A prospective, multi-center, randomised controlled trial for evaluation of the effectiveness of the Blimp scoring balloon in lesions not crossable with a conventional balloon or microcatheter: the BLIMP study.

BACKGROUND: Balloon uncrossable coronary lesions are lesions that cannot be crossed with a conventional balloon. Multiple balloons have been designed to overcome this problem. The Blimp balloon has a very low scoring profile (0.6 mm) with a very high rated burst pressure (30 atmospheres). We aimed to evaluate the efficacy of this balloon compared to customary low-profile balloons. METHODS: We conducted a multicenter, prospective, randomised, controlled trial in which 126 patients with an uncrossable lesion were randomly (1:1 randomization) assigned to treatment first with the Blimp balloon or low-profile balloon. The primary endpoint was the success of crossing the lesion after initial failure with a microcatheter (group A) or with a conventional balloon (group B). RESULTS: Overall, the first attempt of Blimp was successful in 29 out of 61 cases (48%) while the LP balloon immediately crossed in 30 out 67 cases (45%; p = 0.761). Using a low-profile balloon in the BLIMP group after failure of the Blimp balloon increased the success to 64% (39 out of 61 cases). Using the Blimp balloon in the low-profile first group after failure of the low-profile balloon increased the success to 60% (40 out of 67 cases). After the placement of a guide catheter extension, the overall successful lesion crossing in the BLIMP group was 80% (49 out of 61 cases) compared to 76% (51 out of 67 cases) in the LP Balloon group (p = 0.327). CONCLUSIONS: The Blimp balloon catheter showed no superiority to customary low-profile balloons in uncrossable lesions. It can however be complementary in treating uncrossable lesions.

Investigation of the influence of different physico-chemical parameters upon the susceptibility of planktonic and adherent Escherichia coli cells to beta-lactams and quinolones.

The purpose of this study was to evaluate the influence of different physico-chemical parameters on Escherichia coli susceptibility to ceftriaxone (CRO), cefotaxime (CTX), imipenem (IMP), and nalidixic acid (as marker for resistance by impermeability). The influence of chemical composition of culture medium was evaluated by the comparative assessment of inhibition growth diameters on different solid media: Mueller Hinton Medium (MH), Plate Count Agar Medium (PCA), MacConkey Medium (MC) and Eosin Methylen Blue Medium (EMB). In order to evaluate the differences in antibiotic susceptibility between the biofilm embedded and planktonic cells, an original, simple experimental model was used, by including the bacterial cells in an agar layer, mimicking the biofilm matrix. Our results demonstrated that the inhibition diameter zone was much larger on PCA, EMB and MC than on MH, considered as general standard medium for the antibiosusceptibility testings (CLSI). When bacterial cells were included in the agar matrix, the growth inhibition diameters obtained for different beta-lactams proved to be different of planktonic cells, i.e.: for CTX, a narrow inhibition diameter was obtained, demonstrating the low efficiency of this antibiotic in the treatment of biofilm associated infections, whereas the CRO proved the same efficiency against planktonic as well as to agar embedded bacteria. The different susceptibility results obtained for the cells embedded in the agar matrix by an adapted disk diffusion method are pleading for the necessity to assess new adapted standard methods and specific parameters in the purpose to determine the antibiotic resistance of bacterial cells isolated from biofilm associated infections.

[Soft tissue reconstruction after total pelvic exenteration]. / Reconstructia defectelor tisulare dupa exenteratia pelvina totala.

Total pelvic exenteration leaves a major defect in pelvic-perineal region. Delayed healing, bowel fistulae, occlusion or protrusion and infection are frequent complications of this procedure. During 2000-2006, in General Surgery and Liver Transplantation Fundeni, 73 patients with advanced pelvic cancer and invasive recurrences were operated. For 42 patients, various procedures for pelvic and vaginal reconstruction (omental flap, muscular and musculo-cutaneous flaps--rectus abdominis and gracilis) were performed in order to fill the pelvi-perineal defects and restore form and function. Technical principles, indications, contraindications, advantages and disadvantages of these procedures are outlined. We found that complications related to total pelvic exenteration dramatically decreased and primary healing of the perineal wound was superior, facts that correlate with the literature data.

[Total pelvic exenteration in the treatment of advanced pelvic cancer]. / Exenteratia pelvina totala in tratamentul cancerului pelvin avansat.

Total pelvic exenteration (TPE) is a radical and aggressive procedure performed in the local advanced pelvic cancer started from any pelvic organ. The experience of 73 TPE performed for local invasive cancer and centro-pelvic recurrences with initial malignancy at the cervix (45 cases), rectum (19 cases), vagina (5 cases), endometrial (3 cases) and urinary bladder (1 case), in 61 females and 12 males with age range 27-78 years, are analysed. The procedures were performed for advanced pelvic cancer in 24 cases and also for invasive centro-pelvic recurrences in 49 cases (67.5%). In 5 cases, TPE was extended laterally. In 42 patients reconstructive procedures were added. All patients survived to surgery but 5 postoperative deaths (6.8%) were recorded. Complications occurred in 52% of cases, 38 from 73 patients had one or more than one complication with an average of 1.5 per patient. 22 among these patients (30%) requiring operative treatment. The average survival was 49.07 months, the median survival of 55 months and the estimated survival at 11 and 78 months was 66%, respectively 50%. The procedure is indicated in the absence of pelvic wall invasion and secondary distant dissemination and lengthens significantly the life span and increase the quality of life.

Multifunctional soft hybrid bio-platforms based on nano-silver and natural compounds.

Novel nanohybrids consisting of nano-Ag, chitosan, lipids and phyto-compounds (chlorophyll a and curcumin) have been achieved through a simple bottom-up strategy, resulting in stable (ZP=-30.9mV) and spherical-shaped nano-entities with size <200nm (estimated by AFM analysis and DLS measurements). The formation of these biohybrids was monitored by absorption and emission spectroscopy, exploiting the spectral fingerprint of chlorophyll a. The bio-performances of these hybrid materials such as: high antioxidant activity (96.63%), strong biocidal properties against Escherichia coli ATCC 8738 (exhibiting an inhibition zone diameter of 32mm), hemocompatibility, in vitro cytotoxicity against HT-29 cancer cells and no toxicity to normal cells (in the biohybrid concentration range of 5.7-17%), make them promising candidates in bio-applications (antimicrobial and antioxidant coating, cancer treatment).

[Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem]. / Tumora stromala de diverticul Meckel--cauza rara de hemoragie digestiva si problema de diagnostic.

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.

[Double localization of pancreatic insulinoma. Diagnostic and therapeutic difficulties]. / Insulinom pancreatic cu dubla localizare. Dificultati de diagnostic si atitudine terapeutica.

Insulinomas are the most common cause of hypoglycemia resulting from endogenous hyperinsulinism. Because most of insulinomas are less than 2 cm in size and rarely they not may be visible by CT scan or transabdominal ultrasonography. Intraoperative ultrasonography may be a solution. Although as surgical method is preferred enucleation because operative time is shorter and easier and the low frequency postoperative complications, pancreaticoduodenectomy Whipple is indicated in selected cases. We report a case of double insulinoma located in the head of the pancreas in which the diagnosis and surgical treatment presented difficulties which determined a particular clinical evolution.

Pathological characteristics and clinical specifications in gastroenteropancreatic neuroendocrine tumors: a study of 68 cases.

INTRODUCTION: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a group of tumors, having their origin in cells of diffuse endocrine system, with particular clinical course, diagnosis and treatment. PATIENTS AND METHODS: In our study, were included 68 patients with neuroendocrine digestive tumors admitted, diagnosed and treated in Fundeni Clinical Institute, Bucharest, in the last ten years--2000-2010 (retrospective study). RESULTS: Thirty-three (49%) patients were males, 35 (51%) females, and the main age was 58.9 years. In 62 (90.3%) cases was possible to find the primary tumor. The examined tumors had different localizations: pancreas--32 (47.04%) cases (head--17 (24.99%) cases, and body and tail--15 (22.05%) cases), stomach--7 (10.29%) cases, small intestine--7 (10.29%) cases, 6 (8.82%) cases--unknown primary site (diagnosis was established on metastases), right colon--6 (8.82%) cases, liver--6 (8.82%) cases, rectum--2 (2.94%) cases, and retroperitoneum--2 (2.94%) cases. Microscopic examination revealed 59 (86.8%) malignant tumors and 9 (13.2%) benign tumors. Using WHO 2000 Classification, 28 cases of malignant tumors were well-differentiated neuroendocrine carcinomas, and 31 cases were poor differentiated neuroendocrine carcinomas. From malignant cases, 25 (42.3%) have distant metastases and 15 (25.9%) lymph node metastases. CONCLUSIONS: Cases of gastroenteropancreatic neuroendocrine tumors included in our study had clinical and histopathological features in correspondence with data from literature--slight predominance in women, predominance in 5th and 6th decades of life, the most frequent localizations were at pancreatic level--both head and body and tail, but the rarest were in colon and retroperitoneum. Most of the cases studied, were malignant tumors, from these more than a half were poor differentiated, and a quarter of them having lymph node or distant metastases.

[Descriptive motor sciences]. / Motricitate descriptiva.

The paper presents a new approach to human movements and positions using Descriptive Geometry, a discipline used in 2D and 3D description of object positions in space. Some particular positions of the human body are depicted using a reference system formed by three orthogonal planes: horizontal, vertical and lateral. Positions of arms are described using precise terms used in Descriptive Geometry. The use of precise terms in human positions description can improve communication and understanding of more complex positions in space.

Research on the bacteriocinogen properties of Pasteurella.

Research on the bacteriocinogen properties of 86 Pasteurella strains, 37 of which being Pasteurella (P.) multocida and 49 P. haemolytica, was performed. -Relations of iso- and heteroantagonism were detected and described in the P. multocida and P. haemolytica species. The presence of bacteriocins previously detected in P. multocida was confirmed and extended to P. haemolytica as well. -The bacteriocinosusceptible strains determined the separation of a number of bacteriocinotypes within each Pasteurella species. -Besides the antagonism relations a reciprocal growth stimulation phenomenon was noticed between the two Pasteurella species. In this respect, P. haemolytica displayed a wider activity towards P. multocida than towards itself.

[Behavior of Mycoplasma strains in media with L-cystine]. / Verhalten von Mykoplasmastämmen in Medien mit L-Zystin.

Mycoplasma strains of all origins and species can grow on PPLO agar (pleuropneumonia-like organisms), if thallium and L-cystine are added. Brown-black is the coloration of the growing colonies, with the intensity of blackening varying by colony age. Blackening of the mycoplasma colonies is likely to facilitate germ counting, cloning, and evaluation of the growth inhibition test.

[Renal osteodystrophy (I)]. / Osteodistrofia renala (I).

Renal bone disease represents one of the major complications of end-stage renal disease, accounting for the numerous and various changes at bone level, determined by abnormal calcium and phosphorus homeostasis and by changes in calcitriol and PTH synthesis. PTH represents as well a major uraemic toxin, exerting profound systemic effects, particularly at the cardiovascular level. PTH synthesis is mainly controlled by changes in calcium-phosphorus balance and calcitriol production by the kidneys. Several others factors are important in the development of secondary hyperparathyroidism: acidosis, autonomisation of PTH secretion and peripheral (target-organ) resistance to PTH actions. Although bone biopsy represents the definitive diagnostic test to differentiate between osteitis fibrosa, low-turnover bone disease and bone involvement unrelated to disturbed calcium metabolism (i.e. beta 2-microglobulin-related amyloidosis), plasma intact PTH generally exhibits a reasonably good relation with bone histology parameters. Moreover serum bone-specific alkaline phosphatase isoenzyme, serum pyridinoline and the novel serum markers for bone turnover are highly specific and correlate with bone histomorphometry parameters, so that, preventive and therapeutic strategies should be re-evaluated based solely on biochemical parameters.

[Renal osteodystrophy(II)]. / Osteodistrofia renala (II).

Renal bone disease represents one of the major complications of end-stage renal disease, accounting for the numerous and various changes at bone level, determined by abnormal calcium and phosphorus homeostasis and by changes in calcitriol and PTH synthesis. PTH represents as well a major uraemic toxin, exerting profound systemic effects, particularly at the cardiovascular level. PTH synthesis is mainly controlled by changes in calcium-phosphorus balance and calcitriol production by the kidneys. Several others factors are important in the development of secondary hyperparathyroidism: acidosis, autonomisation of PTH secretion and peripheral (target-organ) resistance to PTH actions. Although bone biopsy represents the definitive diagnostic test to differentiate between osteitis fibrosa, low-turnover bone disease and bone involvement unrelated to disturbed calcium metabolism (i.e. beta 2-microglobulin-related amyloidosis), plasma intact PTH generally exhibits a reasonably good relation with bone histology parameters. Moreover serum bone-specific alkaline phosphatase isoenzyme, serum pyridinoline and the novel serum markers for bone turnover are highly specific and correlate with bone histomorphometry parameters, so that, preventive and therapeutic strategies should be re-evaluated based solely on biochemical parameters.

[Immunoprophylactic methods of prevention of pneumopathies in young cattle]. / Immunoprophylaktische Methoden zur Vorbeugung der Pneumopathien bei Jungrindern.

The bivalent Pasteurella vaccine used to immunise young cattle is an anaculture adsorbed to aluminium hydroxide and consisting of Pasteurella multocida and Pasteurella haemolytica serotypes which could be isolated; most often from pneumonically changed lungs and nasal mucus. It was administered together with trivalent antiviral vaccine and reduced by 50 per cent the loss rate due to mortality and emergency slaughtering. Good protection was obtained from applying the first vaccination dose on the supplier's farm.

[Identification of Pasteurella serotypes by indirect hemagglutination]. / Identifizierung der Pasteurellaserotypen durch indirekte Hämagglutination.

The indirect haemagglutination test was used for serological type identification of Pasteurella strains. The Pasteurella multocida strains were tested by parallel application of antigen production methods (common method plus hyaluronidase treatment). Thirty-nine (72.2 per cent) of 54 Pasteurella multocida strains, which had been obtained from cattle and swine, were serologically tested by the common technique of antigen production, their types being identified, while 42 (77.7 per cent) were tested and typed by means of hyaluronidase treatment. Depolimerisation of hyaluronic acid by means of hyaluronidase increased the agglutinability of eight strains (14.8 per cent) which could thus be identified by types. Serological identification of 47 (87.1 per cent) Pasteurella multocida strains was achieved by parallel use of the two antigen production methods. Identification was not possible of two strains. Cross-reaction was recorded from five strains. Most of the Pasteurella multocida strains isolated from cattle were A serotype (54 per cent), while those of swine were B strains (50 per cent). Thirty-six of 40 serologically tested Pasteurella haemolytica strains were serotypes A1, A2, T3, T4, A5, and A6, and most of these were A5 and T4.

Pasteurella infections in respiratory diseases of young cattle.

Bacteriological examinations performed on 545 extracts of pneumonia-affected lungs and on nasal secretions collected from pneumopathy diseased young cattle led to the isolation of 176 (32.2%) Pasteurella (p.) multocida strains and of 125 (22.9%) P. haemolytica strains. P. multocida was isolated in 46.2% of the lung lesions and in 22.5% of the nasal secretions, P. haemolytica in 26.6% and 20.3%, respectively. Pathogenicity in mice was detected in 81.9% of the P. multocida strains and in 19% of the P. haemolytica strains. Pasteurella strains were very susceptible to chloramphenicol (82.3%), tetracycline (68%), penicillin (47%), and ampicillin and resistant to oxacillin, streptomycin and kanamycin. P. multocida and P. haemolytica strains in the respiratory tract and lung lesions of young cattle affected by pneumopathies represent the main ethiologic agent accounting for the clinical symptoms, anatomic lung lesions and finally for the death of the animal.