ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 50 No. 2, 2009

1. The article has been retracted

The article has been retracted

This article has been retracted

Corresponding author: The article has been retracted

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2. Beta 3 adrenergic receptors: molecular, histological, functional and pharmacological approaches

Oana Andreia Coman, H. Paunescu, Isabel Ghita, L. Coman, Anca Badararu, I. Fulga

Different classes of receptors mediate norepinephrine and epinephrine effects, one of the most recently discovered being the beta 3 adrenergic ones. The paper has proposed itself to present the history of the discovery of beta 3 adrenergic receptors, different techniques for their identification, their structure, localization, genetic data and also the mechanism of regulation of their functions. It also contains an exhaustive approach regarding the histological localization and functions of beta 3 adrenergic receptors in different apparatus and systems, making evident their effect on glucidic, lipidic and energetic metabolism. The substances that influence beta 3 adrenergic receptors activities, especially the agonists, have been studied regarding their practical applications in the treatment of diabetes mellitus and of the disturbances of lipid metabolism.

Corresponding author: Oana Andreia Coman, MD, PhD, e-mail: andreiacoman@yahoo.com

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3. The involvement of metalloproteinases and their tissular inhibitors in the processes of periodontal orthodontic remodeling

Petra Surlin, Anne-Marie Rauten, Garofita-Olivia Mateescu, B. Oprea, Maria Maris, H. Manolea

The orthodontic treatment uses forces that produce structural and biochemical changes in the periodontal space breaking the balance between the synthesis and the breakdown of the collagen in the periodontium. Matrix metalloproteinases (MMP) plays a central role in the normal tissular remodeling processes, those in the tissular morphogenesis and the tissular repair (including the remodeling of the periodontal space of the periodontal ligament, during the dental orthodontic translations). The inter-relation between the molecular mechanism of orthodontic remodeling and MMPs is still unclear.

Corresponding author: Petra Surlin, MD, PhD, e-mail: vsurlin@hotmail.com

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4. Gastric cancer: correlation between clinicopathological factors and survival of patients (II)

Daniela Lazar, Sorina Taban, I. Sporea, Alis Dema, Marioara Cornianu, Elena Lazar, A. Goldis, C. Vernic

Purpose: The purpose of this study was to identify the clinicopathological factors that influence the prognosis of patients having undergone surgery for gastric cancer. The analysis of the potential prognosis factors has included in this study parameters concerning the patient (sex, age), as well as parameters related with the tumor (macroscopic aspect of the tumor according to the Borrman's classification, histological type according to the WHO and Lauren's classifications, degree of tumor differentiation, tumor location, stage of disease, pT and pM parameters according to the TNM classification of AJCC/UICC). Material and Methods: From the total number of 265 patients (186 men and 79 women) diagnosed with gastric cancer in the period 1998-2002, 61 operated patients were selected. On this group, we performed a prospective study regarding the evolution and aggressiveness of gastric cancer, on a duration of 5 years. Survival time was calculated from the month of the surgical intervention until the month of death or confirmation of survival, and survival rate was represented by the percentage of survivals at the end of the observed interval (in years and months). Results: The studied group consisted of 61 patients (43 men and 18 women), with ages between 30 and 80 (average age = 59.34 years). We have identified five papillary adenocarcinomas (8.2%), 28 tubular adenocarcinomas (46%), 17 "signet-ring" cell carcinomas (27.8%), eight mucinous adenocarcinomas (13.1%), and three undifferentiated or anaplastic carcinomas. Most gastric carcinomas examined were included in the category of poorly differentiated carcinomas (63.9%). According to the Lauren's classification, we have identified 38 intestinal type gastric carcinomas (62.3%), 17 diffuse type carcinomas (27.9%), and six mixed carcinomas (9.8%). We have identified aspects of lymphovascular invasion in 38 cases (62.3%). Conclusions: "Signet-ring" cells carcinomas, and the anaplastic ones, prove in our study to be extremely aggressive histological forms, characterized through low rates of survival. We remarked a significant correlation between the degree of tumor differentiation and survival of patients, the values recorded being significantly lower in medium and poorly differentiated carcinomas (p = 0.00871194 FS). Average survival, calculated in months, is significantly lower in patients with diffuse type carcinomas (11.3 months), in comparison with patients presenting intestinal type carcinomas (20.4 months) (p = 0.0415 S). There is a direct proportional relationship between the lymphovascular invasion and the number of positive lymph nodes. Survival after 5 years decreases significantly in the presence of lymphovascular invasion.

Corresponding author: Daniela Lazar, MD, PhD, e-mail: lazar_daniela@yahoo.com

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5. Preliminary study regarding the utility of certain immunohistochemical markers in diagnosing neurofibromas

Mirela Ghilusi, I. E. Plesea, Maria Comanescu, S. D. Enache, Fl. Bogdan

The present study shows the histopathological and immunohistochemical aspects encountered in 49 benign tumors with neural origin diagnosed in the Pathology Department of the Emergency County Hospital of Craiova between 2000 and 2007. Histopathological criteria were used for the histopathological diagnosis, having been diagnosed 22 neurofibromas and 27 schwannomas. Histopathological examination was completed by the immunohistochemical examination using anti-S100 and anti-vimentin antibodies, anti-CD34, anti-CD57 and anti-neurofilament antibodies, as well as the Ki67 proliferation marker. Both tumors showed positive immunostaining for S100, CD34, CD57, but of varying intensity and distribution. Schwannomas and neurofibromas showed a low proliferation index (<5%).

Corresponding author: Mirela Ghilusi, MD, PhD, e-mail: mirela@dass.ro

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6. Positive staining with Congo red in tissues with heat artifact due to cautery

A. Fernandez-Flores

Congo red staining is rarely the source of false positives for amyloid. On the other hand, the heat artifact due to cautery in surgical specimens adopts some hyaline features, which can mimic amyloid deposits many times. Therefore, we decided to investigate the behavior of these artifacted areas with some of the ancillary techniques that are commonly used when diagnosing amyloidosis: Congo red staining (with and without treatment of the tissue by permanganate of potassium); Thioflavin T; polarized light and immunohistochemistry (for A amyloid, lambda chain and kappa chain). For that, 10 biopsies of different organs were selected with the condition that there was "evidence of heat artifact border". Our results showed that the artifacted border is strongly positive for Congo red (even after treatment with permanganate of potassium). It also showed apple-green birefringence when observed under polarized light. Nevertheless, it failed to express any of the markers investigated in the immunohistochemical study.

Corresponding author: Angel Fernandez-Flores, MD, PhD, e-mail: gpyauflowerlion@terra.es

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7. Immunohistochemical aspects of the evaluation of the inflammatory answer of the dental pulp

H. Manolea, L. Mogoanta, Cl. Margaritescu, V. Deva, Petra Surlin, O. Caraivan

The inflammatory answer of the dental pulp in front of an antigen presents a series of particularities caused by its special anatomical conditions. The evaluation of the inflammatory answer in the evaluation tests of the biocompatibility of the dental materials is made by histological methods without defining precise quantitative criteria to measure the pulp reaction. In this study, we followed the reaction of the pulp tissue to five antibodies (CD20, CD45Ro, CD4, CD8, and CD68) in order to evaluate the inflammatory aspects of the dental pulp. We did not find positive answers for the CD20 protein, specific for B-lymphocytes, for the fragments of normal pulp tissue taken into study. Even if they are in small number among the pulp cells, the T-lymphocytes that express the protein CD45Ro may be also found in the normal dental pulp. Of the two subsets of T-lymphocytes, we found positive answers on the studied preparations only for the CD8 protein. For the CD68 protein, strongly expressed by the macrophages, we obtained positive results both for the inflammated pulp tissue, and for the normal dental pulp, yet in a very small amount. The use of immunohistochemical techniques, with well-defined markers of the pulp inflammation, can offer better results for a highly accurate evaluation of the inflammatory answer of the dental pulp.

Corresponding author: Horia Manolea, MD, PhD, e-mail: manoleahoria@gmail.com

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8. The immunohistochemical aspects of protein Mena in cervical lesions

Simona Gurzu, I. Jung, I. Prantner, L. Chira, I. Ember

The proteins Ena/VASP (Enabled/Vasodilator-Stimulated Phosphoprotein) family is involved in the regulation of actin cytoskeleton which activity is very important for physiological tissue formation but is sometimes implied in pathological processes. In this study, we analyzed the immunohistochemical expression of Mammalian Ena (Mena), which is a member of this family, in the cervical intraepithelial neoplasia (CIN) and also in the cervical squamous cell carcinomas. We analyzed 30 cases with CIN (1, 2 and 3), and 10 squamous carcinomas. We used the EnVision system by LabVision. The Mena antibody, izotype mouse IgA, clone 21, provided by BD Biosciences. Results: We observed that Mena was not expressed in the normal cervical squamous epithelium but its expression was increased in parallel with the increasing grade of CIN, with up-regulation upon transition to CIN3 and further to invasive carcinoma. This is the first study in the literature about Mena expression in cervical lesions.

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

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9. Immunohistochemical expression and significance of epidermal growth factor receptor (EGFR) in breast cancer

Adriana Meche, Anca Maria Cimpean, M. Raica

Breast cancer is a heterogeneous disease that includes several molecular types, characterized by the expression profile of sex hormone receptors, HER2 protein, cytokeratin 5, p53, and Bcl-2. EGFR is an additional marker predominantly expressed by basal-like carcinoma, but its significance in the other types is not completely understood. The aim of this study was to analyze the immunohistochemical expression of EGFR and its relationships with other factors of prognosis. There were investigated benign lesions and 84 cases with invasive breast carcinoma that were submitted first to the molecular classification. Next, we performed the staining for EGFR and two patterns of the final product of reaction were described. EGFR expression was found in 41.66% of the cases with basal-like carcinoma, in 50% of the cases with luminal B carcinoma, and in 21.42% of the cases with HER2 overexpression. A significant correlation was found between EGFR expression and degree of differentiation and distant metastasis. No significant correlation was found with the lymph node status, excepting for the basal-like carcinoma in which an inverse correlation was noticed. Our results suggest that EGFR expression by tumor cells of the breast cancer defines a specific subset of tumors with poor prognosis and potential resistance to the adjuvant therapy.

Corresponding author: Marius Raica, MD, PhD, e-mail: raica@umft.ro

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10. Immunohistochemical study of skeletal muscle in rheumatoid myositis

Codrina Ancuta, E. Ancuta, Cristina Iordache, M. Ceausu, Rodica Chirieac

Introduction: Rheumatoid myositis (RM) represents a poorly characterized entity, immune mechanism, assessment and management remaining still unclear. The aim of this study was to investigate endothelial and inflammatory cells activation in RM muscle biopsy. Material and Methods: Prospective study on 23 consecutives rheumatoid arthritis (RA) with muscle involvement as defined by clinical, biological and imagistic parameters. CD4, CD8, CD20, CD3, CD45RO and CD68 markers, HLA-DR, cytokines receptors (IL-2, TNFalpha, TGFalpha), pro-apoptotic (CD95) and adhesion molecules (CD54) were assessed by immunohistochemistry in deltoid muscle samples. Results: (1) endomysial, perivascular and perimysial inflammatory infiltrates and moderate muscle fibers involvement; predominance of activated (HLA-DR+), memory (CD45RO+) CD3+TCD8+ cells and macrophages surrounding and invading non-necrotic muscle fibers (34.78%) and TCD4+ activated cells in perivascular and perifascicular areas (65.22%); (2) up-regulation of HLA-DR, CD54 and IL-2R on both endothelial cells and lymphocytes (85%); (3) aberrant increased CD95 in endothelial cells without any other apoptotic sign (83%) have been described. Conclusion: Increased expression of activation markers, adhesion molecules and cytokine receptors may indicate early endothelial activation in RM pathogenesis, while endomysial TCD8+ activation may account for further development and perpetuation of myositis.

Corresponding author: Codrina Ancuta, MD, PhD, e-mail: alexia02ro@yahoo.com

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11. The differences between the endothelial area marked with CD31 and CD105 in colorectal carcinomas by computer-assisted morphometrical analysis

I. Jung, Simona Gurzu, M. Raica, Anca Maria Cimpean, Z. Szentirmay

The aim of our study was to compare the CD31 and CD105 endothelial area (EA) by computer-assisted morphometrical analysis in colorectal carcinomas (CRC). Two hundred and eleven surgical specimens with CRC were immunohistochemical analyzed with markers for angiogenesis CD31 and CD105 (Endoglin). We determined the area of endothelial cells occupied in the microscope field (EA). Results: The median area was 6.93 ± 4.25% for CD31, respectively 5.65 ± 2.23% for CD105. In the majority of cases, the CD31 EA was higher than CD105 EA. In the cases with the predominance of mature vessels, and also in the cases after radiotherapy, the CD105 EA was higher than CD31 (5.69 ± 2.49%, respectively 10.23 ± 5.93%). In our study, we tried to describe the clinico-morphological features of these cases. Conclusions: The CD105 seems to be the best marker for study of neoangiogenesis in CRC. Sometime, CD105 marks the activated endothelium of preexistent mature vessels. The radiotherapy destroys the neoformed but also the preexistent vessels. For the antiangiogenic treatment, it is important to determine the intensity of angiogenesis but also the type of neoformed vessels.

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

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12. Liquid Based Preparation (LBP) cytology versus Conventional Cytology (CS) in FNA samples from breast, thyroid, salivary glands and soft tissues. Our experience in Crete (Greece)

N. Mygdakos, Sylvia Nikolaidou, Anna Tzilivaki, D. Tamiolakis

Background: The improvement in quality of cytological preparations with the use of LBP methodology has been well-documented, but the cytological artifacts resulting from this technique have not been adequately described. This study describes and illustrates the cytological artifacts introduced by LBP technique when used on fine-needle aspirates (FNAs), and evaluates these artifacts as potential diagnostic pitfalls. Study Design: We reviewed a total of 96 FNAs simultaneously processed by both conventional smears and LBP. FNAs were obtained from the following sites: lymph node (38), breast (28), soft-tissue sites (nine), salivary glands (six), and thyroid gland (15). Results: The LBP smears were consistently devoid of obscuring elements, and the cells were adequately preserved and evenly dispersed. However, we noted some cytomorphological alterations that should be recognized to avoid erroneous diagnoses. The size of cell clusters was decreased, large branching sheets were fragmented, and there were more single cells, resulting in apparent discohesion. Small cells such as lymphocytes tended to aggregate. All cells were generally smaller and occasionally spindled, the chromatin detail was attenuated, and nucleoli were more prominent. Intranuclear inclusions were difficult to visualize. Background matrix was often altered in both quantity and quality. Extracellular particles, small mononuclear cells, red blood cells, and myoepithelial cells were markedly decreased in number. Conclusions: Cytopathologists should be careful in interpreting FNAs prepared using LBP technique if that is the only methodology employed. Familiarity with artifacts is essential to avoid misdiagnoses.

Corresponding author: Nikolaos Mygdakos, MD, e-mail: Nikolas@doctors.net.uk

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13. Clinical and cytological correlations in pericardial effusions with cardiac tamponade

D. P. Petcu, C. Petcu, Carmen Florina Popescu, C. Bataiosu, D. Alexandru

We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.

Corresponding author: Dorel Petrus Petcu, MD, PhD, e-mail: petrus_dorel.petcu@yahoo.com

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14. Orthodontically induced root resorption correlated with morphological characteristics

Cristina Teodora Preoteasa, Ecaterina Ionescu, Elena Preoteasa, C. A. Comes, Mona-Corina Buzea, Alexandra Gramescu

Orthodontically induced root resorption is an irreversible process that can have medical, ethical and legal implications. Aim: The objective of this research was to identify morphological risk factors, in order to prevent it. Material and Methods: We realized a retrospective study on 50 patients and made correlation between the prevalence and gravity of radiological identified root resorption and multiple biological and anatomical features. Results and Conclusions: We found that, when removable orthodontic appliances were used, there were not found root resorption (0%), and in cases in which fixed appliances were used, the root resorption was found, and it generally presented a high prevalence (96%) and low severity. Prevalence of root resorption is influenced by the sex and age of the patients (is greater for males than for females and higher in older patients). Topographically, differences were found in prevalence of root resorption (79.33% in mandibullary frontal teeth and 74% in the maxillary ones). The highest prevalence of root resorption was found in the lower central incisor (86%). Prevalence of root resorption is higher when there are alterations of the normal anatomy (facial hypo- or hyperdivergence, Angle class II and III malocclusion, angulated roots). Some anatomical aspects may present a fact of prevision of the appearance of root resorption within the orthodontic treatment.

Corresponding author: Cristina Teodora Preoteasa, MD, PhD candidate, e-mail: dr_elena_preoteasa@yahoo.com

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15. Crohn disease or intestinal fistulising tuberculosis? Diagnosis difficulties in a case treated with Infliximab and corticosteroids

S. Cazacu, C. C. Vere, Violeta Comanescu, Cristiana Dumitrescu, S. D. Enache, T. Ciurea

Crohn disease represents an idiopathic inflammatory bowel disorder with possibility of local and extra intestinal complications. Infliximab therapy is one of major therapeutic alternatives but this treatment may by followed by several possible infections, especially the reactivation of a latent tuberculosis. We present a case of a 28-year-old patient who was admitted in our hospital with clinical signs of bowel obstruction. Colonoscopy revealed close stenosis al the level of splenic flexure. Surgery was soon performed for the imminence of occlusion and pathology has revealed chronic inflammatory infiltrate with lymphocytes and plasma cells, interpreted as Crohn disease complicated with stenosis. A treatment with prednisone 30 mg/day, ciprofloxacin 1000 mg/day administrated intermittently and sulphasalasine 3 g/day for one year was indicated but the patient develop external abdominal fistula. Infliximab therapy 5 mg/kg/dose was administered at two weeks interval, with initial good results after two doses. At two weeks after the second dose, the patient has presented fever and weight loss; abdominal CT-scan has revealed inflammatory adherences of right flexure of the colon with external fistula, resolved by surgery. The evolution was later complicated by right tibio-tarsian involvement, which imposed orthopedic intervention. Pathology has revealed bone tuberculosis and antibacillary therapy was initiated with good results. Conclusions: Bone tuberculosis may represent a rare evolutive modality at a patient with Crohn disease treated by Infliximab and corticoids. Infliximab therapy in a patient with immunosuppressant (previous corticotherapy, splenectomy) may activate a latent center of tuberculosis. Ciprofloxacin therapy may explain insidious modality of evolution by minor antibacillary effect.

Corresponding author: Sergiu Cazacu, MD, PhD, e-mail: cazacu2sergiu@yahoo.com

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16. Warthin tumor: a curious entity - case reports and review of literature

Alexandra Faur, Elena Lazar, Marioara Cornianu, Alis Dema, Camelia Gurban Vidita, Atena Galuscan

Warthin tumor was first described in the American literature, by Aldred Warthin, in 1929, the pathologist who named this tumor papillary cystadenoma lymphomatosum, but since than it was also knew as adenolymphoma, cystadenolymphoma, and Warthin tumor. Because of its microscopically appearance and unknown origin, this tumor entity is still fascinating head and neck surgeons and pathologist. We evaluate the histopathological aspect of Warthin tumors using Hematoxylin-Eosin stain, and immunohistochemical and histological techniques. We reviewed the medical record of patients with salivary gland tumors diagnosed at County Hospital of Timisoara from 2002-2008. In six years, 22 cases with Warthin tumor were diagnosed and among them 17 men and five women, with average age 58.47. The analysis showed that 77.27% of Warthin tumors occurred in men, and the main histopathological aspect was with 50% epithelial component. The stromal component showed a prominent B-cell population by staining with CD20, and histological techniques for mucin were positive, and reticulin fibers were revealed while using Gordon-Sweets stain. The standard and the histological and immunohistochemical techniques highlighted the complex and variable microscopical appearance of Warthin tumor that the pathologist should consider when a diagnosis for this tumor is to be considered.

Corresponding author: Alexandra Faur, MD, PhD, e-mail: alexandra_pantu@yahoo.com

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17. Spitz nevus with an uncertain malignant potential

Ligia Stanescu, Carmen Florina Popescu, Iuliana Georgescu, Claudia Valentina Georgescu, Liliana Anghelina, Ileana Petrescu, G. Calin

We present the case of 10-year-old girl who have had from birth a plane tumor, of tan color, 3-4 mm of diameter, localized on the face on the cutaneous part of the superior lip. This tumor has been stabile until 8-year-old. Then, after repeated sunlight exposures, the lesion has become more stark, hemispheric in shape, has increased in size becoming about 5-6 mm, with irregular borders, and after an accidental traumatism it began to bleed. We have performed the electroexcision of the lesion for diagnostic and therapeutic purpose. The histopathologic exam distinguished typical images of Spitz nevus on some of the histological sections but also of melanocytary tumor with uncertain malignant potential on the others where atypical mitoses localized in the deeper component of the tumor are being noticed. The immunohistochemical assessment of the tumoral cells showed positivity for the melanocytic markers HMB45 and Melan A, within junctional intraepidermic nevic cells and in the nevic cells from superficial dermis, and also for CD44 protein (belonging to the adhesion molecules family). However, cyclin D1 was positive in rare nevic cells, and the proliferation rate of the tumor was small, with a proliferation index for Ki67 lesser than 5%. The correlation between histopathological and immunohistochemical data conducive to final diagnosis of Spitz nevus with uncertain malignant potential. The clinical evolution confirmed the histopathological diagnosis by the fact that the patient did not presented clinical signs of local recurrences or metastasis at three years after the excision of the tumor.

Corresponding author: Ligia Stanescu, MD, PhD, e-mail: ligstanescu@yahoo.com, cpopescu67ro@yahoo.com

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18. Neuromuscular investigation in diabetic polyneuropathy

Ligia Rusu, Mirela Lucia Calina, Elena Taina Avramescu, Elvira Paun, Mirela Vasilescu

The aim of this paper is to present to new method for assessment diabetic polyneuropathy, before the moment of first clinical sign. Our working presents the method of tensiomyography (TMG) for assess the muscle composition rapports with muscle fibers types I and II. This composition can help to have an image regards the neuromusuclar potential of muscle during diabetic process. Tensiomyographic parameters included time contraction Tc, time delay Td, sustain time Ts, displacement Dm, and relax time Tr. All these parameters give information regards muscle fatigue in correlation with muscle composition. Muscle composition regards fibers type I or II is in relation with Tc, increase of these parameters means decrease of muscle fibers type I that means muscle fatigue. Also, values of Dm help us to assess the muscle tonus, elasticity and response to electrostimulus. We consider that this method helps the clinicians to have a prediction of a future polyneuropathy at diabetic patients.

Corresponding author: Ligia Rusu, MD, PhD, e-mail: ligiarusu@hotmail.com

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19. Congenital patellar syndrome

J. Terrence Jose Jerome, M. Varghese, B. Sankaran

Congenital patellar syndrome is bilateral isolated absence of patella. Congenital patellar aplasia or hypoplasia associated with genetic disorders belongs to a clinically diverse and genetically heterogeneous group of lower limb malformations. Absence of patella as an isolated anomaly is extremely rare and we discuss such a case in a 9-year-old boy.

Corresponding author: J. Terrence Jose Jerome, e-mail: terrencejose@gmail.com

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20. Anencephaly: pitfalls in pregnancy outcome and relevance of the prenatal exam

V. I. Tica, M. Beghim, Irina Tica, M. Zaher, Esra Beghim

Anencephaly is an embryological malformation of the central nervous system, invariable lethal, characterized by the absence of the brain and cranial vault and by other defects of the cranial structures. It has no cure but it can be detected during the pregnancy with ultrasonography. We present a rare case of a 15-year-old primipara, with no prenatal care, who delivered at 37 weeks an anencephalous female newborn. Ultrasonography avoided the confusion with a breach presentation, which, in conjunction with the prematurity, premature rupture of membranes and the young maternal age would have favored the cesarean section. The rarity of the case is increased by the singularity of the malformation. The importance of the prenatal care and genetic workup are stressed out in this embryologic pathology.

Corresponding author: Vlad I. Tica, MD, PhD, e-mail: vladtica@datanet.ro

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21. Hereditary spastic paraplegia

Eugenia Rosulescu, Cosmina Stanoiu, Elena Buteica, B. Stanoiu, F. Burada, Mihaela Zavaleanu

Hereditary spastic paraplegia (HSP) or Strümpell-Lorrain syndrome is a heterogeneous group of inherited disorders, with prevalence ranged from 4.3 to 9.6 cases per 100 000 population. A common feature of these disorders is the slowly progressive and often severe spasticity, noticeably especially in the low limbs. Conventionally, HSP is divided into two clinical groups, uncomplicated (pure spastic paraplegia) or complicated HSP depending on the presence of other neurological features in addition to spastic paraparesis. Inheritance may be autosomal dominant, autosomal recessive or rarely X-linked, but autosomal dominant inheritance is most commonly associated with pure forms of the disease, whereas autosomal recessive HSP shows greater phenotypic variability, including several well-defined syndromes. Genetic studies have revealed as many as 31 different chromosomal HSP loci. We investigated two subjects, brother and sister, who were diagnosed using the criteria for a diagnosis of HSP proposed by Fink (1996), as "definitely affected" with HSP. As some particularities, we noticed an iliopsoas pseudohypertrophy in male patient and a mild atrophy in female, maybe due to degeneration of anterior columns. Family history recorded the presence of same manifestations in relatives. The pedigree of patients revealed some anomalies that could be related with the pathology. Our findings supported the diagnosis of complicated form of HSP in both cases.

Corresponding author: Eugenia Rosulescu, MD, PhD, e-mail: erosulescu@yahoo.com

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22. Dual innervations of mylohyoid muscle: a case report

Sampath Madhyastha, Latha V. Prabhu, Vasudha V. Saralaya, S. R. Nayak, Sujatha D'Costa, Abhijith Acharya

Mylohyoid and anterior belly of the digastric muscles are supplied by a branch from the inferior alveolar nerve called the mylohyoid branch. Here we present an unusual finding in a 60-year-old male cadaver in which the mylohyoid muscle is supplied by a branch from hypoglossal nerve in addition to its usual nerve supply. Hypoglossal nerve after giving superior root of the ansa cervicalis and muscular branches to thyrohyoid and geniohyoid muscles gave another branch to supply the mylohyoid muscle. Any variation in the formation and/or branching pattern of ansa cervicalis or hypoglossal nerve can cause confusion and may complicate the procedures involving this nerve such as skull base surgery, neck dissection, and anterior cervical spinal approach. Developmentally mylohyoid muscle is from the mesoderm of the first arch, therefore, must be innervated by the mandibular nerve. Hence, we report this uncommon variation based on embryology and the clinical implications.

Corresponding author: Sampath Madhyastha, PhD, e-mail: sampath.m@manipal.edu, madhyast@yahoo.com

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23. An anomalous belly of sternothyroid muscle and its significance

S. R. Nayak, Rajalakshmi Rai, A. Krishnamurthy, Latha V. Prabhu, B. K. Potu

The sternothyroid muscle and other infrahyoid muscles play a vital role in the process of vocalization, swallowing and mastication by mobilizing the hyoid bone and thyroid cartilage. During routine dissection of a 70-year-old male cadaver, we observed an anomalous sternothyroid muscle. It was arising from the posterior surface of the manubrium sterni and partly from the cartilage of the first rib. After a distance of 3.3 cm, the belly of sternothyroid muscle was divided into lateral and medial fibers. The lateral belly was inserted above the oblique line on the lamina of the thyroid cartilage, but the medial additional belly turned into a tendon, which was crossing over the thyroid artery and inserted to the hyoid bone and intermediate tendon of digastric muscles. The superior thyroid artery was below the above tendon on its way to the thyroid gland. The muscle was innervated by a branch from the ansa cervicalis.

Corresponding author: Soubhagya Ranjan Nayak, MSc, e-mail: ranjanbhatana@gmail.com

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24. Book Review - Harold Ellis: Clinical Anatomy: Applied Anatomy for Students and Junior Doctors, 11th revised edition, Blackwell Publishing, Oxford, 2006

B. K. Potu, Shakunthala R. Pai, Thejodhar Pulakunta, S. R. Nayak

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25. New approaches to cancellous bone bio-modeling

Elena Taina Avramescu, Mirela Lucia Calina, Ligia Rusu, M. C. Neamtu, Denisa Enescu-Bieru

The purpose of our research is to develop a model of cancellous bone that would allow us to forecast the changes in this structure under various mechanical forces and to simulate the dynamics of the cancellous bone behavior under these circumstances. At the same time, the suggested model will allow the measurement of the tension/forces applied onto the bone structure, with the purpose of comparing these with the in vitro values, identification of the areas with increased trauma risk, and simulation of the behavior of cancellous substance under different mechanical stimuli, which affect the growth and aging of the bone, as well as to study the materials used in endoprostheses. Two groups of methods have been used for this purpose: micro-anatomical methods - for the visualization of bone structures, and bio-mathematical methods (finite element method) - for the modeling of these structures. The micro-anatomical studies were performed on a group of six bone items, from which 12 samples were harvested from the femoral head and neck, from corpses of both sexes and of varying ages, whose death was not due to specific pathological states or which could regard the bone itself. The obtained results have allowed us in identification of dependency relationships between the microscopic structure of the trabecular bone and its mechanical properties, as well as for the elaboration of bidimensional reconstructive and analytic models of the cancellous bone, which would further allow detailed representation of samples of cancellous bone that are big enough to supply macroscopic information. The conclusions of the present research have illustrated the usefulness of using the finite element method in the study of the mechanical behavior of spongy tissue, thus opening large perspectives in approaching the issue of the behavior of this tissue.

Corresponding author: Elena Taina Avramescu, PhD, e-mail: taina_mistico@yahoo.com

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