ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 56 No. 2 Suppl., April-June 2015
This supplement was not sponsored by Outside Organizations.

1. Metal-based nanosystems for diagnosis

Roxana Cristina Popescu, Mariana Oana Mihaela Fufa, Alexandru Mihai Grumezescu

The impressive diversity related to etiologic factors and the distinctive genetic and immunological behavior attained by various conditions represent the fundamental reasons for high-rated inefficient and eventual hazardous strategies entailed by conventional healthcare practice. Thanks to the tremendous progress reported in nanotechnology during the last decades, various unconventional and promising strategies have been successfully developed and examined with respect to potential genuine biomedical applications. Given the amazing possibility to manipulate matter at a molecular and atomic level and the incessant need to design and implement personalized therapies, various nanosized systems have thus been engineered. Among the newly developed nanomaterials, metallic nanoparticles have gain attention during the intense biomedical research activity, thanks to their peculiar size-conditioned properties. An efficient therapeutic strategy begins with an accurate diagnosis result, so the immediate requirement of such specific detection tools is conspicuous. The use of silver and gold in day-to-day activities is acknowledged since ancient times, but the novel technological opportunities extended their particular applications towards personalized medicine. It is worthy to mention that the unexpected nanodimension-related features of the aforementioned noble metals strongly recommend them for a large number of current applications in nanomedicine, including novel and specific metallic nanostructures used in diagnostics.

Corresponding author: Alexandru Mihai Grumezescu, Chem. Eng., PhD; e-mail: grumezescu@yahoo.com

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2. Current understanding of the neurobiology of major depressive disorder

Anca Livia Chirita, Victor Gheorman, Dan Bondari, Ion Rogoveanu

Depression is highly prevalent worldwide and associated with significant morbidity and mortality. Approximately 340 million people worldwide suffer from depression at any given time. Based on estimates from the World Health Organization (WHO), depression is responsible for the greatest proportion of burden associated with non-fatal health outcomes and accounts for approximately 12% total years lived with disability. Probably no single risk factor can be completely isolated in major depressive disorder (MDD), as interactions between many sources of vulnerability are the most likely explanation. Buttressing the identification of grief, demoralization, hopelessness and styles of psychological coping of the depressed patient are vital, ongoing scientific developments that flow from an increased understanding of this interplay amongst the immune system, endocrine system and brain. The rapidly accumulating body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depressive symptoms and has important implications regarding the treatment and even prevention of depressive symptoms in patients.

Corresponding author: Victor Gheorman, MD, PhD student; e-mail: victor_gheorman1@yahoo.com

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3. Morphological features of melanocytic tumors with depigmented halo: review of the literature and personal results

Roxana-Ioana Nedelcu, Sabina Andrada Zurac, Alice Brinzea, Mirela-Daniela Cioplea, Gabriela Turcu, Raluca Popescu, Catalin-Mihai Popescu, Daniela Adriana Ion

Halo (Sutton s) phenomenon has been described as a depigmented halo that is associated most commonly with acquired melanocytic nevi; but it may be associated with various types of melanocytic skin tumors, melanoma being the most concerning. Different authors have been preoccupied with elucidating morphological features of melanocytic tumors associated with a depigmented halo. We reviewed the literature and discussed the main features of melanocytic halo tumors regarding histopathological, immune microenvironment profile and dermatoscopic appearance. We highlighted similarities and differences between Sutton s nevus and halo melanoma, also presenting relevant aspects of our results. Depigmented halo must be regarded as a phenomenon that may be associated with different types of melanocytic tumors and with a broad spectrum of histopathological atypia degree. Certain correlations between the shape, diameter, symmetry observed in clinical examination, histopathological appearance, dermatoscopic aspect of peritumoral halo and central tumor type could not be established due to insufficient data and contrasting results. Further studies are expected to add valuable information regarding the depigmented halo tumors features.

Corresponding author: Roxana Ioana Nedelcu, MD, PhD; e-mail: roxanaioana.nedelcu@yahoo.com

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4. Correlation of angiogenesis with other immunohistochemical markers in cutaneous basal and squamous cell carcinomas

Carmen-Diana Ciortea, Ioan Jung, Simona Gurzu, Attila Kovecsi, Sabin-Gligore Turdean, Tivadar Bara

The aim of this study was to establish an immunoprofile of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), and to explore as first time in literature the possible correlation between maspin, DOG-1, p16 protein and angiogenesis in these tumors. For SCCs, the histological grade of differentiation was also taken into account. The angiogenesis was quantified in 38 randomly selected cases of SCCs and 17 BCCc, respectively, using the antibodies vascular endothelial growth factor (VEGF-A) and COX-2, while the microvessel density (MVD) was evaluated with the CD31. Results: In SCCs, maspin cytoplasm to nuclear shift was an indicator of a deeper tissue invasion and dedifferentiation in the invasion front. The poorly differentiated cases, compared to G1/G2-SCCs, expressed more frequent the markers p16 (30.77% vs. 8%) and VEGF-A (53.85% vs. 32%), regardless the MVD. However, the p16 positivity was more frequent in BCCs than SCCs (52.94% vs. 15.79%). All of the p16-positive carcinomas were located in the head and neck area. DOG-1 marked 21.05% of SCCs and 5.88% of BCCs, being directly correlated with COX-2 positivity. Eccrine glands and hair follicles also expressed DOG-1. Conclusions: In cutaneous SCCs located in the head and neck area, sun-dependent p16/VEGF interaction seems to be responsible by tumor dedifferentiation, whereas maspin cytoplasm to nuclear shift might indicate a high degree of invasiveness. This is the first report about DOG-1 positivity in BCCs and eccrine glands, the significance of this pattern being unknown.

Corresponding author: Simona Gurzu, Associate Professor, MD, PhD; e-mail: simonagurzu@yahoo.com

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5. KRAS gene mutations - prognostic factor in colorectal cancer?

Maria Dobre, Daniela Elena Dinu, Eugenia Panaitescu, Rodica Daniela Birla, Cristina-Ileana Iosif, Marius Boeriu, Silviu Constantinoiu, Roxana Nicoleta Ivan, Carmen Maria Ardeleanu, Marieta Costache

The colorectal cancer (CRC) modern therapy is using adjuvant and neoadjuvant companion therapeutic agents, part of them having an anti-angiogenic action. Their benefic effect can be annulated by some gene mutations, which are interfering in signal transduction pathways. One of the more frequent activating mutations is occurring in the KRAS gene. We assessed the KRAS mutations by two molecular methods, in a group of patients with a follow-up until 144 months, aiming to establish eventual correlations between the presence of mutations and the evolution of patients. We tried to appreciate the prognostic value of these mutations. A retrospective study was conducted on 74 patients treated by radical surgery; the surgical specimens were analyzed macroscopically and the histopathological type and degree were established. PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) and pyrosequencing were performed on paraffin-embedded tumor specimens. Statistical analysis showed significant differences in survival between patients with wild type gene and patients with mutation in codon 13; the same results were also obtained regarding TNM I, II stages or Dukes type A and B cases. However, for the patients in stage IV pTNM, the evolution was slightly better in association with a KRAS mutation than in wild type cases.

Corresponding author: Carmen Maria Ardeleanu, MD, PhD; e-mail: cmardeleanu@yahoo.com

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6. Preliminary study of correlations between the intratumoral microvessel density and the morphological profile of colorectal carcinoma

Theodor Viorel Dumitrescu, Constantin Daniel Uscatu, Stelian Stefanita Mogoanta, Dragos Ovidiu Alexandru, Alexandra Dumitrescu, Michael Schenker, Cristian Mesina, Elena-Raluca Nicoli, Dan Ionut Gheonea, Manuela Vasile, Iancu Emil Plesea

Aim: New blood vessel formation (angiogenesis) is a fundamental event in the process of tumor growth and metastatic dissemination. The aim was to evaluate intratumoral vascular density (ITMVD) and to analyze possible correlations between ITMVD and the morphological profile of colorectal carcinoma. Materials and Methods: The studied group consisted of 50 patients that underwent surgery for colorectal tumors, 12 of them receiving preoperatory radiotherapy. The analyzed morphological parameters were tumor site, tumor gross aspect, tumor longitudinal and transverse diameter, tumor grading, local invasion (pT), regional invasion (pN), distant metastases (pM) and intratumoral microvessel density (ITMVD) expressed as number of capillaries/mm(2). The malignant tissue samples were included in paraffin blocks and serial tissue sections were cut both for Hematoxylin-Eosin staining and CD34 immunomarking. For each case, five consecutive fields without necrosis were randomly selected with x10 objective. Quantitative measurements were performed using special software for image analysis. Results: For non-irradiated colorectal tumors, ITMVD was the highest in rectal localization, in infiltrative tumors, in circumferential tumors, in tumors with low longitudinal extension, in moderately differentiated (G2) tumors and in pT4, pN0 and pM1 tumors. Discussion: Correlations showed different trends of ITMVD depending on each parameter: ITMVD was higher when the tumor was closer to the rectum, when it was more infiltrative, more circumferential or with low longitudinal diameter. These trends might be exploited in defining future anti-angiogenic therapeutic strategies. Conclusions: There were some interesting correlations between ITMVD and studied morphological parameters that have to be validated on larger series of cases.

Corresponding author: Stelian Stefanita Mogoanta, Assistant Professor, MD, PhD; e-mail: ssmogo@yahoo.com

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7. Toxicity of L-DOPA coated iron oxide nanoparticles in intraperitoneal delivery setting - preliminary preclinical study

Maria Victoria Comanescu, Mihaela Andreea Mocanu, Laurentiu Anghelache, Bogdan Marinescu, Florian Dumitrache, Anca-Daniela Badoi, Gina Manda

Iron oxide nanoparticles are promising candidates for theranostics in cancer, that aims to achieve in one-step precise tumor imaging by magnetic resonance, and targeted therapy through surface attached anti-cancer drugs. The aim of this study was to investigate in preclinical setting the biocompatibility of new iron oxide-based nanoparticles that were coated with L-DOPA for improved dispersion in biological media. These nanostructures (NPs) were designed for biomedical applications as contrast agents and/or drug carriers. We investigated the effect exerted in vitro by NPs and L-DOPA on the viability and proliferation of normal mouse L929 fibroblasts. NPs exhibited good biocompatibility against these cells. Moreover, L-DOPA contained in NPs sustained fibroblasts proliferation and/or limited anti-proliferative effects of naked nanoparticles. In the animal study, C57BL/6 mice were injected intraperitoneally with a single dose of NPs (approximately 125 mg/kg body weight). We followed up hematological and histological parameters for one, three and seven days after NPs administration. Results indicated that NPs possibly induced local inflammation and consequent recruitment of peripheral lymphocytes, whilst the decrease of platelet counts may reflect tissue lesions caused by NPs. The histopathological study showed mild to moderate alterations in the hepatocytes, splenic and renal cells, while the brain parenchyma only presented nonspecific congestive changes. Taken altogether, the preclinical study indicated that the new iron oxide nanoparticles coated with L-DOPA were biocompatible against fibroblasts and had a convenient toxicological profile when administered intraperitoneally in a single dose to C57BL/6 mice. Accordingly, the proposed nanostructure is a promising candidate for imaging and treating dispersed peritoneal tumors.

Corresponding author: Maria Victoria Comanescu, MD, PhD; e-mail: mariacomanescu@yahoo.com

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8. Expression pattern of beta-catenin during the development of human fetal spinal cord

Wei Ma, Jin-Wei Yang, Yan Gao, Tao Luo, Jing-ru Cheng, Dong-yan Wang, Jian-hui Guo, Li-yan Li

Development of the human fetal spinal cord is a very complicated process involving numerous signaling pathways including Wnt signaling pathways. These pathways are critical for the development and function of the mammalian nervous system. beta-Catenin is a key molecule in the canonical Wnt signaling pathway. However, the distributions of beta-catenin during development of the human fetal spinal cord have not been well characterized. Therefore, in this study, we performed immunohistochemical analysis of the beta-catenin distribution in the developing human spinal cord from 35 fetuses at three weeks to eight months of gestation. As early as E3W and E4W, beta-catenin was mainly expressed in the internal limiting membrane of the neural tube and neuroepithelium (E: Embryos; W: Weeks). During developmental stages, beta-catenin was widely expressed in various structures and cells including the neuroepithelium, internal limiting membrane, mantle layer, marginal layer, basal plate, alar plate, ependyma, gray matter, white matter, neurons with multiple processes, glial cells, and nerve fibers. This study clarifies the morphological developmental characteristics of the human fetal spinal cord as well as the distribution and expression pattern of beta-catenin in chronological and spatial aspects. Our results suggest that the Wnt/beta-catenin signaling pathway might play a crucial role in various stages of the formation and differentiation of the human fetal spinal cord.

Corresponding author: Li-yan Li, e-mail: kmliyanl@163.com; Jian-hui Guo, e-mail: guojianhuikm@163.com

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9. Real-time quantitative PCR detection of WT1 and M-BCR-ABL expressions in chronic myeloid leukemia

Annamaria Szanto, Zsuzsanna Pap, Lorand Denes, Erzsebet Benedek Lazar, Adrienne Horvath, Aliz-Beata Tunyogi, Beata Agota Baroti, Zoltan Pavai

The Philadelphia chromosome and the resulting BCR-ABL fusion gene represent the hallmark event in chronic myeloid leukemia (CML) and their discoveries radically changed the management of these patients. Currently Wilms tumor 1 gene (WT1) is intensively investigated as high WT1 expression levels have been demonstrated in case of multiple solid tumors and malignant hematological syndromes (acute myeloid and lymphoid leukemia, myelodysplastic syndromes and chronic myeloid leukemia). The aim of our study was to investigate the WT1 expression in CML patients and its possible contribution to disease evolution. Patients and Methods: In the Laboratory of Molecular Biology, University of Medicine and Pharmacy of Tirgu Mures, Romania, we regularly determined the M-BCR-ABL and WT1 expression levels by RQ-PCR (real-time quantitative polymerase chain reaction) testing in case of 19 CML patients: six patients monitorized from the diagnosis and 13 patients first tested during therapy. Results: Eight CML (four advanced stage and four CP) patients showed high WT1 expression level, and in case of 11 patients the WT1 expression levels were undetectable or lower than 0.02%. The only significant difference between the high and low WT1 expression groups was represented by the clinical stage. In the majority of pretreated patients (10 out of 13 patients), the WT1 expression levels were low or undetectable. Conclusions: High WT1 expression in CML patients is detected especially in the advanced stages of the disease. Efficient Imatinib therapy may contribute to low WT1 levels in CP patients.

Corresponding author: Lorand Denes, Lecturer, MD, PhD; e-mail: deneslorand@gmail.com

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10. Interplay between expression of leptin receptors and mucin histochemical aberrations in colorectal adenocarcinoma

Velimir Milosevic, Filip Vukmirovic, Miljan Zindovic, Miljan Krstic, Sanja Milenkovic, Snezana Jancic

Background: There is no information on the effects of leptin receptors expression on mucin-histochemical alterations in human colorectal adenocarcinoma. Aim: Testing the correlation of leptin receptors expression with histochemical dysregulation of mucins in colorectal adenocarcinoma. Patients and Methods: The study included 75 patients with colorectal adenocarcinoma who underwent surgical resection. Following a routine histopathological tissue analysis, 3-4 micro-m thick cuts were made onto resected tumors, which underwent a routine Hematoxylin-Eosin, histochemical Alcian Blue-Periodic Acid Schiff, pH 2.5, and High Iron Diamine-Alcian Blue, pH 2.5, methods for mucin differentiation and immunohistochemical Avidin-Biotin peroxidase complex method with anti-Ki67 and anti-leptin receptor antibodies. Following the quantification of results for the statistical analysis, the statistical software package SPSS for Windows (13.0) was used, and the tests for analyzing the significance of differences and correlation analysis - Spearman s rank correlation coefficient, were conducted. Results: Increased expression of leptin receptors is with highly significant correlation coefficient associated with hypersecretion of sialomucins. Significant positive correlation coefficient exists between the leptin receptors expression against neutral-fucomucins secretion. With weak and negative, but a significant correlation coefficient, leptin receptors expression is associated to the sulfomucins generation. Conclusions: Increased expression of leptin receptors in colorectal adenocarcinoma is associated with mucin-histochemical abnormalities that are manifested by sialomucins hypersecretion and reduction, ultimately resulting in the absence of sulfomucins secretion.

Corresponding author: Velimir Milosevic, MD, PhD; e-mail: vejja@t-com.me

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11. c-abl and YWHAZ gene expression in gastric cancer

Emil Moraru, Ionica Daniel Vilcea, Cecil Sorin Mirea, Stelian Stefanita Mogoanta, Mihai Cruce, Ion Vasile, Manuela Vasile, Alina Maria Vilcea

This study aims to determine the gene expression for c-abl and YWHAZ in gastric cancer and the differences between the c-abl and YWHAZ gene expression inside the tumor versus healthy tissue (at the resection edges). This prospective study included 34 patients with gastric neoplasia, 21 men and 13 women, aged between 49 and 79 years (65.5 years median). After the surgical procedure, in these cases, we collected two tissue samples: one sample was obtained from inside the tumoral tissue and another sample from the gastric tissue, which was identified as normal apparently, as far as possible from the tumor (resection edge). For determining the c-abl and YWHAZ gene expression, we used the quantitative real-time polymerase chain reaction. Regarding the c-abl gene expression in gastric cancer, c-abl expression was identified as lower inside tumor cells comparing to the normal gastric tissue (resection limit). This difference of gene expression emphasize the role of the c-abl gene in normal tissue growth and the involvement in apoptosis induction when alteration of DNA occurs, as a result to different agents actions as stress, ionizing radiations. The loss of expression or even the down-regulation of the c-abl is a fundamental event that leads to genesis and progression of tumors. No significant differences of the YWHAZ gene expression between the tumoral and normal gastric tissue probes were recorded in our study.

Corresponding author: Ionica Daniel Vilcea, Associate Professor, MD, PhD; e-mail: id.vilcea@yahoo.com

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12. Enhanced expression of vascular endothelial growth factor and increased microvascular density in women with endometrial hyperplasia: a possible relationship with uterine natural killer cells

Amr K. Elfayomy, Shaima M. Almasry, Ghalia M. Attia, Fawzia A. Habib

This case-control study aimed to investigate the expression of natural killer cells (NKCs) and the integrated optical density (IOD) of vascular endothelial growth factor (VEGF) and to quantify microvascular density (MVD) in endometrial biopsies from women with endometrial hyperplasia (EH) relative to normal subjects. Histological data from four groups were analyzed. The study population included 30 women with simple EH without atypia, 25 patients with complex EH without atypia, 25 with complex EH with atypia and 25 healthy women with non-hyperplastic endometrium (control group). Paraffin sections were immunostained with antibodies against CD56, VEGF-A and CD34 using an Avidin-Biotin-Peroxidase technique. The evaluation of NKC density and IOD of VEGF expression and measurement of MVD were performed using light microscopy examination and image analysis techniques. Increased numbers of NKCs were documented in cases of complex EH with atypia compared with the other groups (p<0.001). The number of NKCs was lower in cases of hyperplasia without atypia compared with the controls, but the difference was not significant. The IOD of VEGF-A and MVD increased significantly with progression from the non-hyperplastic endometrium through the three groups of EH (p<0.001). We observed a significant correlation between the MVD and the IOD of VEGF-A in the studied groups (r=0.434; p<0.001). Additionally, NKCs density was correlated significantly with IOD of VEGF-A (r=0.661; p<0.001) and with the MVD (r=0.473; p<0.001). These results suggest that NKC-count, IOD of VEGF and endometrial MVD are all related to the histological changes of the endometrium and that endometrial hyperplasia exhibits distinct immunological backgrounds in the context of NKC infiltration and VEGF production.

Corresponding author: Shaima Mohamad Almasry, MD, PhD; e-mail: almasry.shaima@gmail.com

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13. A hardware approach for histological and histopathological digital image stain normalization

Mircea Sebastian Serbanescu, Iancu Emil Plesea

Advances in technology made the migration of pathological diagnosis to digital slides possible. As the need for objectivity and automation emerged, new computer software algorithms were proposed. Computer algorithms demand accurate color and intensity values in order to provide reliable results. The tissue samples undergo several processing steps from histological preparation to digitalization, which cannot be completely standardized. Thus, non-standardized input data generates unreliable output data. In this article, we discuss a new computational normalization algorithm for histopathological stained slides that uses a hardware color marker. The marker is added to the glass slide together with the tissue section, exposed to all the processing steps and altered in the same manner as the biological material of interest, thus becoming a solid color marker for image normalization. The results of the proposed method are numerically and perceptually tested in order to prove the advantages of the method. We conclude that our combined hardware-software technique for staining normalization of digital slides is superior to the existing methods based on only software normalization, and that its implementation will tackle not only the acquisition errors but also the technical errors that may occur during the staining process.

Corresponding author: Mircea Sebastian Serbanescu, MD, PhD Student; e-mail: mircea_serbanescu@yahoo.com

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14. Ovariectomized rats femur treated with fibrates and statins. Assessment of pore-size distribution by 1H-NMR relaxometry

Remus Sebastian Sipos, Radu Fechete, Ramona Ioana Chelcea, Dumitrita Moldovan, Zsuzsanna Pap, Zoltan Pavai, Dan Eugen Demco

The effects of two wonder drugs, simvastatins and fenofibrates on the proximal part of the femoris of a series of ovariectomized and non-ovariectomized Wistar albino rats was estimated qualitatively and semi-quantitatively by the modern method of 1D 1H-NMR T2-distribution. The 72 rats subjected to this study were divided in six groups and were sacrificed at two, four, six and eight weeks after ovariectomy and the proximal part of femoris was harvested. The CPMG (Carr-Purcell-Meiboom-Gill) echoes train curves were measured for the bones fully saturated with water during two months after two months of natural drying. These decays were analyzed by Laplace inversion and an average of normalized T2-distributions was considered for all rat s groups. The 1D averaged T2-distributions present four peaks, which were associated with protons in four major environments, from which the free water protons are used as spy molecules to explore the boundaries of cavities. In the approximation of spherical pores, the averaged T2-distributions were transformed in distributions of pores diameters. These were found in the range from 2 micro-m up to 2 mm. The relative amplitudes, widths and position of deconvoluted distributions of small, medium and large cavities are used for a qualitatively analysis of the effect of our lipid-lowering drugs. For a semi-quantitatively analysis, we chose the diameter d of proximal part of femoris trabecular cavities. We show that the positive or negative effects of treatments with simvastatins and fenofibrates are strongly dependent on the duration of treatment. Moreover, the treatment of healthy bone is generally counter-indicated.

Corresponding author: Remus Sebastian Sipos, Assistant Professor, e-mail: dr_sipos@yahoo.com; Radu Fechete, Associate Professor, Dr. Habil., e-mail: rfechete@phys.utcluj.ro

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15. The assessment of lower face morphology changes in edentulous patients after prosthodontic rehabilitation, using two methods of measurement

Anca Jivanescu, Dana Cristina Bratu, Lucian Tomescu, Alexandra-Cristina Maroiu, George Popa, Emanuel Adrian Bratu

Using two measurement methods (a three-dimensional laser scanning system and a digital caliper), this study compares the lower face morphology of complete edentulous patients, before and after prosthodontic rehabilitation with bimaxillary complete dentures. Fourteen edentulous patients were randomly selected from the Department of Prosthodontics, at the Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. The changes that occurred in the lower third of the face after prosthodontic treatment were assessed quantitatively by measuring the vertical projection of the distances between two sets of anthropometric landmarks: Subnasale - cutaneous Pogonion (D1) and Labiale superius - Labiale inferius (D2). A two-way repeated measures ANOVA model design was carried out to test for significant interactions, main effects and differences between the two types of measuring devices and between the initial and final rehabilitation time points. The main effect of the type of measuring device showed no statistically significant differences in the measured distances (p=0.24 for D1 and p=0.39 for D2), between the initial and the final rehabilitation time points. Regarding the main effect of time, there were statistically significant differences in both the measured distances D1 and D2 (p=0.001), between the initial and the final rehabilitation time points. The two methods of measurement were equally reliable in the assessment of lower face morphology changes in edentulous patients after prosthodontic rehabilitation with bimaxillary complete dentures. The differences between the measurements taken before and after prosthodontic rehabilitation proved to be statistically significant.

Corresponding author: Dana Cristina Bratu, Assistant Professor, DMD, PhD; e-mail: danacristinabratu@yahoo.com

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16. The storage period of the formalin-fixed paraffin-embedded tumor blocks does not influence the concentration and purity of the isolated DNA in a series of 83 renal and thyroid carcinomas

Adela-Corina Nechifor-Boila, Andrada Loghin, Victor Vacariu, Vasile-Bogdan Halatiu, Angela Borda

Optimal recovery of nucleic acids from formalin-fixed paraffin-embedded (FFPE) tissues is highly dependent on a series of pre-extraction steps, mainly related (but not limited) to fixation. The aim of our study was to investigate if the storage period of the FFPE blocks had a significant effect on the isolated DNA. We examined the quantity and purity of the isolated DNA from 83 FFPE blocks, corresponding to malignant thyroid (n=28) and renal (n=55) carcinomas that had been stored in our department for up to eight years. The DNA extraction protocol was based on a precipitation method (MasterPure DNA Purification Kit, Epicentre), in accordance to the manufacturer instructions, optimized in our laboratory. A spectrophotometer was used to determine the yield (A260) and purity (A260/A280 ratio) of the isolated DNA. We successfully isolated good DNA quantity and purity from all our study cases (mean concentration: 223.4+/-104.16 ng/micro-L; mean A260/A280 ratio: 1.68+/-0.09). Moreover, no statistically significant differences were observed between tumor blocks stored for 2-3 years and 7-8 years, respectively, both in terms of DNA quantity (p=0.196) and purity (p=0.663). In conclusion, we successfully validated an efficient, reproducible DNA extraction technique that provided a good range of DNA concentrations and purity, regardless the type of tissue (thyroid or kidney). Moreover, we demonstrated that the storage period of the FFPE blocks does not have a significant influence on the DNA quantity and purity.

Corresponding author: Andrada Loghin, Associate Professor, MD, PhD; e-mail: andradaloghin@yahoo.com

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17. Etiopathogenic, therapeutic and histopathological aspects upon the anterior vaginal wall prolapse

Sabin Sorin Badi, Maria-Camelia Foarfa, Nicolae Rica, Florin Grosu, Casiana Stanescu

The pelvine organ prolapse (POP) is a condition affecting million of women, with a major impact upon the social and professional life of the patients. According to various studies, it affects approximately 40% of the women aged over 50 years. About 10% of women with POP require a surgical procedure for POP or urinary incontinence. Our study comprised a number of 14 patients, aged between 55 and 70 years, hospitalized and treated in the Clinic of Urology within the Emergency County Hospital of Craiova, Romania, between 2011 and 2013, for second-degree cystocele. Of these, 11 (78.57%) patients had more than two natural deliveries, 10 suffered more than three abortions, and eight (57.14%) women suffered from obesity. The increase of abdominal pressure, induced by chronic coughing, constipation or hard physical work, was identified in more patients. Thus, six (42.8%) patients presented chronic bronchitis, four (28.57%) patients were smokers, eight (57.14%) patients presented chronic constipation, and 10 (71.42%) patients stated that they had performed hard physical work. The presence of effort urinary incontinence, associated to the cystocele, was found in eight (57.14%) cases. The surgical intervention consisted in the performance of a direct cystopexia with a synthetic tent, placed in a transobturatory way, in a tension free manner (Perigee System). The post-operatory evolution was a good one; the results after six months showed that 12 (85.71%) women were cured, two (14.29%) cases of cystocele relapsed, while in two patients there maintained the effort urinary incontinence. The histopathological examination of the anterior vaginal wall fragments, harvested during the surgical intervention, showed the presence of a chronic inflammatory infiltrate in the lamina propria of the uterine mucosa, which may cause the post-operatory relapses. We consider that the reduction of the inflammatory process through the administration of anti-inflammatory drugs could reduce the POP onset and progress.

Corresponding author: Florin Grosu, MD, PhD; e-mail: drfloringrosu@gmail.com

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18. Electron microscopic aspects of the effects of certain prostaglandin analogs on mouse testes

Anca Sava, Andrei Gheorghe Marius Motoc, Cristinel Ionel Stan

Prostaglandins were highlighted in the seminal plasma and then in the rest of the male and female genital tract. Prostaglandin analogs, firstly used in obstetrics and gynecology, are now widespread in both sexes, especially in the treatment of gastric and duodenal ulcers, glaucoma, etc. Therefore, we tried to highlight the effects of repeated administration of Cloprostenol and CIPG isopropyl ester (both prostaglandin F2alpha analogs) for the male gonad. In our experiment, we used Cloprostenol and CIPG isopropyl ester. We used three groups of white, male mice, aged 50-80 days, kept in standard laboratory conditions, which received the same feed. Each group included 12 mice. The first batch was the control group and received no substance at all. The second batch received 25 micro-g/kg of Cloprostenol dose per body per day, intraperitoneal administration (a single dose per day) on a daily basis for a four weeks period of time. The third batch received a 25 micro-g/kg CIPG isopropyl ester dose per body/day intraperitoneal administration (a single dose per day) on a daily basis for a four weeks period of time. After 7, 14 and 28 days of treatment, we sacrificed four animals in each of the batches by cutting their carotid arteries. The prostanoid analogs we used, Cloprostenol and CIPG isopropyl ester, have similar actions on male gonad in mice. These analogs induced significant changes in the evolution of the spermatogenesis and spermiogenesis. In relation to the treatment duration there were cellular changes suggesting apoptosis in different stages. With regard to spermiogenesis, the ultrastructural aspects indicate a decrease of the sperm structuring processes, especially in the acrosomal apparatus and chromatin.

Corresponding author: Anca Sava, Associate Professor, MD, PhD; e-mail: dr_anca_sava@yahoo.com

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19. Vascular calcification in continuous ambulatory peritoneal dialysis patients

Ileana Peride, Ionel Alexandru Checherita, Diana Ruxandra Steluta Smarandache, Daniela Radulescu, Ruxandra Diana Sinescu, Andrei Niculae, Catalin Pricop

Vascular calcifications represent a severe complication of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stage 5. The factors influencing the development of this complication are in close relation with the pathology of chronic dialysis premorbid condition, and with therapy as well. The present article highlights the association between several factors and the development or the aggravation of vascular calcifications in continuous ambulatory peritoneal dialysis (CAPD) patients. The results are not always in accordance with similar literature data, but there is a lack of researches regarding mineral metabolism in peritoneal dialysis patients versus those on chronic hemodialysis.

Corresponding author: Ionel Alexandru Checherita, Associate Professor, MD, PhD; e-mails: fizij@yahoo.com, al.checherita@gmail.com

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20. Studies regarding the protective effects exhibited by antidepressants on cell models

Nicoleta Carmen Purdel, Rucsandra Danciulescu Miulescu, Marius Cristian Neamtu, Elena Taina Avramescu, Mihaela Ilie, Gina Manda, Denisa Marilena Margina

The study aimed to assess in vitro the short-term effects exerted by fluoxetine, sertraline and venlafaxine on certain physiological properties in two different study models: U937 monocytes and erythrocytes isolated from patients treated with the above-mentioned molecules. Results on U937 cell suspensions revealed the depolarization of the cell membrane induced by the three antidepressants. The maximal depolarization effect was registered after 15 minutes of cell exposure and was concentration-dependent, in a non-monotonic manner. The effect was also dependent on the tested compound, fluoxetine presenting the strongest depolarizing effect compared to sertraline and venlafaxine. The erythrocyte susceptibility to lipid peroxidation and glucose-6-phosphate dehydrogenase activity were assessed on red blood cells isolated from patients with depressive disorder. Our results revealed that antidepressant treatment induced the antioxidant defense, by decreasing erythrocyte susceptibility to lipid peroxidation and increasing glucose-6-phosphate dehydrogenase activity. The effect is more intense in the case of severe pathology and less evident in the case of moderate or minor disorder, as expressed by MADRS (Montgomery-Asberg Depression Rating Scale) score. Our results could indicate that selected antidepressants at therapeutic concentrations, besides their known pharmacological effects, exhibit a protective effect against oxidative stress and also influence cells with immune properties.

Corresponding author: Mihaela Ilie, PhD; e-mail: m16ilie@yahoo.com

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21. Histological and immunohistochemical aspects of papillary thyroid cancer

Tatiana Georgiana Radu, Laurentiu Mogoanta, Cristina Jana Busuioc, Casiana Stanescu, Florin Grosu

Papillary thyroid carcinoma is one of the most common malignancies of the endocrine system. In recent years, its incidence has increased worldwide, including children, which concerns the entire community. Although the histopathological diagnosis seems rather easy, the existence of particular forms of thyroid cancer and the inclusion of the follicular aspect as a variant of papillary carcinoma lead to diagnostic confusion. Therefore, in the last 20 years were reviewed several immunohistochemical markers, which are useful in the positive and differential diagnosis, and which offer better data on disease prognosis. Our study included a total of 27 cases of papillary carcinomas, which we evaluated the immunohistochemical expression of Ki-67, p53, p63, E-cadherin, CD56, calretinin, and bcl-2 markers. The most intense expression was found in p53, E-cadherin, and bcl-2. Ki-67 and p63 expression were moderate and inconsistent, and CD56 and calretinin had a negative expression in all cases.

Corresponding author: Laurentiu Mogoanta, Professor, MD, PhD; e-mail: laurentiu_mogoanta@yahoo.com

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22. Histological differences between laser-assisted and suction-assisted lipoplasty aspirates - a comparative study

Cristian Radu Jecan, Alexandru-Daniel Hernic, Elena Cristina Tianu, Ioan Petre Florescu, Ioan Lascar

Introduction: The authors aimed to assess the histological differences between the traditional suction-assisted lipoplasty (SAL) and the more recently developed laser-assisted lipoplasty (LAL) aspirates, in a 20-case comparative study. Patients and Methods: Between March of 2011 and March of 2012, we operated on 20 healthy female patients seeking body contouring procedures of the abdomen, flanks and outer thighs, all having good to moderate skin tone and moderate to heavy adipose deposits and no previous treatment of the interested areas. After initial aspiration of a 100 mL sample of fat tissue through the SAL technique, we applied the LAL protocol, using a Lipolite device with a 1064 nm Nd:YAG laser, again sampling the aspirate for histological study. Results: The analyzed samples revealed significant histological difference between the two aspirates: the adipose tissue architecture, after conducting the LAL procedure, appeared to be disrupted, consisting of deformed and ruptured fat cells surrounded by coagulation-modified collagen, small lymphocytic inflammatory infiltrate, coagulated small blood vessel and intact nerves. In contrast, the cytological patterns of the adipose tissue after using the SAL technique resembled normal fat tissue structure. Conclusions: Our study succeeded in demonstrating significant histological differences between SAL and LAL aspirates, many of which could explain certain disparities between the clinical outcomes of the two procedures.

Corresponding author: Cristian Radu Jecan, Lecturer, MD, PhD; e-mail: radujecan@yahoo.com

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23. Histological and immunohistochemical study of the eyelid basal cell carcinomas

Andrei-Theodor Balasoiu, Maria-Rodica Manescu, Maria Balasoiu, Ioan Avramoiu, Ionica Pirici, Marian Burcea, Laurentiu Mogoanta, Carmen-Luminita Mocanu

The eyelids represent a frequent site for numerous malignant tumors, which generally present subtle symptoms or can imitate benignant tumors. Our study was carried on 80 patients, 48 males and 32 females aged between 48 and 92 years. The patients were hospitalized in the Ophthalmology Clinic of the Emergency County Hospital of Craiova, Romania. The study was conducted over five years, between 2010 and 2014. Our study included 80 basal cell carcinomas of the eyelids, of which 48 (60%) were nodular basal cell carcinomas, 15 (18.75%) were adenoid basal cell carcinomas, 10 (12.5%) were cystic and seven (8.75%) were morpheaform basal cell carcinoma. Our study showed a moderate expression of bcl-2 marker in the nodular type of basal cell carcinoma and a high expression in the other histopathological types, thus inducing an increased malignancy comparing to the nodular type. E-cadherin was absent in nodular, cystic and adenoid basal cell carcinomas and had a moderate expression in morpheaform basal cell carcinoma. Morpheaform and adenoid types presented 20% expression of Ki67 of the malignant cells nuclei, while the cystic type presented Ki67 expression in less than 10% of the malignant cells nuclei. Due to high morbidity and increasing incidence, basal cell carcinoma of the eyelid represents an important health issue nowadays.

Corresponding author: Laurentiu Mogoanta, Professor, MD, PhD; e-mail: laurentiu_mogoanta@yahoo.com

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24. Chondrosarcoma of the hyoid bone: a case report

Mircea-Sorin Ciolofan, Elena Ionita, Iulica Ionita, Carmen Aurelia Mogoanta, Florin Anghelina, Anca-Stefania Enescu, Diana Maria Ciobirca, Andrei Osman, Maria-Camelia Foarfa, Garofita Olivia Mateescu

Chondrosarcoma is a malignancy of the mesenchymal tissue derived from transformed cells that produce the cartilage matrix. In the neck area, it represents less than 0.5% of malignant tumor pathology. Chondrosarcoma of the hyoid bone is extremely rare, only 20 cases having been published so far (PubMed 2014). We present the case of a 30-year-old patient from the urban area, admitted in the ENT (Ear, Nose and Throat) Emergency Service with inspiratory dyspnea, dysphagia, stomatolalia, with evolutive and progressive clinical history of 2-3 months. Endoscopic examination revealed a pharyngolaryngeal tumor process located in the right vallecula, who by mass effect displaces the above-hyoid epiglottis. CT (computerized tomography) scan described a cervical polycystic tumor aspect, with multiple septae and inside calcifications with a diameter of 3-4 mm. Surgery consisted in removal of the tumor process together with the hyoid bone. Histopathological and especially immunohistochemical examination established the diagnosis of low-grade chondrosarcoma of the hyoid bone. For assessment of the phenotype of the tumor cells, the following immunohistochemical markers were used: p53, Ki67. The patient followed radiochemotherapic oncological treatment and returned for regular follow-ups. There was a positive development with no signs of regional or remote relapse or metastasis for 24 months after surgical treatment. Surgery is the treatment of choice, with complete removal of the tumor, with chemoradiation playing an adjuvant role. Regular tracking of the patient is mandatory.

Corresponding author: Mircea-Sorin Ciolofan, Assistant Professor, MD, PhD; e-mail: sorin.ciolofan@yahoo.com

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25. A challenging case of ocular melanoma

Mariana Costache, Adrian Vasile Dumitru, Oana Maria Patrascu, Daniela Alina Popa-Cherecheanu, Patricia Badila, Jeni Catalina Miu, Alexandru Procop, Manuela Popa, Mircea-Stefan Tampa, Maria Sajin, Olga Simionescu, Monica Mihaela Cirstoiu

Ocular melanoma is a rare malignancy found in clinical practice. In this paper, we present a case of highly aggressive ocular melanoma, which was surgically removed at the Department of Ophthalmology and diagnosed at the Department of Pathology, Emergency University Hospital, Bucharest, Romania, using conventional histopathological techniques. Uveal melanoma, a subset of ocular melanoma, has a distinct behavior in comparison to cutaneous melanoma and has a widely divergent prognosis. Approximately half of patients with ocular melanoma will develop metastatic disease, predominantly with hepatic, pulmonary or cerebral location, over a 10 to 15 years period. No systemic therapy was associated with an evident clinical outcome for patients with advanced disease and overall survival rate remains poor.

Corresponding author: Adrian Vasile Dumitru, MD; e-mail: eldarlight@yahoo.com

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26. Congenital solitary kidney with multiple renal arteries: case report using MDCT angiography

Petru Matusz, Gratian Dragoslav Miclaus, Christian Dragos Banciu, Ioan Sas, Shamfa C. Joseph, Laurentiu Cornel Pirtea, R. Shane Tubbs, Marios Loukas

A congenital solitary kidney with multiple renal arteries is a rare congenital abnormality that can occur in the presence of multiple other anomalies. We describe an atypical case of a right congenital solitary kidney with three renal arteries (RA) one main RA and two additional renal arteries in a 75-year-old woman with uterine didelphys. The main RA had an intraluminal diameter larger than the diameter of the additional renal arteries (AdRAs) at the origin (0.53 cm for the main RA; 0.49 cm and 0.32 cm for the two AdRAs). Both the AdRAs had a greater length than the main RA (3.51 cm for the main RA; 3.70 cm and 4.77 cm for the two AdRAs). The calculated volume of the kidney was 283 cm(3), while the volume of the renal parenchyma was 258 cm(3). Knowledge of this variant is extremely important in clinical practice as it has been found to be associated with proteinuria, hypertension and renal insufficiency.

Corresponding author: Ioan Sas, Associate Professor, MD, PhD; e-mail: sasioan56@yahoo.com

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27. Solitary trichoepithelioma: clinical, dermatoscopic and histopathological findings

Loredana Elena Stoica, Rucsandra Cristina Dascalu, Virgil Patrascu, Raluca Niculina Ciurea, Daciana Elena Branisteanu, Diana Monica Georgescu, Paulina-Lucia Ciurea

Trichoepithelioma is part of the adnexal carcinomas. It is a benign, small tumor, usually under a centimeter in diameter, which develops in the basal cells of the hair follicle. Case report: We present the case of a 30-year-old female patient, from rural area, which was hospitalized in the Clinic of Dermatology, Emergency County Hospital, Craiova, Romania, in March 2015, for the presence of a skin tumor, with round-oval shape, 0.5 cm in diameter, brownish colored, located on the left cervical region. The patient had no past medical history. The skin tumor appeared two years ago, and it was slowly increasing in size. Physical examination was in normal ranges. The dermatoscopic examination reveal a pearly white background covered with tumor islands that were oval shaped, with hyperpigmentation, centered by keratin cysts and surrounded by collagen. During hospitalization, we performed tumor biopsy. The histopathological examination showed microscopic structure of trichoepithelioma. After history taking, physical examination, dermatoscopic examination and histopathological result, our diagnosis was left cervical trichoepithelioma. Conclusions: Trichoepithelioma is a rare trichogenic tumor, which appears at any age, including newborns, with potential for local recurrence. Our case report represents a classic dermatoscopic aspect of trichoepithelioma, that can have close resemblance to basal cell carcinoma and other skin adnexal tumors, clinically, dermatoscopic and histopathological.

Corresponding author: Loredana Elena Stoica, Lecturer, MD, PhD; e-mail: tanaseloredanaelena@yahoo.com

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28. A rare case of concomitant tuberculosis of the nose, paranasal sinuses and larynx: clinical, histological and immunohistochemical aspects. A case report

Vlad Andrei Budu, Ioan Alexandru Bulescu, Alexandra Schnaider, Cristiana Gabriela Popp, Claudia Lucia Toma, Carmen Aurelia Mogoanta, Gheorghe Muhlfay

Extrapulmonary tuberculosis is a rare condition determined by Mycobacterium tuberculosis. It can affect any organ, and has a higher incidence with the increase of HIV infection, or in countries with high pulmonary tuberculosis. Diagnosis is difficult, mostly because of non-specific symptoms and a low rate of presentation for medical consult when symptoms do occur. Complete diagnosis is usually set by histological, immunohistochemical examinations, and also with Polymerase Chain Reaction (PCR) in selected cases. The authors present a case of concomitant tuberculosis of the nose, paranasal sinuses and subglottic larynx, without primary involvement of the lungs. The diagnosis was imposed by histological examination and immunostaining of probes obtained in surgery. The treatment was surgical debridement followed by specific antituberculosis medication.

Corresponding author: Ioan Alexandru Bulescu, MD, PhD candidate; e-mail: ibulescu@gmail.com

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29. Low-grade appendiceal mucinous neoplasm mimicking an adnexal mass

Daniel Alin Cristian, Florin Andrei Grama, Gabriel Becheanu, Anamaria Pop, Ileana Popa, Valeriu Surlin, Sorin Stanilescu, Ana-Magdalena Bratu, Traean Burcos

We present a rare case of malignant epithelial neoplasm of the appendix, an uncommon disorder encountered in clinical practice, which poses a variety of diagnostic and therapeutic challenges. We report a particular case in which the appendix was abnormally located in the pelvis, mimicking an adnexal mass. Therefore, it was difficult to make the preoperative diagnosis on clinical examination, imaging studies and laboratory tests and we discovered the lesion during the diagnostic laparoscopy. No lymphadenopathy or mucinous ascites were found. The case was completely handled via the laparoscopic approach keeping the appendix intact during the operation. The frozen section, the detailed histopathology overview as well as multiple immunostaining with a complex panel of markers report diagnosed a low-grade appendiceal mucinous neoplasm (LAMN) with no invasion of the wall. No adjuvant therapy was considered needed. At a one-year follow-up oncological assessment, the patient was free of disease. In women with cystic mass in the right iliac fossa an appendiceal mucocele should be considered in the differential diagnosis. Laparoscopic appendectomy can represent an adequate operation for the appendiceal mucinous neoplasm if the histological report is clear and surgical precautionary measures are taken.

Corresponding author: Florin Andrei Grama, MD; e-mail: florin_gramma@yahoo.com

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30. Inflamed molluscum contagiosum in a 6-year-old boy: a case report

Radu Diaconu, Bogdan Oprea, Maria Mirela Vasilescu, Elena Carmen Niculescu, Mircea Ovidiu Ciobanu, Carmen Diaconu, Cristian Gheonea, Georgeta Ligia Stanescu

The precise prevalence of molluscum contagiosum (MC) is still unknown. The pediatric studies showed a cumulative incidence of 17% in children less than 15 years, but there are no studies available for Romania. The papular skin lesions are generally less than 5 mm, but the immunocompromised patients may develop large uncommon lesions. The pediatric cases are located mostly on the limbs, trunk or the face. The lab investigations are not usually required because the clinical features are typical. A biopsy followed by a light microscopy may help in some cases. We are presenting the case of a 6-year-old boy suffering from MC since almost a year. When examined in our clinic, the child developed 2 to 4 mm dome-shaped flesh-colored papules with central umbilication on his trunk diagnosed as MC. The microscopic examination revealed bud-like proliferation of the epidermis, molluscum bodies and moderate chronic inflammation of the dermis. In about one month of treatment, all the lesions disappeared without other local or general complications.

Corresponding author: Bogdan Oprea, Assistant Professor, MD, PhD; e-mail: oprea.bogdan@yahoo.com

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31. Necrotizing fasciitis in oro-maxillo-facial area after radiotherapy for squamous cell carcinoma of the soft palate

Alina Ormenisan, Silviu Horia Morariu, Ovidiu Simion Cotoi, Mihai Dorin Vartolomei, Radu Ionut Grigoras, Simona Liliana Mocan, Mircea Suciu

The fascia s and subcutaneous adipose tissue s impairment by mono or polymicrobial infection, which also can involve the skin and the muscles, is rarely seen in oro-maxillo-facial area. The present case report is presenting a case of necrotizing fasciitis in a patient who had a history of an invasive squamous cell carcinoma of the soft palate, with surgical treatment and with radiotherapy. He was admitted in our Clinic with malaise and subsequently developed a toxico-septic shock. Clinical symptoms, serological and bacteriological analysis and histopathological examination confirmed the diagnosis of necrotizing fasciitis (NF). The patient subsequently underwent a series of surgical reconstruction and aesthetic treatments because of the complications that had arised in the meantime. Postoperative evolution was favorable towards complete closure of the defect. The prognosis of this disease is generally reserved, the favorable evolution depending on the possibility of wound sterilization and the surgery is required despite its mutilating effect.

Corresponding author: Silviu Horia Morariu, Associate Professor, MD, PhD; e-mail: silviu_morariu@yahoo.com

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32. Early intrauterine development of mixed giant intracranial teratoma in newborn: a case report

Luminita Paduraru, Daniela Claudia Scripcaru, Gabriela-Ildiko Zonda, Andreea-Luciana Avasiloaiei, Maria Stamatin

Teratoma is one of the most frequent fetal intracranial tumors, but it usually grows very quickly and the fetus is generally a stillborn. Rare cases have slow development or are located in areas that afford immediate surgery after birth with variable chances of survival. Even more rare cases survive days or weeks, but with no chance of surgical treatment and with prolonged palliative care. We present a 34 weeks premature infant, born by C-section with a giant intracranial tumor, whose origin could not be ascertained, occupied almost all-intracranial space and survived 25 days with supportive care. The histological examination established a G3 mixed teratoma, predominantly with immature cells from all three embryonic layers. The cerebellum was normal and infra-mesencephalic structures were present. The infant presented with severe anemia and mild respiratory distress, and was out of neurosurgical therapeutic resources. Antenatal examination was normal until 30 weeks, when fetal ultrasound described a degree of hydrocephalus, but no tumor was individualized. Conclusions: G3 type complex teratoma, even rare, can be localized at cerebral level and get giant development and growth only in the third trimester of pregnancy, ending with a neonate that has no chance of survival. Such cases cannot benefit of therapeutic interruption of pregnancy and generate serious difficulties for parents and clinicians.

Corresponding author: Luminita Paduraru, Lecturer, MD, PhD; e-mail: luminita.paduraru@gmail.com

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33. Neuroendocrine tumor arising de novo in the left upper thigh: a case report

Ion Paun, Andrei Costin, Mariana Paun, Mihaela Tenovici, Claudia Valentina Georgescu, Corneliu Cristian Georgescu, Vlad Denis Constantin

Neuroendocrine tumors (NETs) originate in the neuroendocrine cells of the neural crest (Kulchitsky cells). If neuroendocrine tumors arising in the digestive tract or lung may occasionally result in skin metastases, primary soft tissue or skin NETs are infrequent. The current paper presents the case of an elderly woman patient with neuroendocrine tumors arising de novo in the left upper thigh, accompanied by lymph nodes metastases in the left groin and in the left pelvic sidewall, in close vicinity of the iliac vessels. The diagnosis of NET was performed based on immunohistochemical tests. Such tumors show a slow growth and, generally, have a good prognosis. It is emphasized that complete surgical excision, in some cases associated with adjuvant external radiotherapy is the optimal therapeutic modality in dealing with such lesions.

Corresponding author: Ion Paun, MD, PhD; e-mail: dripaun@gmail.com

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34. Fenestration of the middle cerebral artery in a patient who presented with transient ischemic attack

Horia Ples, David Kimball, Gratian Dragoslav Miclaus, Nicoleta Iacob, Heather Kimball, Petru Matusz, R. Shane Tubbs, Marios Loukas

Cerebral artery fenestrations are usually detected incidentally during angiography, have a reported incidence ranging from of 0.03% to 1%, and rarely cause neurological symptoms. They can, however, be associated with aneurysmal dilatation at the proximal or distal end of the fenestration, cerebral arteriovenous malformations, or (rarely) ischemic symptoms. We present a case of a 54-year-old obese woman who presented with a large convex-lens-like fenestration of the right middle cerebral artery (MCA) at the M1 segment (distal to the origin of the temporopolar artery) associated with a transient ischemic attack. The MCA fenestration caused a local change in hemodynamic blood flow, which leads to cerebral ischemia. Magnetic resonance angiography (MRA) also revealed an associated small slit-like fenestration of the basilar artery (BA), hypoplasia of the A1 segment of the right anterior cerebral artery, bilateral fetal posterior cerebral arteries, and bilateral absence of the posterior communicating arteries. To our knowledge, this is the sixth reported case of MCA fenestration with an associated ischemic attack. In our case, fenestrations of the MCA, the BA, and hypoplasia of the A1 segment of ACA were not associated with any aneurysms.

Corresponding author: Petru Matusz, Professor, MD, PhD; e-mail: matusz@umft.ro

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35. Prosthodontic management of an extreme atrophy of the mandible correlated with a prominent genial tubercle - a clinical report

Mihaela Rodica Pauna, Iuliana Babiuc, Alexandru-Titus Farcasiu

Extreme atrophy of the mandibular alveolar crest can pose a great prosthodontic challenge, especially when the genial tubercles remain as a bony projection in the floor of the mouth. This article is a clinical report on the prosthodontic management of a severe mandible atrophy correlated with a prominent genial tubercle. A complete denture was carefully designed and fabricated in order to restore both the function and esthetics of the patient.

Corresponding author: Mihaela Rodica Pauna, Professor, DMD, PhD; e-mail: mihaela.pauna@gmail.com

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36. Choriocarcinoma developed in a tubal pregnancy - a case report

Izabella Petre, Elena Bernad, Anca Muresan, Anca Bordianu, Sandor I. Bernad, Onut Bacean, Roxana Folescu, Amelia Milulescu, Stelian Pantea

Carcinoma of the Fallopian tube is the least frequent tumor of the female genital tract. The diagnosis is difficult but could be made more frequently if the causes of abnormal bleeding were thoroughly investigated by means of cytology and endometrial curettage. Treatment is by resection of the tumor, total hysterectomy, and bilateral salpingo-oophorectomy followed by chemotherapy. A 25-year-old patient, presented herself at the emergency room, accusing intense lower abdominal pains, accompanied by vaginal bleeding. The histological aspect corroborated with the Ki-67 index is strongly suggestive for a choriocarcinoma developed in a tubal ectopic pregnancy.

Corresponding author: Elena Bernad, Assistant Professor, MD, PhD; e-mail: ebernad@yahoo.com

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37. An unusual duplication of the inferior vena cava in a patient with endovascular repair for abdominal aortic aneurysm

Michal Polguj, Wojciech Szubert, Miroslaw Topol, Ludomir Stefanczyk

A 66-year-old Caucasian male, with sensation of abdominal pulsation was admitted to our hospital. In multidetector 64-row computed tomography (CT) angiography, an abdominal aortic aneurysm was observed. Endovascular aortic repair was performed. Control CT confirmed prosperity with stent graft fixation and absence of any vascular complications. Investigation also showed asymmetrical duplication of the inferior vena cava (IVC). Right (RIVC) and left (LIVC) inferior vena cava arose from the confluence of the right and left iliac veins. The LIVC continued as left renal vein.

Corresponding author: Michal Polguj, Associate Professor, MD, PhD; e-mail: michal.polguj@umed.lodz.pl

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38. Waardenburg syndrome type 2: an orthodontic perspective

Raluca-Diana Suhani, Mihai-Flaviu Suhani, Alexandrina Muntean, Michaela-Florica Mesaros, Mindra-Eugenia Badea

Waardenburg syndrome is a rare form of neurocristopathy. It is a disorder in the development of neural crest cells, caused by an altered cellular migration during the embryonic phase. That alteration causes an association of different abnormalities such as pigmentary disturbances of the hair, iris, skin, stria vascularis of the cochlea, dystopia canthorum and sensorineural hearing loss. We report a case of a 14-year-old Romanian male, with a family history of Waardenburg syndrome (mother) and Usher syndrome (father - congenitally sensorineural hearing loss and retinal degeneration). The case particularities are: the correlation between malocclusion and Waardenburg syndrome due to hypoplastic alae nasi and also factors that produced hearing loss, which could be Waardenburg syndrome, Usher syndrome or the presence of the connexin 26 (W24X) gene mutation.

Corresponding author: Raluca-Diana Suhani, Teaching Assistant, PhD student; e-mails: raluca.suhani@gmail.com, raluca.suhani@umfcluj.ro

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39. Ethical issues in therapeutic endoscopy - can communication between patient and physician make a difference?

Marian Valentin Zorila, Bogdan Silviu Ungureanu, Roxana Eugenia Zavoi, Marius Eugen Ciurea, Dan Ionut Gheonea

Therapeutic endoscopy represents a major step in evidence-based medicine with great potential in the evolution of non-invasive surgery. The evolutionary status of endoscopy has reached a level where some of the surgical intervention can be performed in a minimal invasive way, with great benefits for the patient. However, this rises up some ethical issues regarding the patient s comfort zone, possible risks and complications and subjected the physician to possible litigation situations if not well trained. A rather good interaction and communication between patient and endoscopist is mandatory, as the health-care experience might be more satisfying. Unfortunate situations may also be avoided if intensive training and up to date knowledge and skills are acquired before jumping to therapeutic endoscopy. The continuous development and general focus on interventional endoscopy seems to have a key role on current medical standings. Therefore, in the following paper we have tried to underline the potential ethical problems that both the patient and the physician should take into consideration towards a better therapeutic endoscopic result.

Corresponding author: Bogdan Silviu Ungureanu, MD, PhD Fellow; e-mail: boboungureanu@gmail.com

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