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Volume XIX, Number 4, 2015 - Therapeutics Pharmacology and Clinical Toxicology


Global clinical experience with Boron neutron capture therapy

Gales N. Laurentia, Anghel M. Rodica
Abstract: Boron neutron capture therapy (BNCT) represents a top therapeutic method that relies on knowledge in the area of nuclear technology as well as on medicine experience in treating malignant tumour. Various pre-clinical experiments have been initially applied in order to demonstrate the effectiveness of BNCT concept. Once they demonstrated the concept, pre-clinical experiments continued by focusing on a better establishment of the irradiation parameters in each facility, in view of acquiring dosimetry systems, a treatment plan and, most importantly, the development of boron compounds that fit, as best as possible, the ideal BNCT requirements. The first clinical trials focusing on Boron neutron capture therapy were initiated by Dr. Sweet şi Brownell (Massachusetts Institute of Technology - MIT Boston) and Farr (Brookhaven National Laboratory – BNL) in 1951. Between 1951 and 1961, patients with glioblastoma from USA were irradiated, both at BNL as well as MIT. Based on the support provided by EORTC the first BNCT clinical studies were also initiated in Europe. Consequently, EORTC formed a study group for BNCT. A first phase I trial included 25 patients with optimally operated glioblastomas in 5 neurosurgery centres. Another EORTC protocol studied BSH and BPA administration in patients with different types of solid tumours in order to identify new targets for BNCT. Simultaneously, another study following BNCT and BPA in cutaneous metastases of malignant melanoma was implemented. A fourth protocol was initiated for BNCT with BSH in glioblastoma multifome. A third tumour type approached through BNCT was recurrent head and neck cancer. The first studies were established by Kato in Japan. In September 2003, Hiratsuka treated a recurrent papillary thyroid cancer with BNCT, in Japan. Yanagie and collaborators also used BNCT in Japan in recurrent rectal cancers. Other BNCT experiments evaluated treatment methods for locally recurrent breast cancers. Multiple liver metastases of the colorectal adenocarcinoma were among thy first liver tumours that raised researchers’ interest, from the area of BNCT. In February 2005, in Kyoto, Japan, at KUR the first patient with hepatocarcinoma was treated with BNC. The project “Study, research and application in the oncological clinical practice of treatment with neutron capture by B-10” participated in 2005 at the CEEX governmental competition- “Research Excellency Programmes”. The project was selected for financing and benefitted from a grant offered by the Romanian Government, PC-D01-PT11-94 - 2005.Although there are still considerable inconveniences, BNCT may be regarded as a promising method for cancer treatment.

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Original Papers

A study regarding the interrelation between a good state of mind as an indicator of health state and psychotherapy in children with Attention Deficit Hyperactivity Disorder

Mitu Ana Mihaela, Davitoiu Ana Maria, Truta Elena, Stanciulescu Luminita, Ionica M.
Abstract: Throughout one year: 2013 – 2014, a lot of 50 children from the residential institution “SOS Satele Copiilor” Bucharest, was included in our research The children were distributed in two groups: Group A which consisted of 25 children (12 girls, 13 boys) who were not diagnosed with ADHD and Group B which consisted of 25 children (14 boys, 11 girls) who were diagnosed with ADHD. Initially, the two groups were subjected to a psychodiagnostic battery of tests, one of them being: “ Evaluating the Health State of children with ADHD questionnaire” elaborated by the study team, particularly for this research, with the purpose of highlighting the direct link between children’s health status and their ADHD symptoms. Subsequently, the children from group B benefited from a psychotherapy protocol which combined the strategies of the short term psychodynamic psychotherapy. The emotional wellbeing average values of the children from group B and group A were significantly different at the beginning of our program, whileat the end the difference were highly reduced based on the statistical analysis.

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Therapeutical Practice

Treatment in oropharyngeal cancer- an update

Palade O.D., Lazar Andra Sorina, Oprea Alina, Toader Miorita, Toader C.
Abstract: Oropharyngeal cancer is a common malignancy which includes a wide variety of histopathologic tumors. Unfortunately it affects not only the elderly population, but also young patients, its incidence rising alarmingly in the last decade. The gold standard for the treatment of ororpharyngeal cancer is the multidisciplinary approach. The authors present a literature review of the current therapeutic regimens, with an emphasis on the surgical techniques.

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Case Report

Acute myeloid leukaemia in a 19 year old patient previously treated for osteosarcoma

Dragan C., Meilin Murat, Trifa A., Tevet Mihaela, Lupu Anca Roxana
Abstract: As patients with osteosarcoma become long-term survivors, increasing attention revolved around the burden of late effects. Recent studies showed an increase in the incidence of secondary malignant neoplasms in patients with osteosarcoma compared with the general population. The risk of developing leukaemia was reported to be in an increasing rate in the last decade. [1] Case report. In this report we present the case of a 19 year old patient diagnosed in the Haematology Department of Colentina Clinical Hospital in February 2015 with Acute Myeloid Leukaemia following the treatment (chemo- and radio-therapy) for an osteogenic osteosarcoma performed 3 years earlier. The cytogenetic examination revealed an abnormal karyotype with 91 chromosomes (XXY). The molecular biology exam did not find mutations in the FLT3ITD, FLT3D835 and NPM1 A genes. After the first induction course of chemotherapy the patient achieved complete remission, which was consolidated by 3 more courses of chemotherapy and an allogeneic stem cell transplant. Conclusion. Taking into consideration the prior treatment for osteosarcoma consisting in radiotherapy and chemotherapy we identified a secondary Acute Myeloid Leukaemia, this representing a major negative prognostic factor, along with the cytogenetic abnormalities found. These factors strongly indicate that the first complete remission should be consolidated by allogeneic stem cell transplant. Particularities of this case are the association of the two malignancies in a young patient, the presence of an abnormal karyotype (hyperploid), and also a good response to the induction therapy, thus achieving complete remission after the first induction course, and of course, sustaining that response.

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Intoxication with Diazinon

Dumitrascu Monica, Macovei R.A., Caragea Genica, Avram Ruxandra, Ionica M.
Abstract: Acute poisoning with organophosphoric compounds (OP) still remains an issue for the doctors, due to its’ high prevalence and sternness, many cases evolving to death. This occurs because the organophosphoric compounds are frequently used as insecticides in agriculture and in the household. They are extremely toxic and one of the most frequent types of contamination is through the lung, by inhalation of substances. More often the organophosphoric compound is not so poisonous for humans thant a metabolite of the compound. The diagnosis of poisoning is established based on two components: the clinical and analytical diagnostic. Clinical diagnostic refers to the clinical symptoms; it is called the cholinergic toxidrome. The analytical diagnostic concerns, on one hand, the level of pseudo cholinesterase and, on the anther hand, the identification of the organophosphoric compound. In the last years, great progress has been achieved in order to identify these compounds and their metabolites. The biological monitoring of pesticides is performed using Gas Chromatography coupled with Mass Spectrometry (GC-MS).

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Correlation of histological findings with bacterial culture in children with Helicobacter pylori gastritis

Nastase Gabriela, Anghel Malina, Galos Felicia, Stoicescu M., Munteanu M., Balgradean Mihaela
Abstract: The correct diagnosis and effective treatment of Helicobacter pylori (H pylori) gastric infection are essential in controlling this condition. The methods available have both advantages and limitations related to factors such as the level of technical difficulty, costs and extensive accessibility in hospitals. Bacterial culture from the gastric biopsy is the gold standard technique and recommended for antibiotic susceptibility tests. Many patients investigated for H. Pylori infection have been taking antibiotics or following a non steroidal anti-inflammatory treatment beforehand. These factors influenced the culture. We present the case of a 15-year -old girl with continuous pain in the upper abdomen that woke her in the early hours of the morning for several months, and nausea. She also has a psychiatric condition, having attempted suicide repeatedly. This case report presents some of the most relevant diagnostic methods for H pylori infection, as well as the influences from previously followed treatments, environmental factors (i.e. smoking) and conditions which influenced the grows colonies. In the case of a negative culture and in the absence of response to the empirical therapy based on current antibiotics (amoxicillin, clarithromycin, metronidazole), we consider it is useful to use other methods when it comes to detecting the primary antibiotic resistance.

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An atypical cause of nausea

Ilie Madalina, Turculet C., Diaconu Camelia, Tincu R., Constantinescu G., Stanciulescu Luminita, Macovei R., Enache V., Popa B., Ene D.
Abstract: Even if, ileal carcinoid tumours have a low incidence (0.2-0.8/100000), the diagnosis must be considered in the presence of hepatic metastasis of unknown origin. We report a case of 55 years old female that presents persistent nausea, for one year prior to admission. She was suspected of gallbladder stones and an abdominal ultrasound was performed. The result was normal and the patient presented to our clinic for a routine check-up. At the repeated ultrasound we found multiple focal hyperechoic liver lesions of maximum 10 mm. She was referred immediately for a CT-scan with intravenous contrast but the result was surprisingly normal. We insisted in our investigation and the patient was sent for a total abdominal MRI. The result revealed ileal tumour of 2 cm with liver metastases. Palliative surgery with resection of ileal tumour and liver metastasis biopsy is performed. The pathology result was compatible with neuroendocrine tumor G1(Ki 67 index 1-2%) with liver metastasis.

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Compressing Dermoid Cyst of the Neck

Palade O.D., Rebega Catalina, Cobzeanu M.D., Oprea Alina, Toader Miorita, Toader C.
Abstract: Neck masses always require an extensive differential diagnosis, including both benign and malignant etiologies. Therefore an accurate diagnosis is of paramount importance and three broad categories should be taken into account: congenital, inflammatory and neoplastic. In particular, congenital lesions are usually midline, nontender, mobile, submental neck masses. For example dermoid cysts are due to entrapment of epithelium in deeper tissue, occurring either developmentally or post trauma. They are treated by surgical excision. The authors report a clinical case presentation of dermoid cyst in the midlevel lateral cervical area which, beside the usual symptoms, adds cardiovascular and respiratory symptomatology by compression.

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A rare case of isolated oesophageal Crohn s disease

Ilie Madalina, Constantinescu G., Diaconu Camelia, Stanciulescu Elena-Luminita, Enache V., Macovei R., Popa B.
Abstract: Crohn s disease (CD) may affect any segment of the gastrointestinal tract. Although rare, its oesophageal manifestation may be seen as the first sign of this disease. We present the case of a 27 years old female who is admitted with heartburn and dysphagia for 4 years, being misdiagnosed as reflux esophagitis. Endoscopy performed in our unit pointed out erythema, segmental ulcers separated by normal mucosa, “cobble stone’’ aspect. The histological findings were ulcers and a chronic inflammatory mucosal infiltrate. The patient was unresponsive to PPI(Proton Pump Inhibitor), but a rapid improvement was seen after corticosteroid administration. Differential diagnosis and treatment opportunities are presented below.

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