[General anesthesia in ophthalmology]. / Particularitati farmacoterapeutice în anestezia generala în oftalmologie.

General anesthesia is less utilized in ophthalmology. There are some criteria that lead to general anesthesia: patients with auditive debility, aged and senile patients, allergic patients, children and young patients, and subjects who totally refuse loco-regional procedures. General anesthesia utilizes as basic products: narcotic substances, analgesic substances, or neuroleptic substances utilized separately or associated, with posology adaptated to several factors: patients' pulse, physical statement, age, duration. The type of anesthetic substance depends also of specialist anesthetist experience.

Immunohistochemical expression of growth factors in the exocrine pancreas of patients with chronic liver diseases.

Acute viral hepatitis has been reported to cause acute pancreatitis. It was also reported that exocrine pancreatic function is damaged in chronic liver disease (CLD). Growth factors stored in the extracellular matrix and released in the course of pancreatic degradation are major mediators of inductive processes. The immunostaining technique was used to evidence the changes of the expression of the growth factors in different pancreatic cells. VEGF and FGF-beta are involved in the angiogenesis processes and in the evolution of the pancreatic interstitial tissue in case of chronic pancreatitis. Theses markers can also be used for the diagnosis of pancreatitis, but their value is variable. They stimulate the pancreatic star cells, the myofibroblasts and play an important role in the genesis of the extracellular matrix and in the repairing of the tissue after the aggression. TGF beta is important for its role in cellular differentiation and growth and in the development of the fibrosis in liver and other organs. The present paper studies the immunohistochemical expression of these growth factors in pancreatic cells.

Distinct ErbB-2 coupled signaling pathways promote mammary tumors with unique pathologic and transcriptional profiles.

ErbB-2 overexpression and amplification occurs in 15% to 30% of human invasive breast carcinomas associated with poor clinical prognosis. Previously, we have shown that four ErbB-2/Neu tyrosine-autophosphorylation sites within the cytoplasmic tail of the receptor recruit distinct adaptor proteins and are sufficient to mediate transforming signals in vitro. Two of these sites, representing the growth factor receptor binding protein 2 (Grb2; Neu-YB) and the Src homology and collagen (Shc; Neu-YD) binding sites, can induce mammary tumorigenesis and metastasis. Here, we show that transgenic mice bearing the two other ErbB-2 autophosphorylation sites (Neu-YC and Neu-YE) develop metastatic mammary tumors. A detailed comparison of biological profiles among all Neu mutant mouse models revealed that Neu-YC, Neu-YD, and Neu-YE mammary tumors shared similar pathologic and transcriptional features. By contrast, the Neu-YB mouse model displayed a unique pathology with a high metastatic potential that correlates with a distinct transcriptional profile, including genes that promote malignant tumor progression such as metalloproteinases and chemokines. Furthermore, Neu-YB tumor epithelial cells showed abundant intracellular protein level of the chemokine CXCL12/SDF-1alpha, which may reflect the aggressive nature of this Neu mutant mouse model. Taken together, these findings indicate that activation of distinct Neu-coupled signaling pathways has an important impact on the biological behavior of Neu-induced tumors.

[Local anesthesia in ophthalmology]. / Anestezia locala în chirurgia oculara.

Ocular surgery presents some particularities: local anesthesia continues to be the most utilized and it consists in topical corneo-conjunctival anesthesia and local or regional infiltrative anesthesia. The term of locoregional anesthesia is utilized in ophthalmology for the reason that the two forms of anesthesia could be associated. In this paper the authors insist on different types and methods of anesthesia utilized in ophthalmology and on indications and benefits of each method. There are also presented the incidents and complications of local anesthesia in ophthalmology.

[Retinopathy in severe acute pancreatitis]. / Retinopatia din pancreatita acuta severa.

Retina examination performed in patients with severe acute pancreatitis showed intra and peri-retinal hemorrhages. They were associated with cottonwool exsudates induced by micro-infarction of the retina and the optic nerve similary to the Purtscher retinopathy. This feature of the retina examination indicates a severe outcome due to the multiple organ failure syndromes. This condition mainly developed in young male patients between 36 and 56 years of age. In 2 patients with septic shock, acute hemorrhagic retinopathy was identified within the first 24 hours and the patients died after a few days, while for other 3 patients with septic shock the outcome was also death after a few weeks. For 9 patients with severe sepsis, examination of retina showed perivascular exudates and vascular occlusion subsequently leading to partial optic atrophy; examination of other 6 mild sepsis patients did not show any retinal abnormalities. Ophthalmoscopy performed within the first 24 hours for patients with severe acute pancreatitis is a predictor of disease evolution and outcome.

Histopathological changes in acute ischemic stroke.

We study here the histopathological changes in twenty-two cases of acute ischemic stroke. The average age of the patients was 62-year-old, and the interval from the onset of the disease to the death varied from 6 hours to 15 years. The brain lesions after acute stroke were observed in all regions. Their evolution allowed us to classify them in fourth stages. Phase one changes (1-2 days after onset) (n=2 patients) included red hypoxic and "ghost" neurons and other acute neuronal injury and spongiosis. The second phase (n=14 patients) was subdivided into: (a) a phase of acute inflammation (3-37 days after onset) (n=5 patients), where we observed especially features of acute inflammation together with coagulative necrosis, and (b) phase of chronic inflammation (10 days-53 years after the onset) (n=9 patients), in which prevail mononuclear and macrophage infiltrate, astrogliosis, spongiosis and neo-vascularization. In the third phase (26 days-23 years after the onset), we included six cases characterized by the absence of an inflammatory reaction, presence of cavitation, astrogliosis and macrophages. Our study describes the heterogeneity of brain injury after acute ischemic stroke with the participation of all brain components, and the chronology in which these lesions develop and evolve.

The complexity of hemorrhage-generating factors in various organs in acute kidney injury.

Bleeding disorders, associated with macroscopic and microscopic lesions in different organs are frequently found in acute kidney injury (AKI), in the third stage of the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification, treated by hemodialysis. The study included 81 cases of AKI of various causes (septic, posttraumatic, postoperative, toxic, medical nephropathies). 59.25% of the patients presented various forms of bleeding disorders (gastrointestinal bleeding, meningo-cerebral hemorrhage, epistaxis, hemodialysis vascular access bleeding, etc.). In the deceased patients that underwent necropsy, various bleeding lesions were found, involving the lungs, kidneys, brain, gastrointestinal tract and liver. A physiopathological interpretation of the factors generating these lesions and their impact on the evolution and prognosis was performed. These factors are related to the AKI's etiology, as well as the physiopathological disorders regarding the uremic syndrome and the various therapies required (blood transfusions, hemodialisys, heparin administration, surgery, macromolecule perfusion). In conclusion, multiple factors are involved in causing bleeding disorders in various organs with a major impact on the evolution and prognosis of AKI patients.

Microscopic assays regarding the renal damage following a post-combustional shock.

Over a period of three years (2000-2003) 39 autopsies were performed on patients with burns. Among them a number of 11 men and 28 women were aged between 28-92 years, the total burnt body surface was of 20% to 95%. Of all the cases nine patients died during the first 24-36 hours since the accident happened, presenting a burnt surface of more than 70%. In these cases, the renal lesions were minor but critical, presenting symptoms of acute renal failure (ARF). Subsequently, a number of 25 patients died within 1-4 weeks since the accident. Renal lesions were complex with tubular necrosis, lymphocyte infiltration and micro-abscesses. The burnt body surface of these patients was of 41-85%. In three cases, when death occurred within four weeks of hospitalization, the patients presented damages to other organs as well (multiple organs failure--MOF). The kidneys displayed tubular necrosis, fibrous micro-thrombi and infarct areas. In two cases coagulation intravascular dissemination occurred in patients with burnt body surface of 45-70% and aged of 42 and 60 years. Micro-thrombi and infarct areas dominated the renal lesions.

Electronic microscopic evaluation of the Beta insular cells in type 2 diabetes.

In this work it has been done an electronic microscopic evaluation of the intra-cytoplasmic organelle devices of the pancreatic beta insular cells in the type 2 diabetes mellitus (insulin independent). The motivation of this study is the lesions noticed within another study, photonic microscopic, reason why we have considered it important to show up as well the interest modifications of the constitutive organelles of the beta insular cells.

[Eclamptic amaurosis]. / Amauroza acuta tranzitorie în post-partum.

A 16 years old pregnant women with no pathological antecedents, with normal blood pressure and biological parameters and without edema, presents an eclamptic crisis before delivery and another one after delivery, with total amaurosis. The eye fundus examination did not show pathological elements. The brain computerized tomography revealed the hypodense areas with ischemia aspects, about 5/2 cm in left occipital lobe and 3/1 cm în right loccipital lobe, also left parieto-occipital hypoperfused areas. In development of occipital ischemia beside placenta ischemia, genetic and immunologic factors there is also an inflamatory element determined by cytokines released from placenta.

The Predictive Value of Scores Used in Intensive Care Unit for Burn Patients Prognostic.

PURPOSE: Statistical evaluation of the prognosis of burned patients based on the analysis of prognostic scores as quickly and easily obtainable that track the evolution of burned patient in ICU. Material / Methods: The prospective study included 92 patients were performed with severe burns on 35-67% body surface large area, aiming to establish a cut-off score for each studied and statistically significant prognostic parameter for assessing the risk of mortality. The control group was represented by 20 patients with burns on the body surface of <10%. RESULTS: The death rate was not statistically significant on burned (p> 0.05) sex (male / female), but we had p <0.001 when we referred to the total body surface area, and p <0.05 when we took into account the degree burns, acute respiratory distress syndrome and age. For each index / prognostic score studied by making ROC curve when they take different values, we set a cut-off. Quantification of variables by calculating the area under the ROC curve (AUC), sensitivity and sensitivity, positive predictive value (PPV) and negative predictive value (NPV), allowed a better appreciation of these prognostic scores. CONCLUSIONS: These systems applicable to the burned patient scores, making a cut-off of each index / mortality probability score, he can manifest usefulness in medical decision making process and strategy to reduce the risk of death in patients with severe burns.

The expression of CK19, vimentin and E-cadherin in differentiated thyroid carcinomas.

Thyroid carcinomas constitute lesions with an ascending incidence, for which many prognosis assessment systems were developed. This study focused on analyzing the immunoexpression of CK19, vimentin and E-cadherin in a number of 43 differentiated thyroid carcinomas, of which 39 papillary carcinomas and four follicular carcinomas, and assessed the relationship of these markers with clinico-pathological parameters of interest, such as age and gender of patients, the histological type and subtype, tumor size and extension, metastases in regional lymph nodes and tumor stage. CK19 immunostaining indicated higher scores in conventional and follicular papillary carcinomas compared with tall cell variant. In relation to the size and extension of the tumor, we found significantly higher values of vimentin and E-cadherin scores in T1-T2 carcinomas compared with T3-T4 category and a positive linear distribution of these markers, which sustain their involvement in common mechanisms of tumor progression.

Fronto-parietal pial extension of a basal cell carcinoma of the scalp - case report.

Basal cell carcinoma is the most common malignant tumor of the skin, and it develops most frequently on the head and neck regions. Although most of these tumors are slow growing and with a limited evolution, the existence of some aggressive variants accompanied by a complete neglect from the patient may occasionally lead to invasion of the face and organs of the head and neck. Even though, intracranial invasion of basal cell carcinoma of the scalp is a rare presentation. We describe here the case of a woman who developed an aggressive and neglected morpheiform basal cell carcinoma (ulcus terebrans), which showed a complete invasion through the skull, but with an apparent self-limitation to the pia mater.

The expression of twist in differentiated thyroid carcinomas.

Differentiated thyroid carcinoma are lesions with a generally favorable prognosis, although there are patients with risk of recurrence and metastasis. In this study we analyzed 43 thyroid carcinomas referring to Twist expression in relation to clinicopathological parameters. The immunoreaction was identified in 79% of cases, the expression of twist being low or high, with no differences in relation to the tumors type or subtype. Twist immunoexpression differ depending on tumor stage and presence of metastases, the immunostain being significantly higher in invasive tumors to adjacent structures and in cases of tumors with metastasized. In differentiated thyroid carcinomas overexpression of Twist is associated with an invasive and metastatic immunophenotype.

Gastrointestinal stromal tumor, jejunal atresia and stenosis in a neonate.

Gastrointestinal stromal tumors could rise in different areas of the digestive tract, at any age, but very rarely in neonates. We present the case of a 5-day-old male, with intestinal stenosis and atresia (type II) operated for peritonitis. On the resected specimen, the histopathological examination revealed a small gastrointestinal tumor of 8 mm. The immunohistochemical analysis indicated a low malignant potential. He is currently at two years of oncologic follow-up with no evidence of disease.

The evaluation of p16 and Ki67 immunoexpression in ameloblastomas.

In this study, we investigated the p16 and Ki67 immunoexpression in 19 ameloblastomas in order to highlight some correlations of these markers with the aggressive variants of tumors. The p16 immunoreaction was present in 90.9% of cases; the highest scores are present in the typical follicular and in the intraluminal unicystic variant, at the opposite pole being the granular cells variant. In these cases, the maximum reaction was observed at the level of the stellated reticulum cells while the lowest reaction was present at the level of cubico-cylindrical peripheral cells of the neoplastic islands. The Ki67 immunoreaction was present in all cases, the highest scores being present in the typical follicular variant, opposite being the ameloblastoma with granular cells cases and that with acanthomatous differentiation type. The immunostained cells were located predominantly at the periphery of the tumoral islands but also in the stellated reticulum cells in the central area. The p16 and Ki67 markers may be useful for distinguishing different types of ameloblastomas in terms of aggressiveness.

Polytrauma and Multiple Severity Scores.

The initial assessment and management of seriously injured patients is a challenging task and requires a rapid and systematic approach. Injuries causing this mortality occur in predictable patterns and recognition of these patterns led to the development of advanced trauma life support (ATLS) by the American College of Surgeons, and standardized protocol for trauma patient evaluation has been developed. Different systems of trauma scoring have been developed. This study was conducted out of the need for unified scale to assess polytrauma patients from the moment patient are admitted in, till when discharged from Intensive Care Unit (ICU), so we compared the accuracy of few scoring systems in predicting mortality rate in polytrauma patients, and then assessed the cost-effectiveness applying these methods, and how much are these applicable. Here we chose 3 scoring systems: Glasgow Coma scale (GCS), Revised Trauma score (RTS) and Acute Physiology and Chronic Health Evaluation II scales (APACHE II). APACHE II system proved to be helpful in giving primary impression about case prognosis, and overall it reflects the quality level provided in the facility which is providing the health care for the polytraumatized patients, and it can be used as unified scale to compare the healthcare results and outcomes in different hospitals. APACHE II can be considered to be a largely accurate and applicable system for the polytraumatized patients but the association between three of scores offers better results about predicting prognosis of these patients.

Proatherogenic adipocytokines levels in metabolic syndrome.

INTRODUCTION: Metabolic syndrome was defined by IDF (International Federation for Diabetes, 2007) by abdominal obesity plus at least two of the following: high triglycerides, low HDL-cholesterol, hypertension, high levels of glucose or type II diabetes diagnosed. Obesity is associated with a high cardiovascular risk, abdominal obesity being the most aggressive form, because it secretes cytokines and hormones in comparison to subcutaneous adipose tissue. Adipocytokines secreted by adipose tissue are mediators of atherosclerosis and endothelial damage. MATERIALS AND METHODS: We studied a total of 80 subjects aged between 40 and 60 years with metabolic syndrome, in which the following adipocytokines values were determined: hs-CRP (turbidimetric method), IL-6, TNF-alpha, leptin (ELISA method), in comparison to a control group. RESULTS: The values of these adipocytokines were significantly higher in the studied group compared with the control group and correlated with increased levels of glucose (patients with type II diabetes or increased tolerance test) and with hyper-triglyceridemia. CONCLUSIONS: Patients with metabolic syndrome had increased levels of proatherogenic adipocytokines, particularly leptin, leptin-resistance representing the pathogenic link of obesity. The identification as early as possible of the metabolic syndrome patients allows effective monitoring and correction of cardiovascular risk factors, with the opportunity to reduce morbidity and mortality in young ages. In men, proatherogenic cytokines values presented higher values than in women, which prove the role of abdominal obesity in proatherogenic cytokines production. Although women have a higher percentage of adipose tissue, this is not primarily abdominal adipose tissue.

VEGF, CD105 and α-SMA immunoexpression study in lips squamous cell carcinomas and associated dysplastic lesions.

This study analyzes the microvascular density (MVD) for CD105+ and α-SMA+ vessels and VEGF immunoexpression for 35 oral squamous cell carcinomas and for the associated dysplastic lesions of the lips. CD105+ MVD was superior in the advancing edge compared to the intratumoral area, no matter the analyzed clinico-pathological parameters (gender, age, differentiation degree, tumor stage) (p<0.05), MVD being significantly higher in poorly differentiated carcinomas (p<0.05). α-SMA+ MVD was also superior in the advancing edge compared to the intratumoral area (p<0.05), MVD values being significantly higher in well and moderately differentiated carcinomas (p<0.05). CD105+ MVD and α-SMA+ MVD were significantly lower compared to the analyzed tumor area (p<0.05), in the dysplastic lesions. VEGF score showed significantly higher values in well to moderately differentiated carcinoma and in the tumor area versus dysplastic associated lesions (p<0.05). CD105+ MVD and VEGF are markers able to characterize the angiogenic phenotype of carcinomas and of the dysplastic lesions of the lips, while α-SMA+ MVD quantification is useful in assessing the vascular maturity degree.