Pharmacometabonomics, pharmacogenomics and personalized medicine

The development of genomics in the last decade opened new perspectives to fulfill the permanent ideal of therapy, namely personalization of therapy (of medicine) by using of adage: "the right drug to the right patient". The pharmacogenomics, developed in these 10 years, already permitted the identification of the patients with side drug effects risk by detection of the presence of single nucleotide polymorphisms (SNPs) from enzymatic systems implied in drugs metabolism such as CYP450. More recently, the emergence of pharmacometabonomics permitted the appreciation of the influence of the metabolic factors (and of the environment) on the genes expression. The combination of these sciences can permit a better individualization of drug therapy concerning both the genetic background of individual and exterior interventions. Actual studies seem to confirm this supposition.

[Achalasia in children: Diagnostic opportunities and therapeutical options]

Achalasia is a functional disorder of the distal esophagus, which fails to relax during swallowing. Although being rare, this disorder is the source of a significant morbidity, including developmental disorders in children. Several therapeutical options are available: myorelaxants administration, esophageal dilations and surgery--distal esophageal myomectomy followed by an antireflux procedure. The paper introduces our experience in treating a number of 5 children between 1991 and 1998.

[Helicobacter heilmanii gastritis: the bacteriological, endoscopic and histopathological considerations in 18 cases of infection in children]

The investigations on the presence of Helicobacter pylori in gastric mucosa biopsy specimens have evidenced another morphologically distinct spiral bacterium, Helicobacter heilmanii, which is associated with histopathological lesions of antral gastritis. The authors found 18 cases of such infection in a number of 1508 children with dyspeptic manifestations examined endoscopically. While H. pylori-associated infection was detected in 48.7% of the cases, H. heilmanii-associated gastritis had a much lower prevalence, 1.1%. The diagnosis was made by microscopic examination of the gram fuchsin-stained smear from a biopsy fragment, the urease test being more commonly erratic or late positive. In 10 cases, the endoscopic examination of gastric mucosa revealed nodularity of antral mucosa, in one of these cases a ulcer lesion at the level of the great curvature being also associated. Histopathological changers of active chronic gastritis have been found but in 4 out of children, the examined fragments of gastric mucosa being collected in most cases from the fundic area: in the child with gastric ulceration the histopathological lesions were of antral acute gastritis. Clinical, bacteriological, endoscopic and histological cure of H. heilmanii gastritis is possible by therapy with bismuth compounds alone.

[The endoscopic sclerotherapy of esophageal varices in children]

The injection sclerotherapy of esophageal varices is an important path in the treatment of acute bleeding. This procedure is carried out either in emergency conditions concerning bleeding varices or in the chronic status, the sclerotic drug being injected into and round the dilated infraesophageal veins. This study shows the authors' experience beginning with 1992; since then, at Children's Hospital of Iaşi the injection sclerotherapy has become an usual method in the management of the oesophageal varices, especially in the chronic status. This method turns out to be very useful, because nu matter the etiology would be, allows the postponement of decompressive procedures until the child has a proper age.