.

AIM: Results evaluation in two trials of patients undergoing classical or laparoscopic surgery for inguinal hernia. MATERIAL AND METHOD: We compared 2 homogeneous trials of 80 patients with inguinal hernias treated by classic procedures: Bassini, Shouldice, Lichtenstein (trial I) or by laparoscopic approach with Plastex, Mercilene or Prolene prosthesis (trial II) between 1995-1997. RESULTS: Postoperative morbidity consisted in trial I in 5 seromas, 2 hematomas, 4 cases with neuralgic pain, 1 with testicular hypotrophy and 4 recurrences. In this trial the mean operative time was 22 min. and the mean hospitalization was 7 days. In trial II we registered a parietal bleeding at a lateral port imposing the conversion, 3 serohematomas, 2 recurrences by displacement of the prosthesis and 2 cases of neurologic pain. The mean operative time was 50 minutes and the mean hospitalization was 3 days. CONCLUSION: In spite of the longer operative time and the higher cost (the price of the prosthesis), in trial II the benefits of shorter hospitalization, lower morbidity and rapid socioprofessional reintegration are significant.

[The place of laparoscopy in assessing and treating a pain syndrome of the right iliac fossa]. / Locul laparoscopiei în evaluarea si tratamentul sindromului dureros de fosa iliaca dreapta.

The study is considering a trial of 87 patients (61 women 17 and 76 years old) admitted in our clinic between 1995-1996. The preoperative diagnosis was coincident with the laparoscopic one in 10 cases the laparoscopic one in 10 cases the laparoscopy completed the diagnosis and in 12 cases it showed out other organ's disease, evicting useless operations. In the 87 patients we performed: 53 appendectomies, 20 oophorectomies, 15 partial oophorectomies, 9 right adnexectomies, 2 adhesiolysis, 2 lymph node biopsies, 1 epiploic fringe excision for necrosis, 1 appendicular stump removal. The evolution was favourable in all patients, the mean postoperative hospitalization was 48 hours.