Vol. 46 No. 4, October-December 2005

1. Angiogenesis in urothelial tumors of the upper urinary tract

Flavia Baderca, Rodica Lighezan, Alis Dema, Aurora Alexa, M. Raica

Angiogenesis is an essential process in the progression of malignant tumors. Tumors of the ureter and renal pelvis account for 5% of all urinary tract neoplasms. Little is known about angiogenesis in upper urinary tract urothelial tumors. We tried to demonstrate angiogenesis by using three endothelial markers CD31, CD34, von Willebrand factor and one pericytes marker (alpha-smooth muscle actin) in 26 cases. The pattern of CD31 immunolabelling was more complex and extensive than the vessel pattern shown by CD34 or factor VIII staining. In non-invasive tumors, we observed that angiogenesis process is limited to connective tissue of tumor stroma. In the tumor area, the blood vessels stained with anti-CD31 had large lumen, thin walls and numerous branches, some of them being very thin. Pericyte covered vessels were branching of frequently into smaller, pericyte negative vessels.

Corresponding author: Flavia Baderca, MD, PhD, e-mail:

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2. Endoscopical and histological features in bile reflux gastritis

C. C. Vere, S. Cazacu, Violeta Comanescu, L. Mogoanta, I. Rogoveanu, T. Ciurea

Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increased enterogastric reflux may provide the basis for increased mucosal injury. Bile reflux gastritis can appear in two circumstances: gastric resection with ablation of pylorus and primary biliary reflux due to the failure of pylorus. The aim of the study was to evaluate the endoscopical and histological changes caused by duodenal reflux on the gastric mucosa. The mucosal features were correlated with the risk factors involved in the development of bile reflux gastritis. Our study included 230 patients with alkaline reflux gastritis admitted in Medical Clinic No. 1, Emergency County Hospital of Craiova. In all cases, we performed an upper gastrointestinal endoscopy. Multiple biopsies were taken from gastric mucosa in 89 patients and the histological features were scored in accordance with the Sydney system. The average age of the patients with bile reflux gastritis was 58.387 years and the incidence of alkaline reflux gastritis was higher between 51 and 80 years. Reflux gastritis was noted to 138 males (60%) and 92 females (40%), ratio males/females was 1.5/1. The most frequent risk factors for bile reflux gastritis were gastric and biliary surgery. Alkaline reflux gastritis was observed in 167 cases (72.6%) after gastric surgery, consisting in gastric resection, pyloroplasty and gastroenteric-anastomosis. Gastroduodenal reflux after biliary surgery was noted in 17 cases (7.39%), 13 cases (5.69%) with cholecystectomy and four cases (1.73%) with biliary anastomosis. The average time interval from original operation to the discovery of the alkaline reflux gastritis was 14.91 years after gastric surgery and 15.29 years after biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 139 cases (64.43%), the presence of bile into the stomach in 133 cases (57.83%), the thicken of gastric folds in 22 cases (9.55%), erosions in 12 cases (5.22%), gastric atrophy in 12 cases (5.22%), petechiaes in five cases (2.17%), intestinal metaplasia one case (0.43%) and gastric polyp one case (0.43%). The histologic alterations observed from tissues collected during endoscopic examination were: chronic inflammation in 75 cases (84.06%), foveolar hyperplasia in 36 cases (40.44%), intestinal metaplasia in 31 cases (34.83%), acute inflammation in 16 cases (16.08%), Helicobacter pylori infection in 16 cases (16.08%), chronic atrophic gastritis in 12 cases (13.46%), gastric polyps in 12 cases (13.46%), dysplasia in 10 cases (11.23%), benign ulcerations in seven cases (3.04%), edema in six cases (6.74%) and neoplasia two cases (2.24%). Conclusions. Bile reflux gastritis was more frequent to male gender. The most frequent risk factors for alkaline reflux gastritis were gastric and biliary surgery. Reflux gastritis after gastric resection, pyloroplasty and gastroenteric-anastomosis were more frequent to male gender, while cholecystectomy and biliary anastomosis were predominantly to female gender. The average time interval from original operation to the discovery of the bile reflux gastritis was similar after gastric and biliary surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa, the presence of bile into the stomach, thickens of gastric folds, erosions, gastric atrophy, petechiaes, intestinal metaplasia and gastric polyp. Acute inflammation, Helicobacter pylori infection, gastric polyps and benign ulcerations were more frequent in patients with bile reflux gastritis after gastric surgery, while edema and dysplasia were increased after biliary surgery.

Corresponding author: Cristin Constantin Vere, MD, PhD, e-mail:

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3. P53 protein and bcl-2 expression in glioblastomas. Pathological correlations in a comprehensive series

Carmen Ardeleanu, M. Ceausu, Georgeta Butur, Zenaida Florea Gramada, L. Danaila, Fl. Halalau, D. Arsene

P53 and bcl-2 are two well-known antiapoptotic factors associated with gliomas, and mostly astrocytic tumors. In the present study, we assessed, by immunohistochemistry, the expression of these two factors in a series of 50 glioblastomas. The correlations between their expression and several tumor-related factors (age, location, recurrence, proliferating potential) were investigated. Our results suggest that a valuable correlation between these factors cannot be found. This is in discrepancy with some literature data, which emphasize strong relations of p53 and bcl-2 in oncogenesis spreading or final prognosis. Further studies are needed with unique standard procedures for these evaluations.

Corresponding author: Carmen Ardeleanu, MD, PhD, e-mail:

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4. The generation of the three-dimensional model of the human knee joint

D. Popa, D. N. Tarnita, Daniela Tarnita, D. Grecu

In this paper, we analyze the anatomic elements that compose the human knee joint. Also, we build the spatial model of the human knee joint components. This study is necessary for the design of prosthesis elements and for the establishment of the necessary prosthesis technique.

Corresponding author: Dragos Popa, Eng, PhD, e-mail:

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5. Hepatic steatosis associated with hepatitis C virus infection

Marioara Cornianu, Alis Dema, Sorina Taban, Daniela Lazar, Elena Lazar, Simona Costi

Hepatic steatosis (including microvesicular and macrovesicular fat) is a significant histologic feature associated to the chronic hepatitis C (HCV). The purpose of this paper was to analyze the incidence of hepatocyte steatosis in patients with HCV and the potential role of some the known variables as risk factors possibly involved in the occurrence of steatosis: age, sex, obesity, biological parameters, diabetes mellitus, degree of necroinflammation (NI) and stage of fibrosis. Ninety-six of 125 (76.8%) patients had hepatic steatosis (mild 76%, moderate and severe 24%); in comparison with patients without steatosis, those with HCV and steatosis were more frequently women (males/females: 1/1.9) of older age (49.97 vs. 47.7 years), with a greater ICM (index of corporal mass) (26.55 sqm vs. 23.52 sqm), with raised glycemic values (13 of the 14 patients with HCV and diabetes mellitus had steatosis), an average value of serum ALT significantly raised (95.38 U/L vs. 78.96 U/L), and an average score of NI activity significantly higher (9.39 vs. 6.75).

Corresponding author: Marioara Cornianu, MD, PhD, e-mail:

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6. Microscopic assays regarding the renal damage following a post-combustional shock

Daniela Cernea, Adriana Bold, Garofita Olivia Mateescu, Cristiana Simionescu

Over a period of three years (2000-2003), 39 autopsies were performed on patients with burns. Among them a number of 11 men and 28 women were aged between 28-92 years, the total burnt body surface was of 20% to 95%. Of all the cases nine patients died during the first 24-36 hours since the accident happened, presenting a burnt surface of more than 70%. In these cases, the renal lesions were minor but critical, presenting symptoms of acute renal failure (ARF). Subsequently, a number of 25 patients died within 1-4 weeks since the accident. Renal lesions were complex with tubular necrosis, lymphocyte infiltration and micro-abscesses. The burnt body surface of these patients was of 41-85%. In three cases, when death occurred within four weeks of hospitalization, the patients presented damages to other organs as well (multiple organs failure - MOF). The kidneys displayed tubular necrosis, fibrous micro-thrombi and infarct areas. In two cases coagulation intravascular dissemination occurred in patients with burnt body surface of 45-70% and aged of 42 and 60 years. Micro-thrombi and infarct areas dominated the renal lesions.

Corresponding author: Daniela Cernea, MD, PhD, e-mail:

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7. The importance of CT scan in the clinical-morphological and anatomical assessment of mediastinal lymphomas

A. Motoc, S. Brad, Viorica Brad, S. Bolintineanu

The study points out the value of CT scan in the investigative algorithm of mediastinal lymphomas. Thirty-eight cases of mediastinal malignant lymphoma were evaluated in a statistical retrospective study. CT scan was used for staging the disease in 25 cases and for post-therapeutic evaluation in the other 13 cases. The CT scan for staging purpose has shown the presence of significant isolated and confluent enlarged lymph nodes in the mediastinum in all 25 cases. Post-therapeutic evaluation of the 13 cases examined by CT showed six remissions, five reductions of lymph node masses and two extra nodal extensions. CT scan is the imaging method of choice in the clinico-morphological and anatomical assessment of mediastinal lymphomas.

Corresponding author: Andrei Motoc, MD, PhD, e-mail:

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8. Aspects referring to the morphological variability of the abdominal branches of pneumogastric nerve (nervus vagus)

M. C. Niculescu, V. Niculescu, Ecaterina Daescu, Iulia-Camelia Ciobanu, Alina-Maria Sisu, Adelina Jianu, Codruta-Ileana Petrescu, S. Bolintineanu

Terminal part and the abdominal branches of pneumogastric nerve were and still is an up-to-date problem not only through the anatomic importance but also through its implications in surgical practice. The study was done on 50 corpses using the dissection method. We are looking after torsion variants of pneumogastric nerves around the esophagus, morphological variability of the periesophageal pnemogastric plexus among witch the pnemogastric nerves loose theirs individuality through the mixture and the anastomoses of the fibers and the morphological variability of abdominal branches of the nerve, grouped by us in anterior and posterior branches.

Corresponding author: Marius Corneliu Niculescu, MD, PhD, e-mail:

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9. Sialic acid, possible marker of angiopathic complications at diabetics type 2

L. Faur, M. Motocu, Corina Moldovan, M. Onaca, Gabriela Mutiu

Studies from the last decade emphasize the importance of sialic acid (SA) in general pathology (neoplasic disease, colagenosis), and its implication in appearance and aggravation of atherosclerosis (e.g. appearance of angiopathy like chronic complication in diabetes mellitus). Diabetes is known as a major risk factor for atherosclerosis and has a high incidence in general population. The incidence of diabetes increases from year to year, especially type II of diabetes, the most common type (more than 90% from diabetics are type II). Diabetes mellitus with its chronic degenerative complications like micro and macrovascular angiopathy (coronary disease, nephropathy, retinopathy, arteriopathy) represents a major health and social problem (more than 80% of the mortality to type II diabetics is the result of coronarian and cerebral vascular complications). The early discovery of chronic angiopathic complications to diabetics is a major objective in increasing the hope of life to diabetics. Determination and monitorization of SA could be useful in the early discovering of chronic degenerative complications to patients with diabetes mellitus.

Corresponding author: Lucian Faur, MD, PhD, e-mail:

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10. Correlations between the results of the histological and cytological examination in the diagnostic of the broncho-pulmonary cancer

Ana-Maria Dragan, Elena Rosca, T. Vaida

Introduction. Within the last years, one discusses more and more about the association of the cytological examination with the histological one, becoming an important complementary examination. Casebook record. Hundred and sixty-three patients were taken in the study, age between 37-79 years old, which showed clinical and radiological signs of broncho-pulmonary cancer. At all the patients a fibro-bronchoscopic examination was performed, with harvesting of material for histological and cytological examination. Material and methods. The histological examination was performed on bioptic pieces, fixed with 10% formalin and colored with Hematoxylin-Eosin, Masson and Van Gieson. The cytological examination was performed on material harvested by aimed bronchial brushing and/or on stamps from bioptic material, colored Giemsa. Results. By histological examination (in the 163 cases) the diagnostic of broncho-pulmonary cancer was given with the establishing of the histological type of cancer in 87.12% of the cases, at 17 patients (10.42%) dysplasia was diagnosed and in 2.45% (4 cases) the examination was negative. Out of the 163 cytologically examined cases, in 66.25% (108 patients) diagnose of broncho-pulmonary cancer could be given and the histological type could be established. In 11.66% of the patients the cytological examination was negative and in 22.08% of the cases the cytology was strongly suggestive for broncho-pulmonary cancer, but one could not determine the histological type. According to the current classification of the broncho-pulmonary cancer by histological examination, we diagnosed the NSCLC type (non small cell lung carcinoma) by 123 patients (75.41%) and by cytological examination, by 124 (76.07%); the type SCLC (small cell lung carcinoma) was identified by histological examination in 18 cases (11.04%), while the cytological examination allowed the highlighting of this type of cancer in 5 cases (3.06%). Conclusions. Our data indicate the fact that the cytological examination on stamps from bioptic material or on that obtained by bronchial brushing offers a very high percentage of positive results, close to the histological one, but the establishing of the histological type of broncho-pulmonary cancer is more difficult by cytological examination, due to the heterogeneous structure of the NSCLC tumors. Despite this, the cytology may be extremely useful in diagnose of the small, necrotic tumors as well as in that of the carcinomas with non-small and small cells.

Corresponding author: Ana-Maria Dragan, MD, PhD, e-mail:

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11. Diagnostic particularities in primitive diffuse form hepatocellular carcinoma associated with portal vein thrombosis

I. Rogoveanu, Diana Vacaru, D. Gheonea, Claudia Valentina Georgescu, Violeta Comanescu, T. Ciurea

The diagnosis of primitive hepatocellular carcinoma, infiltrative form, arose on liver cirrhosis is often difficult because the imagistic investigations could not relevate the tumoral formation. We are presenting the case of a 56 years patient, diagnosed with viral B liver cirrhosis, in which the clinical symptomatology and laboratory investigations were leading to hepatocellular carcinoma, but the ultrasonography and CT scan could not confirm the malignant transformation. In these conditions, we performed ultrasonographically guided biopsy from the liver parenchyma and visualized thrombus in portal vein lumen. Histopathological exam from the thrombus tissue samples confirmed hepatocellular carcinoma diagnosis.

Corresponding author: Ion Rogoveanu, MD, PhD, e-mail:

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12. Assessment of angiogenesis in soft-tissue tumors

Virginia Baneth, M. Raica, Anca Maria Cimpean

The aims of our paper were to establish the main morphological and immunohistochemical aspects of tumor vessels, to quantify angiogenesis in soft-tissue tumors and to study the possible relationship between mast cells and angiogenesis. For this purpose, we immunohistochemically investigated 54 cases of benign and malignant tumors for smooth muscle actin and endothelial markers CD34 and CD31. It is presented a simple method to demonstrate simultaneously blood vessels and mast cells in the same section, using anti-CD34 and Alcian blue-Safranin. Our results strongly support the presence of a large number of immature and intermediate blood vessels in the tumor area. Microvessel density was higher especially in liposarcoma and malignant fibrous histiocytoma, and this finding suggests the application of the antiangiogenic therapy in soft tissue tumors in addition to conventional methods.

Corresponding author: Marius Raica, MD, PhD, e-mail:

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13. The value of serum and tissular expression of CA 125 antigen, in evaluation of the response to second line chemotherapy for the relapsed ovarian carcinoma

Fl. Badulescu, Adriana Badulescu, M. Schenker, Carmen Florina Popescu, Zoia Stoica

Purpose. The purpose of this study is to compare the predicted value of the blood levels variations of CA125 antigen and the imunohistochemical expression of CA 125, with imagistic criteria (The Response Evaluation Criteran in Solid Tumor - RECIST) regarding the survival estimation of female patients with relapsed ovarian carcinoma which undergo to second line chemotherapy. Material and method. We included in this study 40 female patients diagnosed with ovarian carcinoma, in the Oncology Clinic of the Emergency County Hospital Craiova, in a period of two years (from 2000 to 2002), which have fulfilled the following criteria: ovarian carcinoma IC-IV stage, according to FIGO system, first line treatment represented by the association between paclitaxel and a platinum salt, refractory or recurrent disease, indications for beginning the second line chemotherapy represented by topotecan or paclitaxel and carboplatin. The serial CA 125 antigen was determined in all patients before starting the chemotherapy and after each two sequences of chemotherapy, and the imunohistochemical expression of CA 125 was evaluated from surgery extracts before the second line chemotherapy (11 cases). The imagistic evaluation of the treatment response was done after four sequences of chemotherapy. Results: All patients had measurable disease according to RECIST criteria and had high values (at least double) of the CA 125 antigen blood level at the time of diagnosis. The imunohistochemically expression of CA 125 was correlated in most cases with the blood level of CA 125. The evaluation criterion of the CA 125 antigen has been shown to be more efficient in estimation the survival rate compared with the RECIST system. In a various analysis, which included numerous potential prognostic factors, only the variation of blood levels of these antigen and the free disease interval from the finalization of the first line chemotherapy have been identified as predictive factors of survival, while the other variables, including the RECIST criteria, had no impact on the prognosis regarding the survival. Conclusions: The response evaluation criteria based on the blood levels variations of CA 125 antigen are a better instrument for the estimation of the compared prognosis with the RECIST criteria for patients on second line chemotherapy for relapsed ovarian carcinoma.

Corresponding author: Florinel Badulescu, MD, PhD, e-mail:

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14. Morphoclinical aspects of the human paraprosthetic gingival mucosa

Monica Scrieciu, Mihaela Niculescu, Veronica Mercut, Victoria Andrei, Oana-Adina Panca

The multiple and various changes that the human gingival mucosa undergoes when coming into contact with a denture, require a histopathological study correlated with that of clinical manifestations. The highlighting of the histological lesions of the prosthetic field's mucosa is extremely important in the study concerning the tolerance of the oral cavity tissues towards the materials of dentures, because it has been observed that different materials can cause the same type of clinical changes. The clinical research has been carried out having as a basis a group of patients, carriers of fixed dentures made of different materials, the study method consisting in their clinical evaluation. The investigation of microscopic preparations, obtained through drawing mucosa from those patients under study, has been made by using both usual colorations for an overall examination of the tissue architecture, as well as special colorations for pointing out certain structures. The results of the investigation have made clear the fact that the clinical changes of the prosthetic field's mucosa can be adaptable to the denture or can react pathologically to the various possibilities of denture aggression. The histopathological picture of the paraprosthetic mucosa lesions is polymorphous due to the morphofunctional complexity as well as to the reacting capacity of the oral mucosa when interfering with a fixed denture.

Corresponding author: Monica Scrieciu, MD, PhD, e-mail:

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