ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 51 No. 1, 2010

1. Neuroendocrine transdifferentiation of prostate carcinoma cells and its prognostic significance

Madalina Marcu, E. Radu, Maria Sajin

Neuroendocrine (NE) cells are a distinct epithelial cell compartment of the normal human prostate gland. Their phenotype and range of endocrine secretion products are similar, but not identical to those of NE-like cells from prostate carcinoma. Neuroendocrine differentiation (NED) is a feature commonly seen in prostate carcinoma and a number of studies pointed out that its extent is associated to hormone therapy refractory and aggressive disease. However, less information is available on the significance of NED in organ-confined prostate cancer, although identification of early predictors of aggressive disease would obviously allow for more adequate therapy. We review here recent advances in understanding the differentiation pathways of normal and malignant neuroendocrine cells as well as current information regarding the prognostic and therapeutic implication of NED assessment.

Corresponding author: Madalina Marcu, MD, PhD, e-mail: mad_marcu@yahoo.com

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2. The value of kidney biopsy in diabetes mellitus

M. Penescu, E. Mandache

The purpose of this work is to emphasize the value of kidney biopsy in patients with diabetes mellitus and clinical renal impairment. Diabetes is the leading cause of end stage renal disease because diabetic nephropathy develops in 30 to 40% of patients. Multiple genetic predisposing conditions are involved in the development or not of a diabetic nephropathy, therefore supporting the existence of several factors in the pathogenesis of this disease. These predisposing conditions may also favor different other types of glomerulonephritis which can occur independently or in parallel with a diabetic nephropathy. All these renal diseases have different treatments, and therefore they must be correctly identified and managed accordingly. The processing of the kidney biopsy samples requires a very careful and highly qualified management to differentiate precisely the nature of each condition. In addition to the mesangial classical lesions, recent biopsy studies provided evidence that podocytes are injured very early in the diabetic nephropathy. On the other hand, transgenic mice models provide a unique opportunity to investigate the natural course of the disease. The paper underlines the main laboratory techniques required for this activity, and the main structural arguments to perform a satisfactory differential diagnosis.

Corresponding author: Eugen Mandache, MD, PhD, e-mail: mandacheeug@yahoo.com

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3. Chronic complications in hemodialysis: correlations with primary renal disease

I. A. Checherita, Flavia Turcu, R. F. Dragomirescu, A. Ciocalteu

Although hemodialysis technique has improved in the last decades and the accessibility to this life-sustaining treatment modality increased rapidly, we are still concerned about the morbidity and mortality rates of dialysis patients. While technical advances are increasing the efficacy and safety of renal replacement therapies, latest studies are focused on other outcomes: increasing survival rates and the quality of life by an adequate management of the complications in chronic renal patients. This article reviews the complications of chronic hemodialysed patient with special considerations for the role of the primary renal disease that caused renal failure.

Corresponding author: Ionel Alexandru Checherita, Junior Assistant, MD, e-mail: fizij@yahoo.com

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4. The diagnostic value of cytokeratins expression in the renal parenchyma tumors

Aurora Alexa, Flavia Baderca, Rodica Lighezan, D. Izvernariu, M. Raica

Renal carcinomas are a heterogeneous group of tumors, difficult to classify and identify precisely. Since their prognosis depends very much upon their type, precise diagnosis might mean the difference between therapeutic success and patient death. Cytokeratins are particularly useful for the identification of the epithelial nature of the tumors, because their expression is maintained even in poorly differentiated tumors. Monoclonal cytokeratins such as CK7 and CK20 stain different components of the renal tubular system and are a useful duo for the identification of the origin of the different tumors that might arise in the kidney. Along with polyclonal cytokeratins such as AE1/AE3 and high molecular weight cytokeratin antibodies (34betaE12, Cam 5.2), epithelial membrane antigen (EMA) and vimentin, they are included in every diagnostic panel for renal tumors. We have selected 138 renal parenchyma tumor specimens, performed morphological diagnosis and then stained them with polyclonal cytokeratin antibody AE1/AE3, and monoclonal antibodies to CK7 and CK20. AE1/AE3 was expressed in 61.7% of the renal parenchyma tumors, with high intensity and percentage of positive cases in the papillary carcinomas (100%), and with rare and weakly positive cells in chromophobic cells carcinomas, clear cells carcinomas and sarcomatous carcinomas. CK7 was positive in 68% of the renal parenchyma tumors, with positive reaction in 100% of the cases of chromophobic cells and sarcomatous carcinomas. Clear cells carcinomas had the less percentage of positive cells, whereas papillary carcinomas were positive in seven out of eight cases. No difference in the staining pattern was noticed between type I and type II papillary carcinomas. CK20 was negative in all cases studied.

Corresponding author: Dragos Izvernariu, Assistant Professor, MD, e-mail: dragos_izve@yahoo.com

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5. Association of +35A/C (intron3/exon3) polymorphism in SOD1-gene with diabetic nephropathy in type 1 diabetes

N. M. Panduru, D. Cimponeriu, M. Cruce, Daniela Adriana Ion, E. Mota, Maria Mota, C. Serafinceanu, Laura Ioana Chivu, Mihaela Panduru, R. D. Chivu, A. C. Covic

Diabetic nephropathy is a major complication of type 1 diabetes whose pathogenesis is insufficiently known, but oxidative stress and genetic susceptibility seem to be involved. The purpose of this study is to assess the possible association of +35A/C (rs2234694) polymorphism in SOD1-gene with advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania. There have been enrolled 238 unrelated patients, having type 1 diabetes, divided into group A (106 patients) with diabetic nephropathy - macroalbuminuria or ESRD (End Stage Renal Disease) and group B (132 patients) without diabetic nephropathy. The genomic DNA was extracted from the peripheral venous blood and the genotyping of +35A/C (rs2234694) polymorphism has been made using the PCR-RFLP technique. The statistical analysis has been made using De Finetti's program. There has not been a significant deviation from the Hardy-Weinberg equilibrium for any group (p=0.229 and p=0.894, respectively). The data analysis revealed that the presence of a C-allele confers a significant risk (p=0.008) for the advanced diabetes nephropathy (OR=4.940, 95% C.I.=1.341-18.198), and the CA-genotype (p=0.015) confers a little lower risk (OR=4.491, 95% C.I.=1.203-16.766). This study shows the association of a mutant C-allele of rs2234694 polymorphism in SOD1-gene with the advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania, suggesting the involvement of the defense against oxidative stress, as an important link in the pathogeny of diabetic nephropathy.

Corresponding author: Nicolae Mircea Panduru, MD, e-mail: nicoly_pmn@yahoo.com

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6. Quantitative characterization of regional differences in the GABAA-receptor alpha1-subunit mRNA expression in the rat brain

Z. Pavai, Zsuzsanna Pap, K. Orban-Kis, T. Szilagyi

Inhibition in the central nervous system is largely mediated by local-circuit neurons that release GABA (gamma-amino-butyric acid). GABAA-receptors play a major role in virtually all brain physiological functions and serve as targets for numerous classes of drugs, used both in clinical practice and as research tools. These receptors are heteropentamers, alpha1 being the most widely occurring subunit; therefore it is the best candidate to be studied in pathological conditions where the inhibitory system might be altered (e.g. epilepsy). We compared quantitatively the regional distribution of GABAA-receptor alpha1-subunit (GABAAR-alpha1) expression in three brain areas: neocortex, hippocampus and cerebellum by RT-qPCR. TaqMan probe was used in order to avoid detection of non-specific amplification products and synaptophysin as internal control. This substance was chosen because it has a stable expression restricted to neurons, and contrary to GAPDH, the most commonly used reference gene for expression analysis, synaptophysin expression is not modified in animal models of epilepsy. Expression of synaptophysin was higher than expression of GABAAR-alpha1 in all samples from the central nervous system. The latter was significantly different among the studied brain areas. It was the smallest in the hippocampus, intermediate in the neocortex and the highest in the cerebellum. Interanimal differences were small for any brain region under study. These results indicate that combination of TaqMan real-time PCR method with synaptophysin as internal control can reliably measure the relative expression of GABAAR-alpha1 mRNA, and are suitable for investigating the modifications that appear under pathological conditions and/or diverse experimental paradigms

Corresponding author: Tibor Szilagyi, Professor, MD, PhD, e-mail: szilagyi67@gmail.com

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7. CD20cy and CD45RO immunoexpression in early rheumatoid arthritis synovium

B. Capitanescu, Cristiana Simionescu, A. Stepan, Cl. Margaritescu, Claudia Valentina Georgescu, Anca Rosu

In this paper, we studied 15 cases of early rheumatoid arthritis presenting with inflammatory lesions in different degrees of evolution. We want to highlight B- and T-lymphocytes in synovial tissue collected from patients diagnosed with early rheumatoid arthritis, to establish the pattern of their distribution, possibly in relation to local neovascularisation to determine the role played by these types of cells. The pathological samples were represented by synovial membrane biopsy fragments, which were examined by histopathological and immunohistochemical methods. We noticed a perivascular distribution of lymphocyte infiltrate, up to formation of lymphoid follicles with germinal centers. There is a close interdependence between B- and T-lymphocytes in these lesions, and their presence in the synovial membrane in relation to newly formed blood vessels facilitates their action and their chemical mediators. Studying the interdependence of different types of lymphocytes and their connection with blood vessels may generate new therapeutic targets

Corresponding author: Bogdan Capitanescu, University Assistant, MD, PhD, e-mail: bogdanc26@yahoo.com

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8. Neurodegenerative changes in human aging brain. An autopsy study

D. Arsene, Carmen Ardeleanu

Neurodegenerative pathological changes are known as occurring in human brain, in some way paralleling aging. We characterized prospectively the occurrence of cortical senile plaques and neurofibrillary tangles in 55 adult human subjects, by post-mortem examination. We tried to determine if aging is associated with greater senile plaque and neurofibrillary tangles burden and what is the cortical distribution of lesions, regardless the mental status of the patient. The series comprised a large spectrum of ages, from 30 to 97-year-old. Immunohistochemistry for amyloid-beta (Abeta) and tau protein was the technique we used. ApoE genotyping was performed in 33 cases by polymerase chain reaction. In our series brain Abeta deposition as senile plaques occurred only after 65-year-old. These accumulations were strongly associated with the occurrence of neurofibrillary tangles. However, several very old patients were lacking both beta-amyloid and tau-positive lesions. As a result, even though Abeta and tau protein show a certain predilection for brain deposition in elder people, their relationship with aging still needs further investigation, mostly in human subjects.

Corresponding author: Dorel Arsene, MD, PhD, e-mail: dorelarsene@yahoo.com, dorelarsene890@hotmail.com

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9. The recesses of the retro-tympanum

A. C. Cheita, Nicoleta Maru, Carmen Aurelia Mogoanta, Elena Ionita

Objective: To study the anatomy of the posterior tympanic wall and to describe the four recesses (Sinus Tympani - ST, Lateral Tympanic Sinus - LTS, Posterior Tympanic Sinus - PTS, Facial Recess - FR) with their variations in shape, dimension, internal configuration. Material and Methods: Thirty-seven cadaver temporal bones were examined through the anterior dissection approach. The opening was enlarged by drilling to allow a good microscopic or rigid endoscopic view to the retro-tympanum. Measurements of the recesses were made with gradually millimeter wire, dial micrometric indicator (comparator clock), various right angled picks and sometimes by means of cast-impression - used in stomatology for dental impression (interior configuration). Results: Out of 37 specimens, we have found PTS in 64.86% (24 cases), ST in 94.59% (35 cases), and LTS in 59.45% (22 cases). For FR, we have found four types. The most constant cell, located in the inferior external part of FR and in the same time, the biggest one was suprapyramidal Sappey's fossa, which we have found in 75.67% (28 cases) of all specimens. Sinus entrance of each recess was very variable, but in the most cases, we have found that the long diameter of ST and LTS was usually directed vertically and of PTS usually horizontally. The deeper recess was ST - 2.74 mm (range 0.5 to 6.2 mm). Pyramidal eminence was visualized in 100% of cases, the pyramidal ridge in 89.18%, the chordal ridge in 78.37%, the suprapyramidal ridge in 35.13%, ponticulus in 83.78% and subiculum in 75.67%. In many cases, the inner configuration of each sinus was irregular, presenting either small recesses (0.2 to 1 mm) under the bone borders at the entrance in the sinuses or communication between the two sinuses. Conclusions: Presence of the all four recess is not a rule. Marked variation in the size and shape and especially in the internal configuration of all recesses is a rule. All recesses of the retro-tympanum can be recognized more easily, if we identify at first all elements of positive projection (pyramidal eminence, chordal ridge, styloid eminence, styloid ridge, pyramidal ridge, suprapyramidal ridge, ponticulus, subiculum).

Corresponding author: Adrian Constantin Cheita, MD, PhD candidate, e-mail: cheita_adrian@yahoo.com

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10. Mucin is not a rare finding in rosacea

A. Fernandez-Flores

Mucin deposit is a feature that is not commonly mentioned in textbooks when talking about rosacea. Nevertheless, it is one of the prominent findings of a severe variant of the phymatous type of rosacea known as the fibrous type. We retrospectively investigated 20 cases of early stages of rosacea and examined the mucin deposit in them, with histochemical stains (Alcian Blue and Periodic Acid-Schiff). We found granulomas in 20% of these cases. Alcian Blue positive deposits of mucin were found in all cases with granulomas. The mucin was located in the granulomas (four cases) as well as in the infundibulum (one case). No deposits of mucin were evidenced in the dermis out of the granulomas, apart from the normal mucin of papillary and adventicial dermis. Periodic Acid-Schiff did not show any deposits in any case. Serologic lupus markers were negative in all patients with mucin deposits. We conclude that: (a) mucin is a common finding in granulomas of rosacea; (b) this mucin is probably not related to any progression to the mucinous variant of rhinophyma; (c) since discoid erythematosus lupus is a clinical differential of rosacea, it is important to be aware of the fact that mucin is a common finding in the granulomas, in order not to misdiagnose both entities.

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

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11. Immunohistochemical study of colorectal cancer liver metastases: the immune/inflammatory infiltrate

Simona Eliza Giusca, Fl. Eloae Zugun, E. Tarcoveanu, E. Carasevici, Cornelia Amalinei, Irina-Draga Caruntu

Our study is focused on the investigation of the immune/inflammatory infiltrate in liver metastases secondary to colorectal cancer. Twenty cases of colorectal liver metastases have been studied, including eight with recurrent metastases occurred after a previous treatment by thermonecrosis (group 1) and 12 with primary metastases treated exclusively by surgery (group 2). The cases were investigated by routine histopathological exam and by immunohistochemistry, using CD3, CD20 and CD68 antibodies. The design of the study envisages a comparative qualitative and quantitative evaluation of the B- and T-lymphocytes and macrophages inside the tumor and at the interface between liver parenchyma and tumor. Student's t-test was used for all statistical comparisons. The qualitative exam revealed, for both groups, the presence of an important T-lymphocyte, and respectively B-lymphocyte cell population at the interface between the tumor and the liver parenchyma, the number of intratumoral cells being extremely reduced. The statistical analysis showed significant differences (p<0.05 for groups 1 and 2, T- and B-lymphocytes, intratumoral vs. peritumoral). However, the comparison of group 1 with group 2 revealed no statistically significant differences between the mean value of intratumoral and peritumoral T- and B-lymphocytes, respectively. The qualitative exam revealed the presence of a well represented macrophage cell population, with a heterogenous distribution from case to case. This finding was confirmed by numerical information, with a lack of a statistically significant difference between the mean number of macrophages quantified intra and peritumoral, for both study groups. However, statistically significant differences were noticed between intratumoral and peritumoral mean value, respectively, for group 1 vs. group 2 (p<0.05). T-lymphocytes are the most numerous, their peritumoral location being the landmark for the histoarchitecture of the immune/inflammatory infiltrate and conducting the immune response developed at the interface between the tumor and liver parenchyma. The quantitative assessment of the immune infiltrate shows similar features in surgically resected metastases and recurrent metastatic disease after thermonecrosis. On the contrary, the quantitative evaluation of the macrophage population indicates a functional association rather with the primary metastasis process than with the recurrent metastatic disorder.

Corresponding author: Irina-Draga Caruntu, Professor, MD, PhD, e-mail: irina_caruntu@yahoo.com

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12. Tie2 expression in human embryonic tissues

Simona Sarb, Anca Maria Cimpean, D. Grigoras

Tie2 is a member of receptor tyrosine kinases family, involved in vasculogenesis and angiogenesis. Its main role is to stabilize, maintain, and facilitate the structural adaptation of the vasculature, during embryo development, and adult wound healing, or tumor development. Tissues from human embryos found in different stages of development (5 and 7-week-old), were investigated for Tie2 expression. The reaction was positive, with maximum intensity in the vascular cords, found in the mesenchymal tissue, and in the connective tissue around the primitive spinal cord. In the 7-week-old embryo, the reaction was negative in large blood vessels, and it was heterogeneous in those showing bridging phenomenon. In conclusion, during the first two months of human embryo development, we have concurrent vasculogenesis, angiogenesis, and blood vessel maturation and stabilization.

Corresponding author: Simona Sarb, University Assistant, MD, PhD, e-mail: simona_sarb@yahoo.com

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13. Clinicopathologic features and five years survival analysis in molecular subtypes of breast cancer

Dana Carmen Zaha, Elena Lazar, Codruta Lazureanu

Purpose. In the last years, the incidence of breast cancer has been increasing; characteristic patterns of gene expression have emerged, reflecting molecular differences between previously known as well as newly defined subtypes of breast cancer. This study aimed to classify the molecular subtypes of breast cancers based on the expression profile of immunohistochemical markers and to evaluate their association with clinicopathological features. Material and Methods. A total of 173 cases of breast carcinoma were examined retrospectively using immunostains for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2). Because the triple-negative phenotype, when defined by IHC using only these three markers, is not the optimal method for defining basal-like breast cancer, we need to use an additional marker - CK 5/6. Results. The luminal type was the most common subtype in breast cancer (71.6%), which was followed by the basal subtype (21.9%). HER2 subtype were 2.8% from the total of cases, being associated with the highest rate of high-graded cases. Basal type is presented largely in premenopausal women and displayed aggressive features, such as large tumor size and poorly differentiated cancers. Luminal A included the highest percentage of patients older than 60 years, the highest proportion of stage I-II tumors and well/moderately differentiated lesions. HER2-type was more frequent in premenopausal women and showed a high percentage of positive lymph nodes. Conclusions. These molecular differences have been shown to correlate very well with clinical features and survival, or even better than traditional histopathological parameters. The discovery of certain molecular characteristics of breast cancers has helped us to understand better the pathophysiology of disease and to develop more direct therapeutic strategies.

Corresponding author: Dana Carmen Zaha, University Assistant, MD, e-mail: danazaha@rdslink.ro

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14. Histological changes in the kidneys of experimental diabetic rats fed with Momordica charantia (bitter gourd) extract

S. L. Teoh, Azian Abd Latiff, S. Das

Momordica charantia (MC) or bitter gourd is widely known for its antidiabetic properties. The aim of the present study was to observe the protective effect of MC extract on the kidneys of streptozotocin-induced diabetic rats. Eighteen male Sprague-Dawley rats (n=18) weighing 200+/-50 g were taken for the study. The study comprised of three groups i.e. a non-diabetic, diabetic untreated and diabetic treated with MC extract, with each group comprising of six (n=6) rats. Diabetes was induced in the overnight fasted rats by intramuscular injection of streptozotocin (50 mg/kg body weight). The MC extract (50 mg/kg body weight) was administered via oral gavage. Both the kidneys were collected on the tenth day following treatment. Histological study using Verhoeff's van Gieson (VvG) and Periodic Acid-Schiff (PAS) stains were performed. The kidneys of the diabetic rats showed thickening of the basement membrane of the Bowman's capsule, edema and hypercellurarity of the proximal tubules, necrosis and hyaline deposits. These features were found to be reversed when the MC extract was administered to the experimental animals. The MC extract acted as an antioxidant thereby preventing the oxidative damage involved in the diabetic kidney. The administration of MC extract prevents oxidative damage in diabetic nephropathy.

Corresponding author: Srijit Das, Senior Lecturer, MBBS, MD, e-mail: das_srijit23@rediffmail.com

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15. Histopathological aspects of benign mesenchymal tumors located in "high risk areas" of the tongue

A. Fronie, Cristiana Simionescu, V. Vasca, Daniela Dumitrescu, Anca Simona Fronie

Although a series of premalignant or potentially malignant lesions are described in the tongue, there are many other lesions whose potential of degeneration can be determined by a prolonged action of irritant or carcinogenic factors. Even if they are practically considered to be harmless, benign formations of mesenchymal origin with lingual location represent in the same time a neoplastic lesion under the influence of local and general factors, for a variable period of time. When these structures are located in major risk areas from the oral cavity and in particular, those directly related to the tongue, special attention should be paid to their development. In this study (conducted on a total of 16 cases of benign mesenchymal malignancies), we planned a histopathological evaluation of surgical excision samples obtained from interventions on lingual neoplasias, and harvested from areas with the highest risk for lingual cancer development (pelvilingual groove, the base of the tongue and the insertion of the anterior pillar) in order to assess the histopathological aspects in different types of lesions and the possible presence of degenerative changes.

Corresponding author: Adrian Fronie, Assistant Professor, MD, PhD, e-mail: adrianfronie@yahoo.com

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16. Histopathological diagnosis of cutaneous vascular sarcomas

Mariana Costache, Ana Maria Ene, Olga Simionescu, Maria Sajin

Cutaneous sarcomas represent a heterogeneous group of mesenchymal lesions. This study investigates the histopathological and immunohistochemical features in different cases of angiosarcoma and Kaposi's sarcoma (cutaneous vascular sarcomas), which are representative for medical practice. The clinical-histopathological-immunohistochemical correlations render possible the differential diagnosis and a proper treatment can be applied to obtain a favorable prognosis.

Corresponding author: Mariana Costache, MD, PhD, e-mail: m_costache_dermatopat@yahoo.com

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17. Eyelid tumors: histopathological and clinical study performed in County Hospital of Oradea between 2000-2007

Mihaela-Cristiana Coroi, Elena Rosca, Gabriela Mutiu, T. Coroi, Marinela Bonta

The work assessment is to analyze eyelid tumors diagnosed in the last years in our hospital. We found 471 tumoral and pseudotumoral cases, in which malignant tumors predominated, with 255 cases. The most affected age range was the sixth decade and the majority of tumors were located to lower eyelid. The histopathological study allowed us to establish the lesions type and subtype. The Meibomian gland cysts, squamous papillomas and basal cell carcinomas were the most frequent related with this three of category lesions represented by pseudotumors, benign tumors and malignant tumors. Early diagnosis of these lesions can determine a favorable prognosis, especially in cases of malignant tumors.

Corresponding author: Mihaela-Cristiana Coroi, Associate Professor, MD, PhD, e-mail: opticlar@gmail.com, opticlar@rdslink.ro

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18. Retrieval analysis on dental implants biointegration phases

L. T. Ciocan, F. Miculescu, M. Miculescu, I. Patrascu

This study was developed for evaluating the possible causes of losing primary stability of dental implants and to find possible associations between implant designs or implant surface treatment and the quality of surrounding bone tissue. There have been evaluated five CP (Commercial Products) titanium dental implants having different shapes and surface morphology. All the implants have been extracted between three and six month from insertion time due to the loosening of primary stability. The lost during three to six months of the primary stability for the dental implants evaluated at the interface was attributed to blood supply deficiency of the surrounding bone in case of the implants inserted in the anteriorâ??lateral and lateral mandible bone, on implant surrounding bone with consecutive necrosis without leaving the possibility of normal healing both for the maxilla and the mandible, or to prosthetic load deficiency by applying forces out of the implant axis.

Corresponding author: Lucian Toma Ciocan, Assistant Professor, e-mail: tciocan@yahoo.com

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19. Three-dimensional cranial suture morphology analysis

Claudia Corega, Ligia Vaida, Mihaela Baciut, A. Serbanescu, Letitia Palaghita-Banias

The aim of the study was to assess the normal and synostosed coronal cranial sutures morphology at an ultrastructural level. Different operative specimens of human coronal sutures were collected. Three-dimensional reconstruction of the microcomputed tomography (micro-CT) slices were obtained and compared with the representative histologic sections. The micro-CT scanning provides a three-dimensional view of the sutures at a microscopical level thus allowing to establish the stage of development and the bone morphology. The micro-CT has the advantage of being able to image more slices than the normal histology without any damage to the analyzed specimens. Micro-CT is a powerful tool in the craniofacial area that allows us to obtain many structure-orientated slices and in conjunction with the histologic sections provides an overall thorough quantitative analysis of all cranial sutures.

Corresponding author: Claudia Corega, Lecturer, DDS, PhD, MScD, e-mail: drclaudiacorega@aol.com

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20. Tissue engineered bone versus alloplastic commercial biomaterials in craniofacial reconstruction

Ondine Lucaciu, Mihaela Baciut, G. Baciut, R. Campian, Olga Soritau, S. Bran, B. Crisan, Liana Crisan

This research was developed in order to demonstrate the tissue engineering method as an alternative to conventional methods for bone reconstruction, in order to overcome the frequent failures of alloplastic commercial biomaterials, allografts and autografts. Tissue engineering is an in vitro method used to obtain cell based osteoinductive bone grafts. This study evaluated the feasibility of creating tissue-engineered bone using mesenchymal cells seeded on a scaffold obtained from the deciduous red deer antler. We have chosen mesenchymal stem cells because they are easy to obtain, capable to differentiate into cells of mesenchymal origin (osteoblasts) and to produce tissue such as bone. As scaffold, we have chosen the red deer antler because it has a high level of porosity. We conducted a case control study, on three groups of mice type CD1 - two study groups (n=20) and a control group (n=20). For the study groups, we obtained bone grafts through tissue engineering, using mesenchymal stem cells seeded on the scaffold made of deciduous red deer antler. Bone defects were surgically induced on the left parietal bone of all subjects. In the control group, we grafted the bone defects with commercial biomaterials (OsteoSet, (R)Wright Medical Technology, Inc., Arlington, Federal USA). Subjects were sacrificed at two and four months, the healing process was morphologically and histologically evaluated using descriptive histology and the golden standard - histological scoring. The grafts obtained in vivo through tissue engineering using adult stem cell, seeded on the scaffold obtained from the red deer antler using osteogenic medium have proven their osteogenic properties.

Corresponding author: Ondine Lucaciu, University Assistant, MD, e-mail: ondineluc@yahoo.com

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21. Suprarenal gland-arterial supply: an embryological basis and applied importance

S. Dutta

Variation arterial anatomy of suprarenal gland is significant for radiological and surgical interventions. Knowledge of anomalous suprarenal artery is required to avoid complications in surgical procedure. Arterial architecture of human suprarenal gland was studied in sixty-eight cadavers of adult male and female. In all cases, superior suprarenal artery on right side was normal in origin but on left side, 24% showed anomalous origin. The incidence of anomalous origin of middle suprarenal artery on right side was 47% and on left side 6%. Anomalous origin of inferior suprarenal artery on the right side was 29% and left side 35%. The superior suprarenal artery was present in all subjects. However, there was absence of right middle suprarenal artery in 29% and left inferior suprarenal artery in 35% subjects. The most variable group was inferior suprarenal artery. The study result is being described to report anomalous origin of suprarenal arteries in the light of surgical, radiological and embryological significances. Present study findings suggest, thorough knowledge of anomalous arterial anatomy of suprarenal gland is required for surgical and radiological interventions of retroperitoneal organs of upper abdomen to avoid complications.

Corresponding author: Sukhendu Dutta, Associate Professor, PhD, e-mail: dutta8suk@hotmail.com

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22. The common bile duct: size, course, relations

Dana Blidaru, M. Blidaru, C. Pop, Carmen Crivii, Andreea Seceleanu

The common bile duct may present a number of anatomical peculiarities regarding its size, course and relations, which should be taken into consideration by the anatomists and by the surgeons as well, during the surgery of the gallbladder, pancreas and duodenum. In the present study, we have analyzed the anatomical peculiarities of the common bile duct in 150 adult corpses of both sexes from the Anatomy Department and 22 human fetuses from the Pathology Department, University of Medicine and Pharmacy Cluj-Napoca.

Corresponding author: Dana Blidaru, Assistant Professor, MD, PhD, e-mail: danadoc1@yahoo.com

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23. Numerical simulations of human tibia osteosynthesis using modular plates based on Nitinol staples

Daniela Tarnita, D. N. Tarnita, D. Popa, D. Grecu, Roxana Tarnita, D. Niculescu, F. Cismaru

The shape memory alloys exhibit a number of remarkable properties, which open new possibilities in engineering and more specifically in biomedical engineering. The most important alloy used in biomedical applications is NiTi. This alloy combines the characteristics of the shape memory effect and superelasticity with excellent corrosion resistance, wear characteristics, mechanical properties and a good biocompatibility. These properties make it an ideal biological engineering material, especially in orthopedic surgery and orthodontics. In this work, modular plates for the osteosynthesis of the long bones fractures are presented. The proposed modular plates are realized from identical modules, completely interchangeable, made of titanium or stainless steel having as connecting elements U-shaped staples made of Nitinol. Using computed tomography (CT) images to provide three-dimensional geometric details and SolidWorks software package, the three dimensional virtual models of the tibia bone and of the modular plates are obtained. The finite element models of the tibia bone and of the modular plate are generated. For numerical simulation, VisualNastran software is used. Finally, displacements diagram, von Misses strain diagram, for the modular plate and for the fractured tibia and modular plate ensemble are obtained.

Corresponding author: Daniela Tarnita, Professor, Eng, PhD, e-mail: dtarnita@yahoo.com

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24. Numerical simulations of the 3D virtual model of the human hip joint, using finite element method

D. Grecu, I. Pucalev, M. Negru, D. N. Tarnita, Nina Ionovici, R. Dita

In this paper, we present a three-dimensional mathematical model for a normal hip joint. The three-dimensional finite element model has been constructed based on Computer Tomograph scans of the bones. The obtained 3D model is studied using the finite element method, taking into consideration the real structure of the bone and the mechanical characteristics of cortical and spongy. The FE model of hip joint, the material properties used to simulate the behavior of the cortical and trabecular bone (of femur and coxal bone) and the cartilage, as well as the boundary conditions are presented. The distribution map of the axial and global movements on the global model and the distribution map of the axial and von Misses strain in the cartilaginous surface of the femur are presented.

Corresponding author: Razvan Dita, MD, e-mail: ban37th@yahoo.com

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25. The valvular segment of the lower limbs venous system: anatomical, physiological and physiopathological aspects

F. Calota, S. S. Mogoanta, Mirela-Maria Vasilescu, I. Vasile, M. Pasalega, M. C. Stoicea, D. Camen, C. Mesina

The valvular segment is a distinct venous structure, which, from a morphological point of view, is comprised of the following components: the valvular insertion, the valvular gorge entrance orifice, the valvular defile, the valvular gorge exit orifice, the valvular sinus. Endoscopic and echo Doppler examinations are used to identify the normal and the pathological morphology of the valvular segment, and the hemodynamic phenomena occurring at this level. Cusps' integrity and size as well as valvular dynamics are key elements directly involved in shaping the valvular segment in general, and the valvular sinus in particular. The valvular sinus shows an obvious hemodynamic determinism. Valvular segment pathology is the outcome either of a progressively long evolving process initialized by gravitational venous pressure overcharges, or of a rapidly evolving process such as the hemodynamic shock following intense physical efforts. Valvular defunctionalisation implies a different mechanism and a different type of cusp lesion._x000D_

Corresponding author: Firmilian Calota, Professor, MD, PhD, e-mail: ssmogo@yahoo.com

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26. The anomalous origin and branches of the obturator artery with its clinical implications

A. R. Jusoh, Nurzarina Abd Rahman, Azian Abd Latiff, Faizah Othman, S. Das, Norzana Abd Ghafar, Farihah Haji Suhaimi, Farida Hussan, Israa Maatoq Sulaiman

The obturator artery (OA) originates from the internal iliac artery. Variation in the origin of the OA may be asymptomatic in individuals and occasionally be detected during routine cadaveric dissections or autopsies. In the present study, we observed the origin and the branching pattern of the OA on 34 lower limbs (17 right sides and 17 left sides) irrespective of sex. The bifurcation of the common iliac artery into internal and external iliac from the sacral ala varied between 4.3-5.3 cm. The distance of the origin of the anterior division of internal iliac artery from the bifurcation of common iliac artery varied between 1-6 cm. The distance of the origin of the posterior division of the internal iliac artery from the point of bifurcation of the common iliac artery varied between 0-6 cm. Out of 34 lower limbs studied, two specimens (5.8%) showed anomalous origin of the OA originating from the posterior division of the internal iliac artery. Of these two, one limb belonged to the right side while the other was from the left side. The anomalous OA gave off an inferior vesical branch to the prostate in both the specimens. No other associated anomalies regarding the origin or branching pattern of the OA were observed. Prior knowledge of the anatomical variations may be beneficial for vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region.

Corresponding author: Srijit Das, Senior Lecturer, MBBS, MD, e-mail: das_srijit23@rediffmail.com

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27. Variations in the origins of the profunda femoris, medial and lateral femoral circumflex arteries: a cadaver study in the Indian population

Prakash, Jyoti Kumari, A. Kumar Bhardwaj, Betty Anna Jose, S. Kumar Yadav, G. Singh

Femoral artery is frequently accessed by radiologists and surgeons. Anatomical knowledge of the variations of femoral artery and its branches including profunda femoris, medial and lateral femoral circumflex arteries is required to minimize complications and hence it is suggested for the clinicians planning surgery and intervention around the aforementioned vessels. Present study was undertaken on Indian population and dissection was performed on 64 extremities of 32 embalmed cadavers. The level of origin of the profunda femoris artery was studied in relation to the midpoint of the inguinal ligament. Prevalence of the mode and configurations of origins of the medial and lateral femoral circumflex arteries was observed. The median distance of separation of the profunda femoris artery from the femoral artery was 4.2 cm distal to the midpoint of the inguinal ligament. The medial femoral circumflex artery in 43 out of 64 (67.2%) extremities originated from the profunda femoris artery; whereas in 21 out of 64 (32.8%) extremities it originated from the femoral artery. On the other hand, the lateral femoral circumflex artery in 52 out of 64 (81.25%) extremities originated from the profunda femoris artery; whereas in 12 out of 64 (18.75%) extremities it originated from the femoral artery. We further suggest that origins of the medial and lateral femoral circumflex arteries directly from the femoral artery is associated with lower level of separation of the profunda femoral artery from the femoral artery.

Corresponding author: Prakash, Associate Professor, MBBSS, MD, e-mail: prakashrinku@rediffmail.com, prakash_sinha2005@yahoo.com

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28. Histopathological and clinical-progressive profile of skin carcinomas: study on 1688 cases

V. Patrascu, Loredana Elena Stoica, Claudia Valentina Georgescu, Emilia Patru

Skin carcinomas represent 90-95% of skin cancers. With the objective of identifying the histopathological and clinical-progressive profile of skin carcinomas, we undertook a retrospective study over a period of seven years, which included a total of 1688 patients with carcinoma of the skin, hospitalized and treated in Craiova Dermatology Clinic between January 1999 and December 2006. Patient data such as identification data, environment, profession, phototype, location of cancer, history of the disease, clinical diagnosis, histopathological diagnosis and response to treatment were included in clinical charts. Basal cell carcinoma (BCC) was diagnosed in a total of 1162 patients, representing 68.84% of cases taken to the study. The most common clinical forms were: pearly BCC (37.95%), nodular BCC (29%), and superficial BCC (22.03%). Regarding the histological type, the most frequent forms were: BCC polymorphic (29.95%), BCC solid (24.96%), and keratinized BCC (19.97%). Epidermoid carcinoma (EC) was encountered in a total of 482 patients, representing 28.55% of all cases. The most frequent forms were: vegetated ulcerated EC (34.03%), nodular EC (31.33%) and keratosic EC (24.27%). Regarding the degree of differentiation, the situation was as follows: well-differentiated EC (64.94%), medium differentiated (29.88%), poorly differentiated (5.18%). Metatypical carcinoma (MC) was found in 44 patients (2.61%). This type of cancer did not presented clinical particular signs, the diagnosis was strictly pathological.

Corresponding author: Virgil Patrascu, Associate Professor, MD, PhD, e-mail: vm.patrascu@gmail.com

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29. Dowling-Degos disease

E. F. Georgescu, Ligia Stanescu, Carmen Florina Popescu, Maria Comanescu, Iuliana Georgescu

Dowling-Degos disease (DDD) is a rare autosomal dominant inherited pigmentary disorder of the flexures with a reticulate aspect and with presence of prominent comedone-like lesions and pitted scars. The diagnosis includes acanthosis nigricans as well as other reticulate pigmentary disorders classified into: dyschromatrosis symmetrica hereditaria (DSH), dyschromatosis universalis hereditaria (DUH) and reticulate acropigmentation of Kitamura (RAPK). We present a 35-year-old woman, which presented with flexural hyperpigmentation considerate as acanthosis nigricans. At a close clinical and histopathological examination, we obtained sure data for Dowling-Degos disease, with a possible familial history of this disease in her son. We review the literature data concerning this disease.

Corresponding author: Eugen Florin Georgescu, Professor, MD, PhD, e-mail: efg@usa.net

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30. A rare case of double recurrent choroidal melanoma, with distinctive immunohistochemical features

Anca Indrei, P. Cianga, Irina D. Florea, Danisia Haba, Liliana Foia, Corina M. Cianga

A 57-year-old woman, with left choroidal melanoma treated by laser photocoagulation and a history of repeated vitrectomies, checked for left eye acute pain and foreign body-like sensation, symptoms that occurred after three years since the primary tumor treatment. The left eyeball was enucleated and the tissues were investigated by immunohistochemistry for markers associated with cell differentiation, proliferation and adhesion, cell cycle regulation, apoptosis control, vascularization, invasiveness and local immune response. We identified, in fact, two independent tumors, with different localization and sharing some common features, markers of a highly aggressive potential: loss of cell differentiation markers and cell cycle regulators, ability to avoid death by suppressing Fas antigen expression and important invasive capacity by down regulation of E-cadherin expression. However, only in the posterior tumor, we found cells with high proliferation rate, Fas ligand molecule expression and MMP-9 secretion, acquisitions associated with a much more aggressive behavior. These particular phenotypes allowed the posterior cells to grow and to invade the surrounding tissues more rapidly than the anterior ones, leading to the development of a large size tumoral mass, responsible for the clinical symptoms. Photocoagulation, by destroying the tissues, makes impossible the evaluation of the primary tumor's biological features, important for the tumor evolution. The absence of these data stresses the importance of patient monitoring, eventually addressing a panel of soluble markers associated with recurrence or metastasis development.

Corresponding author: Corina Cianga, MD, PhD, e-mail: ccianga@hotmail.com

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31. Obliterated, fibrous omphalo-mesenteric duct in an adult without Meckel's diverticulum or vitelline cyst

N. K. Mahato

Vitello-intestinal [omphalo-mesenteric duct (OMD)] connects the developing mid-gut to the primitive yolk sac, provides nutrition to the embryo and remains patent and connected to the intestines until the fifth to ninth week of gestational period. Varied remnants of the vitello-intestinal duct have been reported. The present case-report describes a completely obliterated fibrous remnant of the duct. The remnant presented as a thick cord extending from the umbilicus towards the terminal part of the ileum and beyond. The terminal part of the cord showed a few ramifications that ended in the mesentery. This embryological entity was not found to be associated with any other anomaly usually related to non-regression of the vitello-intestinal duct. Though very rare, the occurrence of such innocuous band of fibrous cord across the abdominal cavity may cause entanglement of intestinal loops around it. Possibility of such a situation should be suspected in an acute abdominal condition. The structure reported in this study might not be detected by investigations used to uncover common anomalies of patent vitello-intestinal ducts.

Corresponding author: Niladri Kumar Mahato, Assistant Professor, MS, DNB, e-mail: mahatonk@yahoo.co.in

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32. Crucial neurovascular structures entrapped in a brachial intramuscular tunnel

Vandana Mehta, R. K. Suri, Jyoti Arora, H. Kumar, Y. Yadav, Gayatri Rath

We report a case where the median nerve accompanied by brachial vessels were found to traverse an intra-muscular tunnel within the brachialis muscle, in the floor of the cubital fossa. The muscular tunnel commenced 5 cm proximal to the neck of radius, measured 4.4 cm in length, and was present unilaterally. This unusual tunnel was distally found to blend with the brachial fascia. The present study was planned with an endeavor to elucidate in an improved way the clinical implications of compressed median nerve and brachial vessels. There are several sites where median nerve maybe compressed along its course in the arm and forearm. The relevance of the present documentation lies in the fact that these vital neurovascular structures may be compressed leading to neuropathies and vascular changes.

Corresponding author: Vandana Mehta, Associate Professor, MS, PhD, e-mail: drvandanamehta@gmail.com, gayatrirath@rediffmail.com

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33. In memoriam Professor Nicolae Esanu (1941-2009)

M. Raica, L. Saptefrati

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

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