Carotenoids produced by halophilic bacterial strains on mural paintings and laboratory conditions.

Due to the presence of efflorescences and improper microclimate conditions for conservation, pink-pigmented areas were reported in two historic monuments in Northern and Central part of Romania. The aims of the present study were to find the nature of pink pigments observed on the pictorial layer, original and infilling mortar, to investigate the presence of carotenoids both on mural paintings and in the isolated halophilic bacterial strains and to preliminary characterize and identify the producing strains. Their role in the aesthetical biodeterioration of historic monuments was also pointed out. Obtained Raman spectra of the pink pigments extracted both from the isolated bacterial cultures (molecularly identified as mostly related to Halobacillus hunanensis and Halobacillus naozhouensis) and from the mural painting samples contain diagnostic bands of carotenoids. These results were confirmed by FTIR spectroscopy. The strong Raman signal of bacterial carotenoids detected on mural painting indicated their potential use as biomarker molecules in the evaluation of contamination and state of conservation of mural paintings and lithic monuments. Our results contribute to opening a new direction in cultural heritage restoration to assess the conservation status on the basis of interdisciplinary research, starting with spectroscopic methods (Raman, FTIR) and confirmed by microbiological analysis.

Mortality prognostic factors in acute pancreatitis.

Background: The aim of the study was to present the biological prognostic factors of mortality in patients with acute pancreatitis. Methods: Several usual laboratory values were monitored: glucose, urea, partial pressure of oxygen, WBC count, hemoglobin, total bilirubin, and cholesterol. A statistical analysis was performed by using ROC curves and AUC interpretation. Results: The overall mortality rate was 21.1% and was different depending on the severity of the disease. Only 2.22% of the patients with a mild disease died, as opposed to 45.63% of the patients with a severe form. All the analyses studied were significantly elevated in the deceased patients. A close correlation between blood glucose, urea, partial pressure of oxygen, WBC, hemoglobin, total bilirubin, and cholesterol and mortality was objectified by measuring the AUC, which was of 97.1%, 95.5%, 93.4%, 92.7%, 87.4%, 82.2%, and 79.0%. Conclusions: The usual, easy to use, fast, and cheap tests were useful in predicting mortality in patients with acute pancreatitis. Our study confirmed that the combination of several factors led to an accurate mortality prediction.

Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients.

BACKGROUND: Despite patient selection, postoperative morbidity after reversal of Hartmann's procedure remains significant. AIM: The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann's operation. PATIENTS AND METHODS: We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality). RESULTS: There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann's procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities. CONCLUSIONS: Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann's reversal and therefore patient selection for this type of surgery is critical.

Clinico-biochemical factors to early predict biliary etiology of acute pancreatitis: age, female gender, and ALT.

UNLABELLED: Background/ Aims: Despite the existence of an easy tool to diagnose biliary tract disease as an etiology for acute pancreatitis (AP), the sensitivity of abdominal ultrasound is around 80%, which can be even lower in certain conditions. METHODOLOGY: We have retrospectively reviewed data of 146 patients admitted for acute pancreatitis between 1999 and 2013. Bivariate analysis for clinical and biochemical variables was performed with respect to etiology of AP (biliary versus non-biliary). Multivariate analysis was performed by using binary logistic regression. RESULTS: There were 87 males (59.6%) and 59 females (40.4%), with a median age of 51. The etiology of acute pancreatitis was biliary in 71 patients (48.6%). Bivariate analysis found the following as significant association (p=0.001) with biliary pancreatitis: older age, female gender, and elevated AST, ALT. A binary logistic regression analysis identified as predictor factors for biliary etiology of acute pancreatitis: age OR = 1.031 (95% CI 1.004 - 1.059, p = 0.024), sex (female) OR = 2.34 (95% CI 1.022 - 5.359, p = 0.044) and ALT OR = 1.004 (95% CI 1.001 - 1.007, p =0.004). The two clinical scores included the three variables (A.S.ALT scores) in categorical format were generated and then checked with the ROC curves (areas under curve are 0.768 and 0.778). CONCLUSIONS: Age, female gender, and elevated ALT can help identifying cases with biliary etiology of acute pancreatitis.

Review of Risk Factors for Anastomotic Leakage in Colorectal Surgery.

Anastomotic leakage after colorectal surgery is a serious complication leading to increased morbidity and mortality. Multiple studies have found as risk factors for anastomotic leakage: male gender, obesity, preoperative steroid and non-steroidal anti-inflammatory drug use, longer duration of operation, surgical experience and preoperative blood transfusion. The laparoscopic approach is not inferior to open surgery in terms of rate of anastomotic fistula. Several studies have also shown the ASA score and tumor distance from the anal verge as predictors for increased operative time and morbidity after laparoscopic total mesorectal excision. There is strong evidence that preoperative radiochemotherapy for rectal cancer increases the risk for anastomotic leakage. The preoperative bowel preparation does not reduce the incidence of postoperative leaks. The use of diversion stoma has not been shown to reduce leak rate, but mitigates the clinical effects of fistula.

Primary aortoenteric fistula: case report.

We report the case of an elderly woman, 81 years old, who was admitted in our department for hematemesis, hematochezia and lower abdominal pain. The abdominal ultrasound and the CT scan diagnosed a primary aortoenteric fistula between an abdominal aortic aneurysm (AAA) and the second part of the duodenum, which is a very rare localization regarding this condition. Surgical pathology,diagnosis and management are discussed.

[Perioperative immunologic changes in colorectal cancer patients]. / Modificari imunologice perioperatorii la pacientii cu cancer colorectal.

The aim of the study was to investigate the perioperative immunological profile in colon cancer patients and possible correlations with disease. To investigate the changes in immune mediators profile induced by tumor resection, we assessed the serum levels of cytokines (IL-6, IL-8, IL-10, IFN-gamma, TNF-alpha), chemokines (MIP-1alpha, MCP-1, ENA-78) and growth factors (VEGF, bFGF) in colon cancer patients before, during and after surgery and compared the results with those measured for a group of healthy controls. We have used XMap profiling technology (Luminex) that allows simultaneous measurement of multiple parameters in small volumes of samples. Circulating levels of proinflammatory cytokines IL-1, IL-6, IL-8 and antiinflamatory cytokine IL-10 were elevated in cancer patients with respect to healthy controls. Before surgery, serum levels of MCP-1 and MIP-1alpha positively correlated with the levels of proinflammatory cytokines. During surgery, an increase in serum concentration of all determined mediators was noticed, with positive correlation between TNF-alpha, IL-8, MCP-1 and MIP-1alpha. Interestingly, these correlations were no more noticed one week after operation. Postoperatively, cytokines levels decreased as compared to those noticed before surgery, but still higher than in control group. These preliminary results suggest that both tumor and surgical act may influence immune mediators' network.

Large thigh liposarcoma--diagnostic and therapeutic features.

We are presenting the case of a 44-year old patient with large, well-differentiated liposarcoma of the right thigh. We are discussing the clinical findings, diagnosis and surgical treatment. The large dimensions (27/25 cm) and the origin of the tumor in popliteal fossa, migrating through the adductor canal (Hunter's canal) in the anterolateral muscular space of the right thigh, represent the particularity of this case.

Giant lipomatous tumors of the upper extremities--a series of 8 consecutive cases.

We present a series of eight consecutive patients evaluated in our department from 2002 to 2007 with giant lipomatous tumors (as defined in medical studies as greater than 5 cm) of upper extremities. There were three male and five female, ranged in age from 17 to 77 years (mean age of 55). The tumor's size ranged from 5 to 34 cm. All patients underwent total excision of the tumors with free margins. All specimens were sent to pathology: seven patients had benign tumors and one patient had liposarcoma. There were no recurrences of the tumors. Appropriate preoperative evaluation and complete surgical excision are mandatory for successful treatment of these tumors.

Great omentum plasty--original method of treatment of the septic complications of hip and pelvis surgery.

UNLABELLED: The septic complications after hip arthroplasty are extremely severe due to frequent chronicity and prosthesis looseness, despite the expensive long-term antibiotic treatment. Starting from the well-know function of the greater omentum to isolate any septic intraperitoneal processes (an "extended lymph node"), we initiated a surgical technique which uses the greater omentum in the treatment of septic complications after hip surgery. METHOD: The technique consist in mobilisation of the greater omentum along the right or left gastroepiploic artery according to the affected hip, and placing it in the septic area after passing it anterior or posterior of the inguinal ligament. Between 1997 and 2004 we performed this technique on 5 patients (4 men and 1 woman) with ages ranking between 24 and 47, which presented chronic infections after hip arthroplasty (4 cases) and after iliac bone resection-reconstruction for fibrosarcoma (1 case). RESULTS: The post-operatory evolution was favourable in all cases. In one case the local septic process pursued demanding a reintervention that revealed that the great omentum has been retracted from the hip area. In 4 cases the septic processes has withdraw spectacularly. CONCLUSIONS: The use of the greater omentum in the treatment of septic complications after hip and pelvic surgery represents in some cases the only effective solution. This technique requires a good collaboration between orthopaedic and general surgeons.

[Hereditary pancreatitis]. / Pancreatita ereditara.

We present the cases of three brothers (a woman and two men) with recurrent attacks of necrotic acute pancreatitis that were treated in our clinic. Two of them have diabetes mellitus controlled through insulin treatment. All patients have presented the first episode of acute pancreatitis around age of 35. We have observed a high level of serum triglyceride at admission, without evidence of lipid disorder. In addition we couldn't identify other causes of these episodes of acute pancreatitis (biliary stones, alcohol, trauma, drugs, lipid disorders). During the last year two members of this family presented recurrent attacks of abdominal pain without any biochemical or imaging signs of acute pancreatitis.

[Gastric stromal tumors--Clinical and histopathological analysis of four cases]. / Tumori gastrice stromale--analiza clinica si histopatologica a patru cazuri.

BACKGROUND: The aim of this study is to present our experience concerning a rare form of gastric tumor--gastrointestinal stromal tumor (GIST). METHODOLOGY: We reviewed data of four patients with gastric stromal tumors, which have been admitted in our department from 1998-2002. RESULTS: There were two females and two males with age of 75, 70, 65 and 63 years old. The average duration of symptoms until hospital admission was 7 days. During surgery we discovered proximal gastric tumors with 4, 5, 10 and 20 cm in largest diameter. We performed excision of the whole tumor with a security limit of 2 cm or gastric resection (one case), without limphadenectomy. One patient developed an anastomotic fistula with a good evolution under conservative treatment. All patients left the hospital in a good condition. Histopathological and immunohistochemical study diagnosed gastric stromal tumors by identifying the CD 117 maker. Postoperatively neither one of our patients received chemotherapy or radiotherapy. One female and one male patient died of peritoneal metastasis at nine months and respectively two years after operation. The other two patients are in a good condition up to date, without metastasis, one and respectively three years after surgical treatment. CONCLUSIOUS: Correct diagnosis, complete tumor resection and surveillance are essential steps in management of gastric stromal tumors.

[Survival in a cohort of patients with rectal cancer]. / Evaluarea supravietuirii într-o cohorta de bolnavi cu cancer de rect.

BACKGROUND: The aim of our study is to analyze the five-year survival for patients with operated rectal cancer in our clinic during a five-year period (1997-2001). METHODS: Our epidemiological clinical study is based on prospective analysis of 196 cases of rectal cancer operated between 1997 and 2001. Survival evaluation was prospective cohort follow-up study. We have used Epiinfo 2000 software package for data analysis. RESULTS: The five-year survival was 54.08% if we take into account all deceases including other causes and 64.28% for exclusive deaths caused by rectal cancer and metastasis. The survival at 5 years (S5) was: stage A S5 = 85.3%; stage B1 S5 = 76.6%; stage B2 S5 = 71%; stage C S5 = 68.7% and stage D S5 = 8.6%. The follow-up in month (e5) was: stage A e5 = 58, stage B1 e5 = 46; stage B2 e5 = 36, stage C e5 = 20 and stage D e5 = 6. The values for S5 and e5 are in accordance with the literature. CONCLUSIONS: Despite progresses of rectal cancer management, the five-year survival doesn't transcend much over 50%. Because the five-year survival for A stage is 85.3% in our study, we may conclude that at present introducing of screening program represents the only chance for improvement of results.

[Cancer of the rectum: clinical and therapeutic aspects. What changes occurred during the last 2 decades?]. / Le cancer du rectum: aspects cliniques et thérapeutiques. Quels changements au cours des deux dernières décennies?

This retrospective study of 440 cases of cancer of rectum was done over a period of 2 decades (1970-1993) which was divided in 3 periods (1970-79, 1980-89, 1990-93) and a comparative analysis was done with respect to clinical features, histo-pathology, treatment and results. At least one predisposing lesion (polyp, villous tumour) was noted in 26.7%, 41.5% and 41.5% respectively. The topographic distribution was unchanged in all three periods. The Dukes staging showed increase in stage A with 1.9%, 9.8% and 10% respectively and decrease in stage D with 26.1%, 20.2% and 16% respectively. The operability rate was 92.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3% and 95.9% and curative resection rate was 83.3%, 86% and 88.2% respectively. Amongst the operations done, abdomino-perineal resection was done in 55.8%, 39.5% and 7.2%; anterior resection was done in 5.5%, 36.6% and 81.4%; thus these two curves crossed in 1985. Hartmann's procedure was done in 11%, 8.7% and 4.1%. The radiotherapy was given in 6.9%, 23.9% and 75.8% respectively. Overall hospital mortality rate was 5.8% which showed progressive decrease in the 3 groups with 13.8%, 1.24% and 2% respectively. The principal factors influencing the mortality rate were the emergency presentation the type and the palliative type of operation. Overall early complication rate was 42% which showed progressive decrease in the 3 groups with 64.8%, 37% and 21% respectively. Rate of local recurrence was 17.2% which was related to the topography of the tumour, Dukes staging, type of operation, margin of resection and preoperative radiotherapy. 5 year survival rate was 43% which in relation to the curative or palliative nature of the operation and the Dukes staging. The expected progress in terms of survival depended on surgery in early stages of disease and use of radiotherapy and chemotherapy.

Abdomino-thoracic shooting wound with multivisceral involvement including injury of abdominal aorta in the supra-mesocolic segment.

Abdomino-thoracic wounds caused by shooting are very serious as they frequently affect several organs and require extreme emergency surgery. Within traumatic abdominal vascular wounds, aortic injury in the supramesocolic segment is associated with a high mortality, 64% (2). The case reported, a 19y. old young man, suffered multiple organ injuries by shooting involving abdominal aorta, stomach, liver, diaphragm and lung. He was operated in extreme emergency. The evolution has been simple, the patient leaving the hospital 19 days after surgery. This case presents a tactical peculiarity about the access procedure to the supramesocolic abdominal aorta through the great epiploon, dividing the gastro-colic and the gastro-splenic ligaments.

Morphological aspects of the rat kidney preserved by cold storage. IV. Histoenzymological changes. V. Endopeptidase activity.

Rat kidneys were preserved by initial washing and cooling perfusion, followed by cold storage at 6 degrees C for 24, 48, 72 and 96 hours, in two different media: Sacks (hyperosmolar electrolytic solution of intracellular type) and Plasmagel (gelation solution 4%). Evidence was found of DPNH-diaphorase, lactate dehydrogenase (LDH), leucylaminopeptidase (LAP) and adenosine-triphosphatase (ATPase) (pH 9.4) activities. Histoenzymological determination showed various levels of enzymatic activities in different segments of the nephron, levels relatively well maintained during storage, even at 72 and 96 hours. At the same time, cathepsin B and D and neutral proteinase activities were determined as parameters of maintained cellular enzymatic activity; different aspects were observed with the two preservation media used.

Morphological aspects of the rat kidney preserved by cold storage. III. Ultrastructural aspects.

The ultrastructural changes of the white Wistar rat kidney, preserved by cold storage into two preservation media (Sacks and Plasmagel) are reported. For each medium two groups of kidney were used; for one of them the medium was used without additives and for the other stabilizing additives were added. The results showed the favourable effects of additives on the maintenance of the cellular ultrastructure during preservation, and more important the damages incurred when Plasmagel was used.

Cytochrome-oxidase and succinate dehydrogenase activity in the rat kidney preserved by cold storage, correlated with the study of mitochondrial suspension.

Succinate dehydrogenase (SDH) and cytochrome-oxidase (CO) activities were determined biochemically in the white rat kidneys after 24, 48, 72 hours preservation by cold storage. The investigations also included the study of infrastructural alterations in mitochondrial suspensions, separately for the medulla and the cortex. The comparison of the enzymatic activity curves showed a mirror-like aspect with a maximum at 24 hours for CO and a minimum for SDH, and a constantly more intense activity in the medulla.

Morphological aspects of the rat kidney preserved by cold storage. I. Glomerular morphometric changes.

The absolute density of glomeruli in the microscopic field was determined in the rat kidney preserved by cold storage for 24, 48, 72 and 96 hrs in two different media: Sacks (hyperosmolar electrolytic solution of intracellular type) and Plasmagel (gelatin solution 4%). Progressive, statistically significant (p less than 0.01) decrease of glomerular density at 24 and 48 hrs was followed by return to initial values at 96 hrs. Decrease of the glomerular density was greater with Plasmagel.

Morphological aspects of the rat kidney preserved by cold storage. II. The juxtaglomerular apparatus.

The present paper reports on the changes occurring in the juxtaglomerular apparatus during preservation of the rat kidney by cold storage, using two media: Sacks and Plasmagel, to which a membrane stabilizing "cocktail" was added (hydrocortisone, chlorpromazine, epsilonaminocaproic acid - EACA, propranolol). Evident alterations appeared at 48 hours more accentuated at 72 and 96 hours, and more intense when preserved in Plasmagel. The most affected structure in the juxtaglomerular apparatus was the macula densa, the epithelial cells having a more stable structure.