Category Archives: Update

Tips and Tricks to Manage Vascular Risks Using the Transnasal Endoscopic Approach to Pituitary Adenomas

DOI: 10.1515/amma-2015-0100

Objective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.
Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.
Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.

Full text: PDF

Risk Management in Clinical Laboratory: from Theory to Practice

DOI: 10.1515/amma-2015-0086

Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment [1]. Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinical level. For this reason, organizations should not see the risk management as a compliance issue, but as an integral part of the decision-making process. EP23-A is a guideline of CLSI that introduces the risk management principles in the clinical laboratory and encourages the laboratories to develop plans of risk management which are addressed to the risks of each laboratory. EP18-A2 proposes 2 techniques for identifying and controlling the errors in the laboratory: FMEA (Failure Mode and Effects Analysis) and FRACAS (Failure Reporting, Analysis and Corrective Action System). The European Committee of Experts and Management of Safety and Quality in Health Care proposed to use the quality indicators to identify the critical stages of each process, thus being possible to assess continuously the medical processes with the aim of identifying the errors when they occur. This review summarizes the principles of the risk management in the clinical laboratory, thus it can achieve its aims to report valid, accurate and reliable test results.

Full text: PDF

The Importance of Vascular Endothelial Growth Factor as a Marker of Angiogenesis and Lymphangiogenesis in Non-small Cell Lung Cancer

DOI: 10.1515/amma-2015-0077

Lung cancer is the main cause of cancer death both in men and women. In spite of progress seen in the early diagnosis of lung cancer, and implementation of new treatment principles for these patients, 5 year survival of non-small cell lung cancer patients undergoing surgery is low. Introduction of anti-angiogenic therapy administered concomitantly with conventional chemotherapy agents represented practically the first success seen in the treatment of lung cancer in the last 20 years. The aim of this paper is to review the literature informations about the importance of VEGF (vascular endothelial growth factor) as a marker of angiogenesis in patients with non-small cell lung cancer. Therefore, we practiced a literature review about these topics : the importance of VEGF in tumor angiogenesis and lymphangiogenesis in patients with non-small cell lung cancer and his importance as a prognostic factor at these patients, the prognostic impact of serum levels of VEGF and of the cellular expression of VEGF at these patients and also we reviewed the value of the antiangiogenic therapy.

Full text: PDF

Obesity Treatment Strategies

DOI: 10.1515/amma-2015-0076

Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking). Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle). Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.

Full text: PDF

Preparation of Biological Samples Containing Metoprolol and Bisoprolol for Applying Methods for Quantitative Analysis

DOI: 10.1515/amma-2015-0071

Arterial hypertension is a complex disease with many serious complications, representing a leading cause of mortality. Selective beta-blockers such as metoprolol and bisoprolol are frequently used in the management of hypertension. Numerous analytical methods have been developed for the determination of these substances in biological fluids, such as liquid chromatography coupled with mass spectrometry, gas chromatography coupled with mass spectrometry, high performance liquid chromatography. Due to the complex composition of biological fluids a biological sample pre-treatment before the use of the method for quantitative determination is required in order to remove proteins and potential interferences. The most commonly used methods for processing biological samples containing metoprolol and bisoprolol were identified through a thorough literature search using PubMed, ScienceDirect, and Willey Journals databases. Articles published between years 2005-2015 were reviewed. Protein precipitation, liquid-liquid extraction and solid phase extraction are the main techniques for the extraction of these drugs from plasma, serum, whole blood and urine samples. In addition, numerous other techniques have been developed for the preparation of biological samples, such as dispersive liquid-liquid microextraction, carrier-mediated liquid phase microextraction, hollow fiber-protected liquid phase microextraction, on-line molecularly imprinted solid phase extraction. The analysis of metoprolol and bisoprolol in human plasma, urine and other biological fluids provides important information in clinical and toxicological trials, thus requiring the application of appropriate extraction techniques for the detection of these antihypertensive substances at nanogram and picogram levels.

Full text: PDF

Is the Oxidative Stress Really a Disease?

DOI: 10.1515/amma-2015-0070

Oxidative stress is an imbalance between free radicals or other reactive species and the antioxidant activity of the organism. Oxidative stress can induce several illnesses such as cardiovascular disease, neurodegenerative disorders, diabetes, cancer, Alzheimer and Parkinson. The biomarkers of oxidative stress are used to test oxidative injury of biomolecules. The indicators of lipid peroxidation (malondialdehyde, 4-hydroxy-2-nonenal, 2-propenal, isoprostanes), of protein oxidation (carbonylated proteins, tyrosine derivatives), of oxidative damage of DNA, and other biomarkers (glutathione level, metallothioneins, myeloperoxidase activity) are the most used oxidative stress markers. Diseases caused by oxidative stress can be prevented with antioxidants. In human body are several enzymes with antioxidant capacity (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase) and spin traps. Antioxidants are synthetized in the organism (glutathione) or arrive in the body by nutrition (ascorbic acid, vitamin E, carotenoids, flavonoids, resveratrol, xanthones). Different therapeutic strategies to reduce oxidative stress with the use of synthetic molecules such as nitrone-based antioxidants (phenyl-α-tert-butyl-nitrone (PBN), 2,4-disulphophenyl-N-tert-butylnitrone (NXY-059), stilbazulenyl nitrone (STAZN)), which scavenge a wide variety of free radical species, increase endogenous antioxidant levels and inhibits free radical generation are also tested in animal models.

Full text: PDF