Category Archives: AMM 2011, Volume 57, Number 4
Eco Doppler Examination in Pregnancies with Fetal Growth Restriction
Fetal growth restriction remains a major cause of perinatal morbidity and mortality in modern obstetric practice. Doppler velocimetry provides a wide array of information on maternal, fetal, and placental aspects of intrauterine growth restriction (IUGR). Delivery is the only practical treatment option, and the timing of delivery must be aimed to maximize gestation while minimizing the risks of continued intrauterine life. The investigation of the fetal circulation using eco Doppler ultrasonography has become more sophisticated, with greater attention being played to the venous circulation, particularly that unique to the fetus: ductus venosus and the umbilical vein.
Update in Haematopoietic Stem Cell Transplantation
The authors review the most important aspects of stem cell transplantation, starting with its objectives, general guidelines and specific issues in rare diseases, and series of complications arising from this complicated therapeutic procedure.
In the 40 years since the first bone marrow transplant for the treatment of a patient suffering from a congenital immune deficiency, this therapeutic modality has become an option to be considered in the treatment of several haematologic, immunologic, metabolic and neoplastic disorders. This has been possible thanks to the progress in our knowledge of the major histocompatibility complex, the supportive therapy for patients with severe pancytopenia and the prevention and treatment of infections and other complications associated to transplantation .
Today, Haematopoietic Stem Cell Transplantation (HSCT), in its different modalities, is the treatment of choice in several malignant and non-malignant haematological diseases and one of the best options in many others .[More]
The von Meyenburg Complexes
Background: Biliary duct hamartomas (the von Meyenburg complexes) is a rare malformation of the hepatic ductal plates usually discovered incidentally during surgery or autopsy.
Case presentation: We present the case of a 66 year-old man who presented symptoms suggestive of a biliary colic. Following an open surgical biopsy from the liver, the sample obtained underwent classic Hematoxylin-Eosin, as well as histochemical and immunohistochemical stains, which allowed establishing the diagnosis of biliary duct hamartoma, using macro- and microscopical criteria (well-defined, subcapsular hepatic lesions and no nuclear atypia).
Conclusion: The recognition of this particular lesion is important due to its macroscopic and microscopic resemblance to multiple liver metastases and other types of multicentric subcapsular hepatic lesions. The mandatory technique in order to diagnose this rare type of hepato-biliary lesion remains the histopathological examination.
Giant Abdominal and Penoscrotal Idiopathic Lymphedema
The lymphatic system produces and transports fluids, immune cells and fats throughout the body. Abnormal transport and accumulation of lymph fluid may cause swelling (lymphedema).
Lymphedema, occurring quite frequently in the medical practice, may appear in a variety of pathologies such as: allergic reactions, infectious diseases, localized infections, radiotherapy, insect bites, as post-surgery reaction, etc. In all cases, it represents a subsequent effect of the main illness .
There is very small number of cases where lymphedema occurs as sole affection, the so-called ”primary or idiopathic lymphedema”. It is considered a genetic disease resulting in agenesis or the insufficient development of the lymphatic system .
The FLT4 gene provides instructions for producing a protein called vascular endothelial growth factor receptor 3 (VEGFR-3), which regulates the development and maintenance of the lymphatic system. Mutations in the FLT4 gene interfere with the growth, movement, and survival of lymphatic cells. These mutations lead to the development of small or absent lymphatic vessels. If lymph fluid is not properly transported, it builds up in the body’s tissues and causes lymphedema. It is not known how mutations in the FLT4 gene lead to the other features of this disorder, but many of these patients do not have a FLT 4 gene mutation. In these cases the cause of the swelling is unknown [1,3].[More]
Eco Doppler Investigation of Utero-placental Circulation in High-risk Pregnancies
Introduction: Inadequate trophoblastic invasion of spiral arteries is associated with intrauterine growth retardation, pregnancy induced hypertension, preeclampsia, and abruptio placentae. The ability to accurately identify pregnant women who will develop these complications is limited. Predictive tests are further challenged by difficulty in the timing of the measurements, because the structural and biochemical characteristics of the placenta change with increasing gestational age. Improvements in ultrasound technology provide potentially useful novel tools for evaluating placental structure.
Aim of our study: To develop methods for early screening of high-risk pregnancies (studying the circulation in the utero-placental arteries — impedance to flow).
Material and methods: We have followed-up pregnant women in their first and second trimesters, who presented for pregnancy care in our unit. Results were calculated using Student-test and Chi-test (for the presence or absence of prothodiastholic notch). Results: Impedance to flow and the frequency of the prothodiastholic notch decrease in the uterine arteries with the evolution of pregnancy. Changes in the resistance of uterine arteries during pregnancy show different patterns in certain obstetrical risk groups: obesity, smoking in pregnancy, uterus with previous interventions (scar from C-section) with the placenta on the anterior wall, pregnancies with „Vanishing Twin Syndrome”. In these groups we noticed a greater resistance in the uterine arteries.
Conclusions: These pregnancies should have an intensified follow-up.
The Results of Allogeneic Stem Cell Transplantation in CML — the Experience of BMT Unit Tîrgu Mureş
Introduction: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder the molecular hallmark of the disease is the BCR-ABL gene rearrangement which occurs as the result of a reciprocal translocation between chromosomes 9 and 22. Imatinib, a small molecule, tyrosine kinase inhibitor (TKI) was the first drug that targeted BCR-ABL. Since the introduction of the first and second generation of TKI the role of allogeneic stem cell transplantation in chronic myeloid leukemia is being reevaluated. With this retrospective analysis our aim was to define the role of allogeneic stem cell transplantation for CML in the tyrosine kinase inhibitor era. The following is a general overview of the role of ASCT in the management of CML.
Material and methods: At the BMT Unit Tîrgu Mureș between 2005–2009 we performed five allogeneic transplantations of high risk CML patients with identical sibling donors.
Results: Two of the patients are at present in complete hematologic and cytogenetic remission with no or minimal immunosuppressive therapy after 6 and respectively 3 years of follow up time. Two of the patients had disease free survival but died from infectious complications appeared in the 3rd and 6th month after the allogeneic stem cell transplantation. One patient had an early relapse with treatment refractory disease and died from the evolution of the disease.
Conclusions: We perform allogeneic stem cell transplantation only in the cases in which we have resistance to first and second generation of tyrosine kinase inhibitors (TKI), intolerance to TKI and if we have a suitable donor.
A Study Upon the Dissolution Properties of Bifonazole Through Complexation with Cyclodextrins
Introduction: The aim of this study is to characterize the interaction in solution between the antimycotic bifonazole and two cyclodextrins: random methyl-beta-cyclodextrin and beta-cyclodextrin.
Material and method: The interaction in solution between bifonazole and random methyl-beta-cyclodextrin/beta-cyclodextrin was characterized using dissolution studies and phase solubility studies. The dissolution of bifonazole was characterized through the index of the rate of dissolution and the dissolution efficiency, and from the phase solubility study we calculated the apparent stability constant of the complex.
Results: The bifonazole – random methyl beta-cyclodextrin binary systems revealed better dissolution properties as compared to bifonazole alone, and to the bifonazole – beta-cyclodextrin binary systems. The phase solubility studies revealed the formation of soluble complexes in the cyclodextrin concentration range, and an apparent stability constant of 17956 M-1 for bifonazole – random methyl-beta-cyclodextrin complex, and of 873 M-1 for bifonazole – beta-cyclodextrin complex.
Discussions: The dissolution studies and the phase solubility studies demonstrated an improvement of the wettability of the particles of bifonazole, due to a better contact between bifonazole and cyclodextrin, and the formation of soluble complexes in the dissolution medium.
Conclusions: The complexation with cyclodextrins determined the increase in the dissolution properties of bifonazole. The best results were obtained with random methyl-beta-cyclodextrin, which demonstrates a better interaction within the components in the liquid medium and the better solubilization properties of this cyclodextrin.
Stem Cells Harvest from Volunteer Donors
Background: Over the last several decades allogeneic hematopoietic cell transplantation (HCT) has emerged as an important therapeutic option for a number of malignant and non-malignant conditions. The collection of hematopoietic stem cells mobilized from the bone marrow into the bloodstream of healthy donors has now become a routine procedure throughout the world.
Materials and methods: A number of 86 procedures of hematopoietic stem cells (HSC) harvest and cryopreservation from 64 volunteer donors, 54 adults (28 women and 26 men) and 10 children (5 girls and 5 boys) with ages between 6–66 years (on ave-rage 30.5) were carried out in the Bone Marrow Transplant Center from Clinical Institute Fundeni, Bucharest.
Results and discussions: HSC mobilization was achieved for all the 64 volunteer donors by administration of Filgastrim, on an average 8.4 mcg/donor weight (limits: 5–16.64 mcg/donor weight), leukapheresis procedure being realized in day +5 of Filgastrim administration.
Conclusions: In conclusion, a healthy volunteer donor, will undergo in most cases 4 or 5 days of Filgastrim administration. The WBC and the number of CD34+ cells from the periphe-ral blood will be counted beginning with the 4th day. When the number of CD34+ cells from peripheral blood will reach a certain level (usually on the 4th or 5th day), the vo-lunteer donor will be sent to the apheresis unit for harvesting stem cells.
Aspects of Suicide in Schizophrenia
Introduction: In the literature, autolytic risk in patients with schizophrenia was estimated at 10–40%, and up to 50% in studies that also refer to patients with schizoaffective disorders.
Purpose: To find the risk factors of suicide in this specific group of patients with schizophrenia who comitted suicide.
Material and methods: A retrospective study made on 53 patients with typical history of schizophrenia, who committed suicide in the 2000–2009 period.
Results and discussions: Of the 794 investigated suicide cases, 53 were patients with schizophrenia (6.7%), 54.7% were between 15–30 years and 66% were male. Marital status seems to play a major role in suicide genesis, 72.7% of the subjects being either unmarried, divorced, separated or widowed. Alcohol consumption was present in 26.1% of cases and smoking in 32.2% of cases.
Conclusions: Although the number of studied cases is too small to draw relevant conclusions, our study indicates that male gender, young age, unmarried status and rural origin act as risk factors for committing suicide.