Mechanistic insights into the SN2-type reactivity of aryl-Co(iii) masked-carbenes for C-C bond forming transformations.

Herein we describe the synthesis and characterization of a family of C-metalated aryl-Co(iii) enolates, which can be considered as masked-carbenes, using diazoacetates as coupling partners. These species have been proved to be necessary intermediates in the C(sp2)-C(sp3) bond forming event to obtain cyclic amides, taming the elusive Co(iii)-carbene species. The scope of diazoacetates has been exhaustively examined, varying the nature of the ester and the α-substitution, and a clear preference for electron-poor carbene precursors is observed. Exhaustive experimental and theoretical studies indicate that an unprecedented intramolecular SN2-type process governs the formation of the newly formed C-C bond. Furthermore, the key role of several Lewis acids as carboxylate-activating reagents is further explored by DFT calculations.

[Post-cesarean acute aortic dissection in a Marfan syndrome patient]. / Disectie acuta de aorta postcezariana la o lehuza cu sindrom marfan. Prezentare de caz.

Marfan syndrome is an uncommon condition in pregnancy. We present the case of 37 years old gravida 1, para 1 with Marfan syndrome. She delivered at term by cesarean section, a healthy male infant weighing 3500 grams with Apgar's of 9. During the postoperative period she developed aortic dissection and was referred to the Cardiovascular Surgery Department. We described such a case and the difficult decisions that we faced.

[Postoperative upper gastrointestinal bleeding in patients with cardiovascular surgery]. / Hemoragia digestiva superioara postoperatorie la pacientii cu interventie chirurgicala cardio-vasculara studiu prospectiv.

UNLABELLED: Patients with cardio-vascular surgery are at risk for upper digestive bleeding due to several factors. AIM: To determine the utility of medication and endoscopy in preventing gastrointestinal bleeding (GB) after cardiovascular surgery. MATERIAL AND METHOD: 79 patients (60 males and 19 women, mean age 61 +/- 16.1 years) were prospectively included in the study from the 850 patients operated in the period 2004 - 2006. Inclusion criteria were: patients with digestive symptoms (dyspepsia) and with risk for GB (personal history of peptic ulcer, gastroduodenitis, esophagitis, hiatus hernia, gastric cancer, gastric surgery and GB). All patients with symptoms and partially patients with risk were evaluated by endoscopy. Patients received standard medication for prevention of GB. RESULTS: Prophylactic medication was partially efficient in GB prophylaxis vs. no prophylaxis (7% vs. 11% p < 0.05). Patients with endoscopy examination before surgery had significantly lower incidence of bleeding (6.6% vs. 10.9%, p < 0.05%). CONCLUSIONS: Gastrointestinal bleeding may occur despite prophylactic medication. Gastrointestinal endoscopy prior surgery may be useful in preventing the bleeding.

[Five years of kidney transplantation in Iasi]. / Cinci ani de transplant renal în centrul universitar Iasi.

The activity of Renal Transplant Center Iasi started in November 2000, when we realized the first renal transplant from a live donor. Since then, 46 renal transplants were successfully realized in our center, to patients aged between 13-47 years (medium age = 30 +/- 5), M/F=27/19, 25 (56.8%) of them selected from HD, 17 (39.9%) from CAPD and 4 (8.7%) pre-emptive. Medium age of donors was 49.1 years (30-64), M/F=29/17. The donors were, in 78.3% of cases, first-degree relatives (parents, siblings). In 10 cases (21.7%) the grafts were donated by "emotionally related"donors (in most cases, spouses). An urologist-cardiovascular surgeon team, performed the transplant operations. There were no important complications during operation. We had one major vascular complication (graft artery thrombosis) in a 13 years recipient, successfully resolved after thrombectomy and stenting. Immunosuppressive therapy associated induction with monoclonal antibodies anti-Tac, cyclosporine, MMF and prednisone. Eight patients from 46 (17.39%) presented acute rejection episodes and all responded at corticosteroids. Medium values of serum creatinine were: 1.54 mg% at 1 month, 1.42 mg% at 6 months, 1.44 mg% at 1 year, 1.21 mg% at 2 years, 1.38 mg% at 3 years, 1.4 mg% at 4 years and 1.2 at 5 years. The survival of patients and donors is 100% and the survival of renal graft--97.1% (one case of chronic allograft nephropathy with lost of renal function). We also present the satisfactory evolution of the 51 renal transplanted patients addressed to our center from different other renal transplantation centers in Romania for management follow-up.

[Efficiency criteria for endoscopic diagnostic in upper gastrointestinal bleeding]. / Criterii de eficienta a diagnosticului endoscopic în hemoragiile digestive superioare.

Endoscopy plays a major role in the evaluation of upper digestive haemorrhage. We evaluate the difficulties in the introduction of emergency endoscopy in a period of transition, regarding mentalities and errors generated by the learning curve. The study includes 512 consecutive patients admitted with upper gastrointestinal haemorrhage. We retrospectively evaluate some proposed efficiency criteria for the diagnostic endoscopy: the frequency of incomplete endoscopic evaluation (14%), frequency and causes of endoscopic diagnostic errors (3%), frequency of upper digestive haemorrhages with no detectable source (24.2%) and the indication of multiple endoscopic examination. We discuss the causes responsible for the generation of such problems as well as the dynamics of those during the evaluated period.

Morphological evaluation of the surgically removed aortic and mitral valves.

In 2001, of the 114 valves surgically excised at the Iasi Center of Cardiology from 59 men and 54 women (mean age 51 years; age range: 25 to 78 years), half were aortic and the other half mitral valves. The 57 aortic valves, from 20 women and 37 men (mean age 51.1; age range 25 to 78 years), had been surgically replaced. Functionally, 57.63 percent (30) were stenotic, 21.05 percent (12) were incompetent, and 26.31 percent (15) were both stenotic and incompetent (aortic disease). Pure stenosis was related to calcification of degenerative (73.3 percent), bicuspid (3.33 percent), post-inflammatory (20 percent), and undetermined (3.33 percent) causes. Pure regurgitation was not related to calcification and causes included infective endocarditis (50 percent), bicuspid valve (16.66 percent), postinflammatory (16.66 percent), aortic root dilatation (8.33 percent), and undetermined (8.33 percent). Aortic disease was secondary to postinflammatory etiologies (40 percent), degenerative calcification (33.33 percent), bicuspid and undetermined (13.33 percent each) causes. The reminder of 57 mitral valves, from 35 women and 24 men (mean age 45.5 years; age range 28 to 71 years), were surgically replaced. Functionally, 40.35 percent (23) were purely stenotic, 19.29 percent (11) were purely regurgitant, and 40.35 percent (23) both stenotic and regurgitant (mitral disease). The causes of pure stenosis were postinflammatory (presumably rheumatic) disease in 91.3 percent (21 cases) and degenerative disease in 8.7 percent (3 cases). Pure regurgitation etiology involved floppy valves in 45.45 percent (5 cases), degenerative disease in 27.27 percent (3 cases), postinflammatory disease in 18.18 percent (2 cases) and infective endocarditis 9.1 percent (1 case).

Presence of viral and inframicrobial germs detected by immunofluorescence reaction in 0-5-year-old children with acute respiratory infections.

The presence of viral and/or inframicrobial antigens was investigated by the immunofluorescence (IF) technique in exfoliated pharyngeal cells collected from 85 children aged 0-5 years, with acute infections of the upper or lower respiratory tract. Positive IF reactions were recorded in 83% of the children with bronchopneumonia, 81.8% of those with acute pharyngitis, 77.7% of those with acute upper respiratory tract infections and 66.6% of those with acute bronchitis. In 68.75% of the IF-positive cases 2-5 different antigens were simultaneously visualized. Herpes and parainfluenza virus antigens appeared to be predominant. The proportion of positive IF reactions was much lower (20%) in a control group of 20 apparently healthy children, where a single viral antigen (parainfluenza 1) was detected.

[Morphologic and clinical correlations in medullar thymoma]. / Corelatii morfoclinice în timomul medular.

The medullar thymoma is a rare and distinctive epithelial thymoma, a thymic tumor characterized histologically by a mixture of spindle epithelial cells and lymphoid cells. We are presenting this tumor to a 68 years old man, admitted at CCI, for a mediastinal tumor, treated by tumorectomy, for revealing the cytological, histological and immunohistochemical characteristic features. The surgical biopsy was prepared by using usual histological techniques and haematoxilin eosin and Van Gieson stainings. We are discussing the relation between the thymoma clinicopathological and prognostic features, resulting a clear correlation between histological type and clinical study. We also pointed the Muller-Hermelink thymoma histological subtypes and their correspondence with OMS histological types, reflecting realistically the thymoma clinical behavior.