The role of maternal hormones in regulating autonomic functions during pregnancy.

Offspring development relies on numerous physiological changes that occur in a mother's body, with hormones driving many of these adaptations. Amongst these, the physiological functions controlled by the autonomic nervous system are required for the mother to survive and are adjusted to meet the demands of the growing foetus and to ensure a successful birth. The hormones oestrogen, progesterone, and lactogenic hormones rise significantly during pregnancy, suggesting they may also play a role in regulating the maternal adaptations linked to autonomic nervous system functions, including respiratory, cardiovascular, and thermoregulatory functions. Indeed, expression of pregnancy hormone receptors spans multiple brain regions known to regulate these physiological functions. This review examines how respiratory, cardiovascular, and thermoregulatory functions are controlled by these pregnancy hormones by focusing on their action on central nervous system circuits. Inadequate adaptations in these systems during pregnancy can give rise to several pregnancy complications, highlighting the importance in understanding the mechanistic underpinnings of these changes and potentially identifying ways to treat pregnancy-associated afflictions using hormones.

Septal myomectomy and coronary artery bypass in one case of hypertrophic obstructive cardiomyopathy.

UNLABELLED: Surgery of the hypertrophic cardiomyopathy remains controversial. The safest procedure and the simples procedure is the mitral valve replacement. Septal myomectomy is difficult because of the poor surgical exposure and complications: incomplete resection, complete heart block, ventricular septal defect. CASE PRESENTATION: A 56 years old man with hypertrophic cardiomyopathy, double coronary stenosis and grade II mitral regurgitation by systolic anterior motion was long time stable under treatment with b-blockers. He developed angina and the circumflex and the left anterior descending arteries were stented. Re-stenosis developed in the left anterior descending stent and the patient was referred to surgery. The intraventricular gradient was 80 mmHg and the maximal septal thickness 28 mm. He was successfully treated by septal myomectomy and bypass on the left anterior descending artery with the left internal thoracic artery. Perioperative transesophageal echography was used to establish the limits of the surgical resection and to control the remnant gradient. The patient is asymptomatic 6 months after the procedure, he has a 30 mmHg remnant gradient and a grade I mitral regurgitation. CONCLUSION: Septal myomectomy is a safe alternative to mitral valve replacement for hypertrophic cardiomyopathy. This procedure must be guided by perioperative transesophageal echography to avoid incomplete resection.

Septal myomectomy and coronary artery bypass in one case of hypertrophic obstructive cardiomyopathy.

UNLABELLED: trophic cardiomyopathy remains controversial. The safest procedure and the simplest procedure is the mitral valve replacement. Septal myomectomy is difficult because of the poor surgical exposure and complications: incomplete resection, complete heart block, ventricular septal defect. CASE PRESENTATION: A 56-years old man with hypertrophic cardiomyopathy, double coronary stenosis and grade II mitral regurgitation by systolic anterior motion was long time stable under treatment with b-blockers. He developed angina and the circumflex and the left anterior descending arteries were stented. Re-stenosis developed in the left anterior descending stent and the patient was referred to surgery. The intraventricular gradient was 80 mmHg and the maximal septal thickness 28 mm. He was successfully treated by septal myomectomy and bypass on the left anterior descending artery with the left internal thoracic artery. Perioperative transesophageal echography was used to establish the limits of the surgical resection and to control the remnant gradient. The patient is asymptomatic 6 months after the procedure, he has a 30 mmHg remnant gradient and a grade I mitral regurgitation. CONCLUSION: Septal myomectomy is a safe alternative to mitral valve replacement for hypertrophic cardiomyopathy. This procedure must be guided by perioperative transesophageal echography to avoid incomplete resection.

[The beneficial effect of physical training in hypertension]. / Beneficille exercitiului fizic în hipertensiunea arteriala.

Hypertension is present in epidemic proportion and is associated with a markedly increased risk of developing numerous cardiovascular disorders. All current treatment guidelines emphasise the role of nonpharmacological interventions, physical activity included, in the treatment of mild to moderate hypertension. A large number of studies have demonstrated that regular exercise reduces the incidence of hypertension. In addition to preventing hypertension, regular exercise has been found to lower blood pressure (10 mmHg average reduction in both systolic and diastolic pressure), improve lipoprotein-lipid profiles and insulin sensitivity. As part of the initial treatment, exercise is recommended for 12 months in patients with stage 1 hypertension, with no other coronary risk factors and no evidence of cardiovascular disease, and for as long as 6 months in those with other risk factor, but not diabetes. In patients with diabetes, cardiovascular disease or with stage 2 or 3 hypertension, drug therapy should be initiated first. Dynamic exercise of moderate intensity, 50-75% VO2max, (e.g. brisk walking, cycling) for 50-60 minutes, 3-5 times per week, is preferable to vigorous exercise because it appears to be more effective in lowering blood pressure. In addition to reducing hypertension, physical activity improves other cardiovascular risk factors.

[Osler--Rendu Disease: an example of a family clustering in a genetic disorder]. / Maladia rendu-osler: exemplu de agregare familiala a unei boli genetice.

The case of a 75 years old woman with hereditary hemorrhagic telangiectasia (HHT) is presented. This condition is an autosomal dominant mucocutaneous and visceral fibrovascular dysplasia in which telangiectasia, arteriovenous malformations and aneurysms may be widely distributed throughout the cardiovascular system. It is usually recognized as a "triad" of telangiectasia, recurrent epistaxis and a family history of the disorder.

Anatomoclinical and bacteriological study on chronic marginal periodontal disease. Therapy with staphylococcic vaccine.

Histological, histochemical and electronmicroscopic investigations were carried out on gum biopsies taken from cases with chronic marginal periodontal disease before and after the treatment with staphylococcic vaccine, thus, morphopathologically proving the findings of Gafar et al. (1985) and of Georgescu et al. (1973; 1974; 1975; 1979; 1995). Before treatment, gum lesions were severe, consisting in an abundance of polymorphic inflammatory infiltrates in the chorion along with oedema and disorganised connective fibres, atrophies and ulceration of the mucosa, purulent deposits at the surface with bacteria and fungi. After the treatment with the staphylococcic vaccine, an epithelial regeneration was seen together with the absence of the chronic inflammation. The intensely fibroparius granulated tissue was also noted, in all cases observing abundant connective fibres, accounting for good results after treatment, notably the firmness of the tooth fitting.

[Retrospective studies on the relation between fibrocystic disease and cancer of the breast with therapeutic conclusions]. / Cercetari retrospective asupra raportului dintre boala fibrochistica si cancerul de sîn, cu concluzii terapeutice.

On the basis of 597 cases of benign and malignant tumoral, respectively dysplastic diseases of the breast, operated at the IInd Surgical Clinic of Tirgu-Mures during the period 1977-1983, the authors consider the fibrocystic disease (FCD) of the II and III degree as a facultative precancerous lesion. The extremely high frequency of FCD associated to the mammary cancer in young women, as well as of intense epithelial proliferations and intermediate forms, of transition from typical epithelial hyperplasias to the atypical forms observed in some of these cases, is pointed out. The 4 cases (1.94%) of mammary neoplasms which occurred late after a mammary sectorectomy performed for FCD illustrate that the risk of mammary neoplasm in FCD is 7.4 times higher than the mammary cancer rate in women without FCD. In the extensive forms of FCD with marked epithelial proliferations, especially if additional risk factors are also present, the authors recommend a uni- or bilateral subcutaneous mastectomy, a uni- or bilateral simple mastectomy respectively. They deem necessary the setting up, in all departments of general surgery, of an adequate organizational framework for the dispensary care, the hormonal therapy and the control of women with FCD.

[5-fluorouracil treatment of acute pancreatitis and of pancreatic and duodenal fistulae]. / Tratamentul cu 5-fluorouracil al pancreatitelor acute si al fistulelor pancreatice si duodenale.

In acute pancreatitis the mechanism involved in the auto-amplification of morbid phenomena can be suppressed in most of the cases by inhibiting the pancreatic secretion. This can also enhance the repair of pancreatic, duodenal and jejunal fistulae. On the basis of experimental studies carried out by Johnson, and on the clinical studies of Guttmann, as well as on original studies done by the authors, Ftorafur was included in the complex therapy of acute pancreatitis, and of pancreatic and duodenal fistulae. A group of 14 cases of acute pancreatitis, were treated. These included 5 necrotic-haemorrhagic pancreatitis, and 9 oedematous pancreatitis. The drug was given by continuous intravenous perfusion in doses of 1,200-1,600 mg per day, for a period of 6-12 days. In all the cases the clinical improvement of the patients as well as recovery of normal values of blood amylase were spectacular, and full recovery was achieved in all the cases. Ftorafur was also used in 3 cases of pancreatic fistulae, and in 2 cases of duodenal fistulae, and recovery was also achieved in a very short time. On the basis of this experience, although small, the authors recommend the introduction of Ftorafur in the complex therapy of acute pancreatitis, as well as in that of pancreatic and duodenal fistulae. Following administration of Ftorafur no adverse effects were noted, and in the doses mentioned above this drug did not delay the repair of surgical wounds.

[An experimental study of the action of 5-fluorouracil on the function and cytomorphology of the exocrine pancreas]. / Studiu experimental privind actiunea 5-fluorouracilului asupra functiei si citomorfologiei pancreasului exocrin.

The authors have taken up previous studies by Martin (1969), and by Johnson (1973), and carried out an experimental study on white rats aimed at evaluating the morpho-functional changes of cells from the exocrine pancreas under the influence of 5-fluorouracil (Ftorafur), a cytostatic drug which is a general inhibitor of protein synthesis by cells. Ftorafur was injected in amounts of 2.3 mg/100 g of body weight, and a significant reduction was noted in the secretion of bicarbonates, amylase and lipase by the pancreas of the animals. Cytologic changes were also noted in the pancreatic tissue of these animals, indicating, on the one hand, a deficient protein and enzyme synthesis by the pancreatic cells, and a blocking of the mechanism of discharge of zymogen granules, on the other hand. The most intensive morpho-functional changes were noted following repeated administration of Ftorafur, probably due to the cumulative effects of this substance at the level of secretory pancreatic cells. The authors consider that 5-fluorouracil inhibits to a considerable degree the synthesis of pancreatic enzymes, and as such it can be used as a therapeutic means for the reduction of the external secretion of the pancreas.

[Gamma interferon induced in human leukocytes by phytohemagglutinin: its production and biological characteristics]. / Inteféron gamma induit dans des leucocytes humains par la phytohémagglutinine: production et carcatéristiques biologiques.

Human gamma type interferon (IFN) preparations were obtained through phytohemagglutinin stimulation of leukocytes from the peripheral blood. Biological value of these preparations varied between 160 u and 800 u/ml, depending on leukocyte incubation medium, culture system and inductor conservation. The rising of the antiviral activity through association between gamma (3 u) and alpha (27 u) interferons was revealed by the virus quantity reduction (in this case the vesicular stomatitis virus was used) during a 24-hour multiplication cycle. The protection ensured by the mixture of the two types of interferon was about ten times higher than the additive effect of the two preparations. Study of the antiproliferative activity of a gamma interferon preparation was conducted on two human cell lines of tumoral origin (T-10 from a glioblastoma, and HEp-2) and revealed the difficulties to quantify precisely this property of the crude gamma interferon preparations.

[Anti-proliferative and antiviral effects of human alpha-interferon on tumor cells]. / Effets antiprolifératif et antiviral de l'interféron humain du type alpha sur des cellules tumorales.

Antiproliferative and antiviral activities of a type alpha human leukocytic interferon on several heteroploidic cell lines: HeLa, HEp-2, and T-10, a cell line of malignant origin (glioblastoma) were investigated, as compared to subcultures of human embryo fibroblasts. The tumor cell multiplication rate decreased proportionally to the amount of interferon in the culture medium. The highest interferon concentration used in our experiments (1,000 mu/ml) induced a decrease of the normal cell multiplication rate (human embryo fibroblasts). The same amount of interferon had a cytotoxic effect against the T-10 cells, but this phenomenon is reversible if the interferon is excluded after 24 h from the culture medium. There was no quantitative relation between the magnitude of the antiviral and of the cytotoxic effects of the type alpha human interferon on the tested cellular substrates.

[Late results in 170 patients operated on for breast cancer]. / Rezultate tardive la 170 bolnave operate pentru cancer mamar.

The authors investigated the late results, or survival at 5 years after the intervention, in 170 patients operated for breast cancer. The total number of survivors at 5 years was of 71 patients, of which 78 belonged to stages I and II, and only 3 to stage III. The authors present their personal attitude for such cases, and stress some of the difficulties encountered in the application of complex therapy. Of the late complications noted, which totalled 58 cases, the authors mention generalized carcinomatosis in 17 patients, pleuro-pulmonary metastases in 14 patients and 11 cases of chronic oedema of the arm, or the so-called "thick arm after Halstead operation".

Clinical and pathological questions concerning the tumor-like giant cell granulomas of the peritoneal cavity.

Seven patients with tumor-like granulomatous lesions of the peritoneal cavity were cured, except one, by correct surgical intervention removing the inflammatory hyperplastic tissues and restoring the permeability of the alimentary tract. The exact diagnosis was suggested by the existence in the personal history of the patients of one or several interventions on the peritoneal cavity (6 of 7), and was confirmed by intraoperative, sometimes repeated, microscopic examination, rendering evident a fibrogenous giant cell granulomatous process; the presence of foreign bodies, especially suture threads or crystals (the latter characterized in polarized light) is very helpful for the diagnosis of these tumor-like inflammations.

[Pancreatic pseudocysts and fistulas]. / False chisturi si fistule pancreatice.

The authors present false pancreatic cysts and fistulae that have been encountered inthe practice of the I-st Clinic of Surgery from Tg-Mures over a period of 10 years (between 1964 ans 1979). The author's personal cases are presented and the rarity of this type of disturbances is stressed. A total of 14 cases are described, of which 8 were false pancreatic cysts and 6 were false pancreatic fistulae. The major complications that occurred in the cases with false pancreatic cysts the most severe was the intra-cyst haemorrhage, that was encountered in 2 patients (of which one developed severe shock), and peritonitis, following rupture of the cyst in the peritoneal cavity. The 6 pancreatic fistulae have developed following surgery (3 cases), trauma (one case), and acute pancreatitis (2 cases). The treatment of the false cysts consisted in the external drainage (two emergencies), and cyst-gastrectomy. Pancreatic fistulae have benefited from fistulo-gastrostomy (two cases), while the remaining 4 patients were treated conservatively. Only one death was recorded in this group of patients.

[Hepatic suppurations requiring segmented or atypical hepatectomies]. / Supuratii hepatice care au necesitat hepatectomii reglate sau atipice

Following studies of cases with hepatic suppurations the authors indicate the necessity for regular or atypic hepatectomies. The extension of the suppurative process in the liver made necessary the ligature of the great sagital vein and the authors show, on the basis of anatomic and topographical data (hepatic segmentation), that it is necessary to extend the hepatectomy to the IV-th para-median segment. The authors also present the indications for bi-segmental right hepatectomy in segments VII-VI as well as of the total left regulated hepatectomy.

[Difficulties in diagnosis and surgical treatment of subacute and chronic thyroiditis]. / Dificultati de diagnostic si tratament chirurgical în tiroiditele subacute si cronice

Out of a total number of 875 cases of thyroid affections of various origins, hospitalized in the two surgical clinics of Tîrgu-Mures, the authors selected 16 cases of subacute and chronic thyroiditis. They indicate the difficulties encountered in establishing the diagnosis before surgery, a fact that determined wide excisions in extremely difficult local conditions. They suggest, as a first therapeutic attitude, a conservative treatment with steroid drugs, antibiotics and roentgentherapy (when necessary), and, if such treatments fail, or when malignancies are suspected, as well as compression phenomena have developed, surgical treatment preceded by an extemporaneous anatomo-pathological examination. When thyroiditis is diagnosed surgery should be limited to decompressing incisions.