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Volume XIX, Number 3, 2015 - Therapeutics Pharmacology and Clinical Toxicology

Review


The importance of molecular and cytogenetic markers in the prognostic of myelodysplastic syndromes

Nicorescu Iuliana-Maria
Abstract: Myelodysplastic syndromes represent clonal diseases of hematopoietic stem cells that occur predominantly in elderly people, but myelodysplastic syndromes can affect younger patients as well. Myelodysplastic syndromes are characterized by ineffective hematopoiesis, causing different forms of cytopenia in peripheral blood, contrasting normal or hypercellular bone marrow. Although less known, due to its absence from current clinical practice or in the prognostic score, molecular analysis could bring a significant contribution in the early diagnosis of disease. In this respect, the latest studies (2011) show that this type of analysis is of great importance in terms of input added to the pathogenic mechanisms of the Myelodysplastic syndromes subtypes establishment, with high conversion. Furthermore, the analysis serves elect the optimal timing for the initiation of specific therapy.

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Original Papers



Acupuncture and bee venom therapy vs Diclofenac in the chronic low back pain treatment

Beatrice Lucache, Irina Jaba, Elena Albu, Mungiu C.O.
Abstract: Chronic low back pain (CLBP) can be treated by quite a large number of treatment methods, each method with its own advantages and drawbacks and comparable from the standpoint of efficiency, side effects, costs, necessary time, easiness, convenience etc. The aim of this paper is to assess and compare the effectiveness and side effects of three of the most common used therapies in CLBP. A prospective case-control study was conducted over o period of six months. A lot of 127 patients divided in three groups, have each followed one of the three mentioned treatments. The effectiveness was assessed through the pain intensity and pressure pain threshold (PPT), while the side effects were evaluated through clinical approach. The results were statistically processed and analyzed, the signification threshold being p=0.05. All the three applied treatments led to an improvement and the differences between the results were not significant. Acupuncture led to better results, but the differences became statistically significant slowly, in the last days of treatment. In what concerns the side effects, these were mostly minor and recorded especially for diclofenac. One major event wsa recorded in the case of bee venom therapy, namely anaphylactic shock was developed by one patient in the sixth treatment session. The results obtained by acupuncture or by bee venom therapy are not significantly , but due to the fact that they less invasive than diclofenac, we conclude that these complementary therapies have to be maintained as cost-efficient alternative procedures in CLBP treatment.

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The dual role of activated species of oxygen in angiogenesis

Aldea C., Aldea Alina Elena, Negoita Valentina, Anghel Rodica, Gruia Maria Iuliana
Abstract: Lately, the expanding accumulation of scientific data has indicated/demonstrated that malignant tumor growth depends on local angiogenesis. This occurs as a result of a process induced by a subgroup of transformed cancer cells which adopt an angiogenic phenotype, resulting in a new local balance of proangiogenic and antiangiogenic factors. The purpose of our work is to explore the hypothesis that activated species of oxygen play an important role in the pathways that stimulate the angiogenesis favouring tumour growth. The study was performed in vivo, on rats with experimental RS-1 tumours treated with bevacizumabum. We made a dynamic analysis of biochemical parameters of oxydative stress (the level of lipid peroxydes, thyolic groups, total antioxydants); apoptosis was measured by flow-cytometry in tumoral and normal hepatic tissues. We registered a decrease in the oxidative status during the antiangiogenic treatment and a significant increase of apoptosis (from 9.12% to 20.14%) in the malignant cells. These data support the hypothesis that activated species of oxygen can initiate the proangiogenic phenotype transformation. In this kind of oxidative circumstances targeted antiangiogenic drugs can reverse the process and induce tumour cells apoptosis, resulting in clinical benefits for cancer patients.

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Outcomes in distal hypospadias

Balanescu R.N., Niculescu Laura, Balanescu Laura, Moga Andreea
Abstract: Hypospadias is one of the most common congenital malformations of the external male genitalia, in which the urethra opens ventrally, anywhere from the glans to the perineum, the penis has an incompletely formed prepuce and may exhibit ventral curvature. Many surgical techniques for the reconstruction of this defect have been devised, each one having a different success rate. The aim of our study is to determine the complication rates and predictive factors for Mathieu and tubularized incised plate (TIP) techniques used in the repair of distal hypospadias. We assessed 62 patients diagnosed with distal hypospadias that were subjected to surgical correction by using either Mathieu or TIP urethroplasty during January 2011 and December 2012 in our clinic. The patients were divided into two groups according to the surgical technique which was performed. Urethroplasty complications, defined as fistula, urethral stricture and dehiscence, were statistically analyzed. There were 23 patients operated using the Mathieu technique and 39 patients using TIP repair. Mean age of presentation was 14 months for the Mathieu group and 20 months for the TIP groups. The urethral complication rate was slightly lower for the Mathieu group than in those cases solved by using the TIP technique (17.39% vs. 23.07%). There was just one case who presented with postoperative fistula in a patient belonging to the Mathieu group, while 5 patients operated with the TIP technique presented urethral stricture. No such cases were reported in the Mathieu group. Dehiscence was present in both groups (13.04% in the Mathieu group vs. 10.25% in the TIP group). We conclude that both techniques are acceptable and effective for the treatment of distal hypospadias, with complication rates being similar in the two groups.

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Therapeutical Practice

Case Report


Acute ectopic pancreatitis with ileus occurring in gastric ectopic pancreatic tissue

Tabacelia Daniela, Ilie Madalina, Ene D., Constantinescu G., Macovei B., Asmarandei R., Stanciulescu Elena- Luminita, Diaconu Camelia, Popa B.
Abstract: Ectopic pancreatic tissue is most often an incidental finding of imaging, surgery, or autopsy. Image-guided diagnosis is difficult and definitive diagnosis usually relies on histological analysis. A case of ectopic pancreatic tissue located near the lesser curvature of the stomach complicated with acute ectopic pancreatitis is presented followed by a brief discussion of the clinical management of heterotopic pancreas.

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Neck suppurations in children

Palade D., Toader Miorita, Constantin Anca, Niculescu L., Draghici M., Vivisenco Iolanda Cristina
Abstract: In the past, neck suppurations were common causes of morbidity and mortality. Nowadays, the progress of antibiotherapy and rapid isolation of pathogenic bacteria with the antibiogram obtained in proper time, along with better living conditions and increased medical education of the population on hygiene conditions led to a significant decrease in the incidence of these diseases and an increase in the therapeutic success rate. Polybacterial etiology remained unchanged, with different pathogen combinations, often multiresistant to antibiotics. Infections can occur both in healthy individuals without significant local or general personal medical history and in people with existing diseases, which have been neglected or unknown. The authors present the diagnostic and therapeutic approach in one case of a child with neck suppuration, in which unusual pathogens for the paediatric ENT pathology were involved.

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Liver metastasis with unknown primary origin

Constantin Alina, Plotogea Oana, Ilie Madalina, Constantinescu G., Macovei B., Asmarandei R., Stanciulescu Elena-Luminita, Diaconu Camelia, Popa B.
Abstract: Pancreatic neuroendocrine tumors (pNETs) are usually slow growing tumors and their malignant potential is often underestimated. Most of them are malignant at diagnosis (50-80%, except for insulinoma) and have an aggressive course with liver metastases as well as other sites. These heterogeneous neoplasms are divided into two groups: functioning tumors, which secrete a variety of peptide hormones and nonfunctioning tumors (up to 90% of pNETs), which often show metastases at the time of diagnosis. We report a case of 44 years old male, non-smoker, recently diagnosed with type II diabetes mellitus, admitted for fatigue, loss of appetite and severe weight loss. Laboratory tests showed discrete inflammatory syndrome, while chest X-ray was normal. Abdominal ultrasound revealed hyperechoic lesions in both liver lobes. Tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA19-9) were elevated. The upper endoscopy and colonoscopy described no lesions. Abdominal computed tomography (CT) revealed hepatic metastases with unknown primary site, while contrast-enhanced ultrasound (CEUS) highlighted a hypoechoic hypervascular mass in the pancreatic tail. Chromogranin A, urinary 5-hydroxyindoleacetic acid, serotonin and neuron-specific enolase were normal. Ultrasound-Guided Liver Biopsy from the hepatic metastases was performed in order to establish the diagnosis. The histopathological and immunohistochemical results were decisive. Poorly differentiated pancreas neuroendocrine tumor (G3) was the diagnosis supported by the Ki67 index > 20 %.The patient was referred to medical oncology.

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