Comparative Study of the Nutritional, Phytochemical, Sensory Characteristics and Glycemic Response of Cookies Enriched with Lupin Sprout Flour and Lupin Green Sprout

This study aimed to compare the nutritional, phytochemical, and sensory characteristics of wheat flour (WF) cookies enriched with different proportions of lupin sprout flour (LSF) and those with different proportions of lupin green sprout (LGS). To achieve this, a control cookie (CC); three cookies with 10%, 20%, and 30% of LSF, respectively, CLSF1, CLSF2, and CLSF3; and three other cookies (CLGS1, CLGS2, and CLGS3) with 10%, 20%, and 30%, respectively, were produced. The proximate composition of each cookie was analyzed using AOAC methods. Also, the measurements of the total polyphenol content, antioxidant activity, individual polyphenols, glycemic index, and a sensory analysis were carried out using recent and accurate methods. The contribution of the main nutrients from 100 g of product to the required daily dose was also calculated. Data analysis revealed that cookies with LSF were richer than cookies with LGS in protein, fat, and energy values. CLGS3 was 35.12%, 1.45%, and 5.0% lower in protein, fat, and energy content than CLSF3, respectively. On the other hand, CLSF3 was lower than CLGS3, with 48.2% and 12.4% in moisture and mineral substances, respectively. Both cookies were lower in carbohydrates than the CC (65.20 g/100 g). Still on the subject of micro- and macronutrients, cookies with LSF were richer than those with LGS in all the minerals analyzed. The study also revealed improvements in phytochemical properties, such as total and individual polyphenols and antioxidant activity with the percentage of lupin sprout flour addition. The sensory analysis revealed that, for LSF and LGS cookies, the 10% samples were the most appreciated by consumers, irrespective of the sensory attributes studied. The glycemic index of the CLSF2 product was lower compared to the CC. This study shows that the LSF cookies have better nutritional, phytochemical, and sensory values than the LGS cookies. LSF is, therefore, better suited than LGS to the enrichment of bakery products in general and cookies in particular. The paper provides significant information to estimate the contribution of the consumption of functional products based on lupin sprouts to the required daily dose of food nutrients and the impact on the glycemic index of fortified products.

Strategies to Formulate Value-Added Pastry Products from Composite Flours Based on Spelt Flour and Grape Pomace Powder

In recent years, sustainability has promoted new research to develop reformulation strategies for value-added food products by exploiting grape pomace. Grape pomace powder (GP) was used to substitute spelt flour (SF) at 0, 5, 10, 15, 20 and 25% to obtain three types of fortified pastry products: biscuits and cakes involving a chemical leavening agent, and rolls leavened by yeast. Proximate composition, total phenolic content (TPC), total flavonoids content (TFC), 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity and ferric-reducing antioxidant power (FRAP) along with physical characteristics and sensory analysis of the enriched products were considered. The retention rate of the functional attributes of formulations in response to baking was also evaluated. Significant improvements in TPC, TFC and both antioxidant tests were achieved in the fortified products by the incremental incorporation of GP. With a substitution of 25% SF by GP, the following increases were recorded in biscuits, cakes and rolls over the control samples: 7.198-, 7.733- and 8.117-fold for TPC; 8.414-, 7.000- and 8.661-fold for TFC; 16.334-, 17.915- and 18.659-fold for FRAP and 16.384-, 17.908- and 18.775-fold for DPPH. The retention rates of TPC, TFC, FRAP and DPPH relative to the corresponding dough were 41-63%, 37-65%, 48-70% and 45-70%. The formulas leavened by yeast revealed higher functionality than those produced with a chemical raising agent. With the increase in GP, the elasticity and porosity gradually decreased for cakes and rolls, while the spread ratio of biscuits increased. Regarding sensory evaluation, all formulations with incorporated GP up to 10% were rated at an extremely pleasant acceptability level. The solutions derived from this study have great practical applicability for the development of new pastry formulations with improved functionality from GP valorisation.

Nutritional, Physico-Chemical, Phytochemical, and Rheological Characteristics of Composite Flour Substituted by Baobab Pulp Flour (Adansonia digitata L.) for Bread Making

The aim of this paper is to improve the nutritional quality of bakery products by replacing wheat flour (WF) with different proportions (10%, 20%, and 30%) of baobab flour (BF). The composite flours and bread obtained were evaluated from nutritional, physical-chemical, phytochemical, organoleptic, and rheological points of view. The results obtained show that BF is a rich source of minerals (K: 13,276.47 ± 174 mg/kg; Ca: 1570.67 ± 29.67 mg/kg; Mg: 1066.73 ± 9.97 mg/kg; Fe: 155.14 ± 2.95 mg/kg; Na: 143.19 ± 5.22 mg/kg; and Zn: 14.90 ± 0.01 mg/kg), lipids (1.56 ± 0.02 mg/100 g), and carbohydrates (76.34 ± 0. 06 mg/100 g) as well as for the phytochemical profile. In this regard, the maximum contents for the total polyphenols content (TPC) were recorded in the case of bread with 30% BF (297.63 ± 1.75 mg GAE/100 g), a total flavonoids content (TFC) of 208.06 ± 0.002 mg QE/100 g, and 66.72 ± 0.07% for antioxidant activity (AA). Regarding the physical-chemical, rheological, and organoleptic analysis, the bread sample with 10% BF (BWB1) was the best among the samples with different proportions of BF. It presented a smooth, porous appearance (73.50 ± 0.67% porosity) and an elastic core (85 ± 0.27% elasticity) with a volume of 155.04 ± 0.95 cm³/100 g. It had better water absorption (76.7%) than WF (55.8%), a stability of 5.82 min, and a zero-gluten index. The scores obtained by BWB1 for the organoleptic test were as follows: Appearance: 4.81; color: 4.85; texture: 4.78; taste: 4.56; flavor: 4.37; and overall acceptability: 4.7. This study shows that BF improved the nutritional quality of the product, organoleptic properties, α-amylase activity, viscosity, and phytochemical profile, resulting in composite flour suitable for the production of functional bread.

Inclusion of rapeseed and pumpkin seed cakes in diets for Murciano-Granadina goats alters the fatty acid profile of milk

The objective of this research was to assess the effects of including oil-rich feedstuffs in diets for lactating goats on the fatty acid (FA) profile of their milk. Thirty-six Murciano-Granadina goats were randomly assigned to three treatment groups, namely a control diet (CTRL), a diet based on whole rapeseed (RS), and a diet based on pumpkin seed cake (PSC). The diets were composed of 1 kg hay (70 % Italian ryegrass, 30% alfalfa) and 1.24 kg concentrate, and were formulated to be isoenergetic and isonitrogenous. Milk yield and its contents of protein, fat and lactose did not differ significantly among the groups. However, including oil-rich feeds in the diet altered the fatty acid profile of the milk significantly, decreasing its saturated fatty acid (SFA) content and increasing its content of unsaturated fatty acids (UFAs). Effects on polyunsaturated fatty acids (PUFAs), conjugated linoleic acid (CLA), and the n-6 to n-3 ratio depended on the source of dietary lipids. The PSC augmented diet increased the relative amount of PUFAs and fatty acid methyl esters (FAME) in milk (+25 %) significantly In comparison with CTRL, whereas the RS diet produced a limited and statistically insignificant increase (+7.5%). The concentration of CLA was higher in milk from does fed the PSC diet, whereas the n-6 to n-3 ratio was lower in milk from does fed RS. These preliminary results form the basis for developing premium dairy products that are enriched in fatty acids that are more favourable for human health.

[Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty]

Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty.

METHODS

Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation.

RESULTS

Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF.

CONCLUSION

In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.

Myasthenia gravis associated with thymoma and toxic multinodular goiter. A case report

Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.

Identical Mutation in SH3BP2 Gene Causes Clinical Phenotypes with Different Severity in Mother and Daughter - Case Report

Cherubism is a particular form of fibrous dysplasia of the jaws. Familial occurrence was reported in most cases. The condition is a rare hereditary disorder with autosomal dominant inheritance, with complete penetrance in males and incomplete penetrance in females and variable expressivity. It is known to be caused by mutations in the gene encoding SH3-domain binding protein 2, SH3BP2 gene. Major diagnostic criteria are cherubic facial appearance, painless hard enlargement of the jaws, and frequently associated dental abnormalities. The aim of the study was to analyze clinical and genetic features of cherubism in a family with 3 daughters in which the youngest one was affected. Clinical and radiographic examinations, hematological and biochemical evaluations and biopsy were performed. Molecular genetic analysis consisted of PCR amplification and direct sequencing of selected exons of the SH3BP2 gene. Cherubism was suspected based on clinical and radiographic examinations of the 9-year-old daughter. She presented asymmetrical enlargement of the mandible, speech and swallowing problems and dental abnormalities on the lower jaw. There was no history of similar clinical findings in any of the daughters or the parents of the affected girl. Abnormal results were obtained by genetic analysis. A c.1244G>A mutation was identified in exon 9 of the SH3BP2 gene in the asymptomatic mother and her affected daughter. The identified mutation in the SH3BP2 gene is probably disease-causing. The asymptomatic mother transmitted the gene mutation to her affected daughter. Our results confirm the reduced penetrance and variable expression of the gene mutation.

[Pancreaticoduodenectomy with or without pylorus preservation: a retrospective analysis of 137 patients]

OBJECTIVE

We performed a retrospective study to assess the postoperative results, long-term survival and quality of life after pylorus preserving pancreaticoduodenectomy (PPPD) versus standard Whipple pancreaticoduodenectomy (WPD).

METHODS

A retrospective study was performed in a nonselected series of 137 patients who were operated in the Surgical Clinics of "St. Spiridon" University Hospital Iaşi, Romania, from January 1st, 1995 till December 31, 2005. Demographics, preoperative and intraoperative data, as well as postoperative morbidity, mortality and follow-up were analyzed. Quality of life, after to at least six months after discharge, was also studied.

RESULTS

There were no significant differences noted in demographics data. Jaundice was more frequent in the PPPD group as for WPD patients (p=0.047). For the most patients the digestive reconstruction after resection were performed as in Child technique: the first anastomosis was pancreaticojejunostomy (end-to-end or end-to-side), the second anastomosis was hepaticojejunostomy (end-to-side) and the last anastomosis was gastrojejunostomy end-to-side (duodenojejunostomy in PPPD group). For 31 cases a pancreatico-gastrostomy were performed. We also noted 14 cases with pancreatico-gastrostomy and duodenojejunostomy end-to-end, and a Roux jejunal loop for 3 patients with previous gastrectomy and gastrojejunostomy (Reichel-Polya). The operating time was shorter in the PPPD group as in WPD (p < 10-3), but the mean blood loss was the same. Postoperative morbidity rate was 46.8% in PPPD group vs 39.2% in WPD (p > 0.05), but the reintervention rate was significant higher in PPPD group (30.6% vs 15%; p = 0.027). We also noted no significant differences of Delayed Gastric Emptying, postoperative mortality rate (14.5% in PPPD group vs 10.1% in WPD group) and mean survival time (42.42 months (24.94 - 59.89; 95% CI) in PPPD group vs 46.78 months (28.07 - 61.50; 95% CI) in WPD group; log rank test p = 0.643). Pathological exam diagnosed a malignancy in 109 cases (54 cases with pancreatic cancer); we noted chronic pancreatitis in 22 cases. Quality of life was also the same in the two groups.

CONCLUSIONS

PPPD and WPD were associated with comparable results, but, there is a tendency of increase rate of postoperative morbidity and mortality for PPPD patients. We also noted that postoperative quality of life is the same for both procedures.

[Malignant peritoneal mesothelioma tumours. Evolution, treatment, prognosis]

Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.

Invasive amebiasis

Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.

Features of pathological assessment in rectal cancer

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

[Necrotizing fasciitis]

The management of a right foot necrotizing fasciitis and severe sepsis in an old diabetic patient is presented. The early and aggressive surgery, adequate antibiotherapy and correction of organic disfunction (cardio-circulatory, renal, respiratory) eliminated the vital risk and resulted in a satisfactory morpho-functional recovery of the foot.

[Evidence-based colorectal cancer screening]

Colorectal cancer has been identified as an appropriate candidate for early detection and treatment of both asymptomatic individuals and those at risk of the disease. The lifetime incidence of colorectal cancer among persons at average risk is sufficiently high to justify screening the general population. This review presents the latest strategies employed in early detection of the colorectal cancer. An ideal screening test should satisfy some basic criteria: must be simple, secure, accepted by the population with valid and reproductive results. Despite the demonstrated benefits of colorectal cancer screening, incidence and mortality rates of this common cancer remain high. More optimally tailored screening tools are needed that combine the features of a potentially ideal screening test.

[Differentiated thyroid cancer--staging and prognostic systems]

Differentiated thyroid cancer (DTC), including papillary and follicular carcinoma with histological variants, has an excellent prognosis; nevertheless a subset of these tumours is clinically aggressive and, in some patients, fatal. Treatment of DTC remains controversial, regarding the extent of primary surgical resection, the need for lymph node dissection and the role of postoperative radioactive iodine ablation. In addition to the widely accepted TNM classification, recognition of significant risk factors and developing of staging systems, such as AMES, AGES, MACIS, MSKCC and NTCTCS, has helped to identify the patients with a potential aggressive course of the disease and high risk of recurrence. This has allowed the development of a rational and selective approach to therapy, thus, avoiding excessive treatment and subsequent morbidity without compromising the oncological outcome.

[Spontaneous esophageal rupture in three patients]

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.

[Surgical initial attitude in epithelial ovarian advanced cancer]

The purpose of this work is to show the value of aggressive excisional surgery in epithelial ovarian advanced cancer (COEA).

MATERIAL AND METHOD

Between May 1993-May 1997, there were 103 obs. with ovarian diseases; 28 obs. (27.1%) with COEA and 75 obs. (72.9%) with benign diseases. All the patients had a subtotal hysterectomy with bilateral anexectomy and omentectomy. The operation was extended to other anatomic elements; in the case of 4 obs., we practiced a segmentary resection of left colon, 2 obs. had an anterior resection of the rectum and a partial resection of the pelvic peritoneum, 15 obs. suffered an excision of tumoral masses from the gastro colic omentum and the right parietocolic space and 7 obs. had a resection of pelvic peritoneum and of the right parietocolic space peritoneum. The optimal cytoreduction with a tumoral residuum less than 2 cm was realized for 23 obs. (82.14%) and for 5 obs., the tumoral residuum was greater than 2 cm (17.76%). The medium survival of the patients with a tumoral residuum inferior to 2 cm was 41 months, at 4 years 54% of the observations being alive, compared to only 14 months for the patients with tumoral residuum superior to 2 cm, at 4 years the survival being only of 15%. All the observations have beneficiated of chemotherapy. The disease reappeared for 23 obs. after a variable period of time. It's treatment consisted of: surgery followed by chemotherapy for 18 obs. and chemotherapy of second line alone for 5 obs.

CONCLUSIONS

The ovarian epithelial cancers, famous for an intermediary answer to chemotherapy, lead to an aggressive surgical management with partial extra genital organ sacrifices, to offer a chance of life.

Dysregulation of p56lck kinase in patients with systemic lupus erythematosus

In this study we investigated one of the possible mechanisms of p56lck down-regulation in peripheral blood lymphocytes (PBLs) from Systemic Lupus Erythematosus (SLE) patients and we correlated p56lck dysregulation with accelerated apoptosis in SLE PBLs. PBLs from SLE patients and healthy donors were isolated. p56lck protein expression and lck mRNA level were estimated by immunoblotting and RT-PCR, respectively. FACS analysis was used to evaluate the apoptosis and p56lck levels in apoptotic and non-apoptotic PBLs. A non-radioactive Tyrosine Kinase Assay Kit was used to measure p56lck activity. Our results demonstrated that PBLs from SLE patients displayed lower levels of lck mRNA and p56lck protein as compared to healthy donors. The apoptosis of fresh or cultured PBLs was enhanced in SLE patients, especially in anti-DNA negative group. The expression of p56lck was inverse correlated with apoptosis of fresh and cultured SLE PBLs, especially in anti-DNA negative patients. Double staining FACS analysis showed that p56lck expression was lower in apoptotic than in non-apoptotic PBLs. p56lck specific activity was directly correlated to apoptosis in SLE PBLs. While the low expression of p56lck may be the result of lower degree of synthesis, the increased specific activity could directly correlated to the extent of apoptosis in SLE PBLs. Based on our observations, we assume that the p56lck dysregulation could play a role in SLE pathogenesis.

Pycnogenol efficacy in the treatment of systemic lupus erythematosus patients

A pilot study was performed to evaluate the efficacy of Pycnogenol treatment in systemic lupus erythematosus (SLE) patients. Eleven SLE patients were treated with first line medication according to disease activity and in addition, six of them received Pycnogenol and five a placebo. The SLE disease activity index (SLEDAI), serum anti-dsDNA antibodies, fibrinogen, C-reactive protein levels, erythrocyte sedimentation rate, production of reactive oxygen species (ROS) by neutrophils, spontaneous apoptosis and p56(lck) specific activity in peripheral blood lymphocytes were evaluated. Pycnogenol treatment determined a significant reduction of ROS production, apoptosis, p56(lck) specific activity and erythrocyte sedimentation rate. In addition, the decrease of SLEDAI was significant in the Pycnogenol treated group compared with the placebo group (p = 0.018). The results obtained suggest that Pycnogenol could be useful for second line therapy to reduce the inflammatory feature of SLE.

[Factors which may influence the surgical outcome in myasthenia gravis]

OBJECTIVE

This study intends to assess the factors which may influence the surgical outcome in myasthenia gravis.

METHOD

52 myasthenic patients were operated on in the IIIrd surgical unit, Iaşi, undergoing extended thymectomy through a complete longitudinal sternotomy during a period of 21 years (1980-2001), the surgical outcome being variable. The following factors: age, clinical stage (Osserman classification), the history length and the histopathology of the specimen were analysed in respect with the surgical outcome which varied from complete remission and clinical improvement till no effect and death. Out of 52 patients, 28 were under the age of 30 years and 24 above 30 years of age. 5 patients were operated on in the first clinical stage, 34 in the second clinical stage, 10 in the third stage and 3 in the fourth. 21 patients had had under 1 year history of the disease, 11 patients under 2 years and 20 patients over 2 years. 40 cases presented non-tumoral pathology of the thymus gland and 12 cases presented thymomas.

RESULTS

The best surgical results were recorded in patients under 30 years of age, operated in the first and second clinical stage, with a history under 1 year and non-tumoral pathology of the thymus.

CONCLUSION

Myasthenia gravis is the only one acquired autoimmune disease in which surgical treatment offers the chance of complete remission if the following criteria are encountered: young patient, short history, initial clinical stage and non-tumoral pathology.

[The value of oesophageal transection and staple gun anastomosis in the elective or emergency treatment of esophageal varices bleeding]

The transabdominal extensive oesophagogastric devascularization with gastroesophageal stapling, known as modified Sugiura procedure, together with other nonshuting operations are widely performed as the operations of choice for bleeding oesophageal varices, world-wide when the non surgical hemostatic procedure are not suitable. We present our experience in 10 selected cases, which have been operated on since 1994 till now in our unit, 6 elective and 4 as emergency, using the stapling technique of oesophageal transection. The results were good with no recurrence of re-bleeding in the postoperative period, with 1 death due to acute liver failure. We consider this procedure a good alternative, which remains the ultimate direct operation to control the variceal bleeding due to portal hypertension despite of many other procedures used to get the hemostasis in these cases of upper digestive tract bleeding due to portal hypertension.

[Multimodality treatment outcome of invasive thymomas]

The aim of the study was to analyze the progression of invasive thymomas associated with myasthenia gravis, after the resection and the progression of unresectable invasive thymomas with a combined chemoradiotherapy. The study was performed on two groups of patients: 8 patients with invasive thymomas and myasthenia gravis operated at the 3rd Surgical Clinic between 1986-1999; 4 patients with unresectable invasive thymomas treated at the Radiology-Oncology Clinic by combined chemoradiotherapy, between 1993-1998. The results are presented for each group of patients, separately.

CONCLUSION

The best treatment of invasive thymomas is the multimodal one. The timing of each method was established based on the collaboration between surgeons, medical oncologists, radiotherapists and neurologists, depending on the characteristics of each patient.

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania

OBJECTIVES

The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children.

METHODS

Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates.

RESULTS

Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin.

CONCLUSIONS

No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.

Comparison of ropivacaine and lidocaine for intravenous regional anesthesia in volunteers: a preliminary study on anesthetic efficacy and blood level

BACKGROUND

Ropivacaine may be useful for intravenous regional anesthesia, but its anesthetic effectiveness and toxicity have not been evaluated.

METHODS

Two doses of ropivacaine (1.2 and 1.8 mg/kg) and one dose of lidocaine (3 mg/kg) were compared for intravenous regional anesthesia in 15 volunteers. An arm tourniquet was inflated for 30 min after injection and then deflated in two cycles. Sensory block was measured by response to touch, cold, pinprick, and transcutaneous electric stimulation, and motor function was measured by hand grip strength and muscle power. Median, ulnar, radial, and musculocutaneous nerve functions were tested before local anesthetic injection and then at 5-min intervals until blocks resolved. The plasma ropivacaine and lidocaine concentrations were determined from arterial and venous blood samples drawn from the unanesthetized arm.

RESULTS

Sensory and motor blocks were complete within 25 min and 30 min, respectively, in all three treatment groups. However, recovery of sensory and motor block after tourniquet release was slowest in the high-dose ropivacaine group. Anesthesia to pinprick and transcutaneous electric stimulation was sustained in all the volunteers in the high-dose ropivacaine group for 55 min and 85 min, respectively, whereas complete recovery was observed in the lidocaine group (P = 0.008) and partial recovery in the low-dose ropivacaine group (P < 0.05) during the same period. Motor block also was sustained in the high-dose ropivacaine group for 70 min, which was significantly longer than in the lidocaine group (P < 0.05). All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7+/-2.1 microg/ml (mean) and 2.7 micro/ml, respectively.

CONCLUSION

Compared with lidocaine, intravenous regional anesthesia with ropivacaine appears to be comparable but has longer-lasting residual anesthesia.

[The parameters of the immune function in the evolution of HIV-1 infection in institutionalized children in Romania]

OBJECTIVE

To describe the evolution of HIV-1 + horizontal infected children nursed in closed community.

METHOD

The biological status of 26 HIV-1 + children nursed in Iaşi Orphanage was assessed in dynamic during April. 1993-Feb. 1994. The income age ranged among 1 month-3 years.

RESULTS

The following progressive stages could be drawn accordingly to the biological status parameters dynamic: stage 1 ("oligosymptomatic"), stage 2 ("multiform, medium or severe symptomatology"), and stage 3 ("severe immunodepression, with predominant infectious symptomatology, waves evolution"). These stages could not be assimilated to the currently CDC or WHO classifications. The following thresholds of the immunologically parameters separate the stages 1 and 2, and respective stages 2 and 3: CD4% lymphocytes (27% respective 20%); absolute CD4+ lymphocytes (1150/microliter respective 700 + 750/microliter), CD4/CD8 ratio (0.75 respective 0.45), beta 2-microglobulin (1.5 mg/1000 respective 2.5 mg/ 1000). Lymphocytes lacking the markers CD4, CD8, CD19, CD3, ranging between 15 + 20% were also detected by flow-cytometry; these cells could be attributed to the immature subpopulations (typically for dystrophy) or to down-regulation of membrane expression of some markers. Also, a dichotomy in the distribution of the CD2/CD3 surface markers was recorded in the case of lymphocytes.

CONCLUSIONS

Immunological features demarcate this epidemiological group versus the current described models for the HIV-1 + child.

An immunohistochemical study of P53 protein on colorectal carcinomas

AIMS

To investigate the frequency of immunohistochemical expression of p53 protein in colorectal carcinomas; to evaluate the correlation between p53 alterations and the histopathological parameters; to determine the prognostic significance of this tumor marker. PATIENT POPULATIONS: Fourty patients with colorectal carcinomas.

METHODS

Paraffin embedded normal and tumoral tissues, stained, with HES, PAS, PAS-Alcian Blue stains. For detecting the p53 protein, a three step (streptavidin-biotin immunoperoxidase) immunohistochemical method was used.

RESULTS

28 out of 40 (70%) colorectal carcinomas were positive for p53. The identification of nuclear accumulations of p53 protein in the present study was significantly correlated with the anatomic site and tumor stage.

CONCLUSIONS

The mutational pattern observed in this study was substantially as expected. The p53 overexpression is present in advanced stage, thus demonstrating the prognostic value of this marker.

Experimental and clinical correlation in acute pancreatitis pathogenesis

Pathological aspects in 100 cases of operated A.P. different in severity are not strictly related to aetiological conditions. Clinical observations have suggested some components of pathogenesis: obstruction of bilio-pancreatic inflow in duodenum at the beginning of the attack, bilio-pancreatic reflux on cholangiograms, strong secretory digestive stimulation before attack. Some experimental animals models (dogs) which can mimic pathogenic mechanism (obstruction of pancreatic flow, common bilio-pancreatic duct, closed duodenal loop, acute cholecystitis) have revealed characteristic pathological changes depending on the initiating process. Our conclusion that severity of pathological changes in A.P. are determined by the initiating mechanisms which may differ in some aetiological condition or may be common for different ones.

[The diagnosis and treatment of benign tumors of the subdiaphragmatic digestive tract]

One hundred twenty-two benign tumors of subdiaphragmatic digestive tract admitted in the interval 1975-1988 at the III-rd Surgical Clinic of Iaşi are reported. Out of these patients 120 required surgical treatment, the remainder of 2 being treated conservatively (diffuse intestinal angiomatosis, Peutz-Jeghers' syndrome). The clinical evolution being atypical, the surgical intervention was required, in most of the cases, due to hemorrhagic and occlusive complications. Histologically, the polyps and schwannomas were prevalent. The diagnostic difficulties, especially in the cases with jejuno-ileal localization, are mentioned.