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Papers accepted for publication

1. Vascular endothelial growth factor - key mediator of angiogenesis and promising therapeutical target in ulcerative colitis

Radu Bogdan Mateescu, Alexandra Eugenia Bastian, Luciana Nichita, Madalina Marinescu, Farid Rouhani, Andrei Mihai Voiosu, Andreea Bengus, Diana Rodica Tudorascu, Cristiana Gabriela Popp

Ulcerative colitis (UC) is an inflammatory bowel disease, triggered by an inappropriate immune response of colonic mucosa. Angiogenesis is an important part of inflammatory process, enhancing inflammation in a vicious circle that aggravates mucosal damage and remodeling. The most important pathway for angiogenesis in ulcerative colitis involves vascular endothelial growth factor (VEGF) and endoglin (CD105) and can be used as target for adjuvant therapy in order to improve patients outcome. We present a retrospective cohort study evaluating mucosal expression of VEGF and CD105 and their correlation with patients evolution and risk of relapse. In our study, patients with UC have correlated increases of VEGF expression and microvessel density (evaluated with CD105 staining), sustaining the hypothesis that angiogenesis is not just a passive process driven by inflammation, but an active player of mucosal lesions in ulcerative colitis.

Corresponding author: Diana Rodica Tudorascu, MD, PhD; e-mail: petridiana@yahoo.com

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2. Mesenteric panniculitis, a rare cause of acute surgical abdomen in children. Case report and literature review

Elena Tarca, Mioara-Florentina Trandafirescu, Elena Cojocaru, Doina Mihaila, Bogdan Savu

Mesenteric panniculitis appears as a less known benign condition due to its infrequency and not fully elucidated etiology; currently, less than 20 cases in children have been reported. It is characterized by a fibrotic and inflammatory transformation of the mesentery fat of the small intestine and, less commonly, of the colon. The 8-year-old patient whose case we report presented in our Service complaining of acute digestive symptoms. A causality relation with the small yet frequent injuries the child suffered at the abdominal level during his sports practice may be hypothesized, although this correlation cannot be proven. Laboratory test values are usually within the normal range in such patients, yet the inflammatory values are sometimes high, just as in our case. The imagistic diagnostic workup detected a solid mass at the level of the hepatic colic flexure, with a non-homogenous structure, with fine contrast uptake in the walls; perilesional fatty infiltration with misty mesentery appearance; infracentimetric adenopathies located in the mesentery root. The tumor was surgically excised and intestinal anastomosis was performed. Achieving the final pathological diagnosis of mesenteric panniculitis was a difficult task, as it required several differential diagnoses, by ruling out a local vasculitis process and an idiopathic inflammatory Crohn s-like disease. The patient s post-operative evolution was positive. The follow-up examinations at one month, six months, one year and two years showed a good general condition, a good nutrition state and clinical-paraclinical test results within normal values. A significant association of mesenteric panniculitis to other malignancies, as well as a predisposition of these patients to the subsequent occurrence of neoplasms has been noted in adults. As these findings have not yet been proven in children, due to the small number of cases and the absence of prospective studies, long-term monitoring is an absolute must.

Corresponding author: Mioara-Florentina Trandafirescu, Lecturer, MD, PhD; e-mail: mioaratrandafirescu@yahoo.co.uk

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3. Rare case of single coronary artery in a patient with liver cirrhosis

Eugen Nicolae Tieranu, Ionut Donoiu, Octavian Istratoaie, Alice Elena Gaman, Maria Loredana Tieranu, Cristian George Tieranu, Dan Ionut Gheonea, Tudorel Ciurea

We report here the case of a 58-year-old male presented with atypical chest pain, dyspnea and fatigue, with a medical history of liver cirrhosis and undergoing treatment with beta-blocker. The clinical exam was normal. The 12-lead electrocardiogram (ECG) showed normal heart rate, without repolarization changes. Transthoracic echocardiography revealed no wall motion abnormalities of the left ventricle, moderate tricuspid regurgitation with mild pulmonary hypertension and left ventricular hypertrophy. The biochemical markers for myocardial infarction were negative. He underwent coronary angiography that revealed a single coronary artery originating from the right coronary sinus of Valsalva.

Corresponding author: Ionut Donoiu, Assistant Professor, MD, PhD; e-mail: ionut.donoiu@umfcv.ro

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4. CDX2 expression can predict response to neoadjuvant therapy in gastric carcinoma

Maria Jesus Fernandez Acenero, Maria Luisa Sanchez de Molina, Ana Caso, Peter Vorwald, Damian Garcia Olmo, Jorge Palomar, Lourdes Estrada, Cristina Diaz del Arco

Purpose: Caudal-related homeobox transcription factor 2 (CDX2) has recently been proposed as a prognostic factor for gastric carcinoma. However and to the best of our knowledge, no previous report has analyzed CDX2 expression in patients with gastric adenocarcinoma receiving neoadjuvant therapy (NAT). Patients, Materials and Methods: This is a retrospective cohort study to analyze the potential role of CDX2 expression to predict response to NAT and prognosis. This study has enrolled 57 patients receiving chemotherapy for locally advanced gastric carcinoma. Results: 59.6% of the patients were men; mean age was 64.96 years. Only 8% of the patients showed a complete response to therapy, 10% had grade 1, 28% grade 2, and 54% grade 3 regression, respectively, according to modified Ryan s criteria. On follow-up, 38.6% of the patients showed recurrence of disease (50% distant metastasis) and 28.1% eventually died of it. Twenty-three (40.4%) patients showed intense CDX2 expression. We found a statistically significant association between CDX2 expression and poor regression with NAT, but we found no association with outcome. Discussion: Our study indicates that CDX2 expression can predict lack of response to NAT. Our results have not confirmed the association with prognosis shown in previous reports. Conclusions: Despite these preliminary results, furthermore studies are necessary to define the potential use of CDX2 in gastric carcinoma.

Corresponding author: Maria Jesus Fernandez Acenero, MD, PhD; e-mail: mgg10167@gmail.com

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5. Preselection of EGFR mutations in non-small-cell lung cancer patients by immunohistochemistry: comparison with DNA-sequencing, EGFR wild-type expression, gene copy number gain and clinicopathological data

Rania Gaber, Iris Watermann, Christian Kugler, Ekkehard Vollmer, Sven Perner, Martin Reck, Torsten Goldmann

Targeting epidermal growth factor receptor (EGFR) in patients with non-small-cell lung cancer (NSCLC) having EGFR mutations is associated with an improved overall survival. The aim of this study is to verify, if EGFR mutations detected by immunohistochemistry (IHC) is a convincing way to preselect patients for DNA-sequencing and to figure out, the statistical association between EGFR mutation, wild-type EGFR overexpression, gene copy number gain, which are the main factors inducing EGFR tumorigenic activity and the clinicopathological data. Two hundred sixteen tumor tissue samples of primarily chemotherapeutic naive NSCLC patients were analyzed for EGFR mutations E746-A750del and L858R and correlated with DNA-sequencing. Two hundred six of which were assessed by IHC, using 6B6 and 43B2 specific antibodies followed by DNA-sequencing of positive cases and 10 already genotyped tumor tissues were also included to investigate debugging accuracy of IHC. In addition, EGFR wild-type overexpression was IHC evaluated and EGFR gene copy number determination was performed by fluorescence in situ hybridization (FISH). Forty-one/206 (19.9%) cases were positive for mutated EGFR by IHC. Eight of them had EGFR mutations of exons 18-21 by DNA-sequencing. Hit rate of 10 already genotyped NSCLC mutated cases was 90% by IHC. Positive association was found between EGFR mutations determined by IHC and both EGFR overexpression and increased gene copy number (p=0.002 and p<0.001, respectively). Additionally, positive association was detected between EGFR mutations, high tumor grade and clinical stage (p<0.001). IHC staining with mutation specific antibodies was demonstrated as a possible useful screening test to preselect patients for DNA-sequencing.

Corresponding author: Torsten Goldmann, Professor, Dr. rer. nat., Principal Investigator; e-mail: tgoldmann@fz-borstel.de

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6. Changes of desmin expression pattern in the myocardium of patients with alcoholic dilated cardiomyopathy

Ruxandra Camelia Deliu, Alexandru Radu Mihailovici, Ionica Pirici, Cristiana Eugenia Simionescu, Ionut Donoiu, Octavian Istratoaie, Tudorel Ciurea

Introduction: It has been suggested that desmin cytoskeleton remodeling may contribute to the progression of dilated cardiomyopathy and might affect long-term prognosis. This study is aiming at evaluating desmin expression in cardiomyocytes from patients with dilated cardiomyopathy of alcoholic etiology in advanced stages of the disease and comparing the results with measurements of normal heart tissue from control patients. Materials and Methods: For immunohistochemistry, sections from 36 myocardium fragments taken from left ventricle of dilated cardiomyopathy patients were immunolabeled with an anti-desmin antibody and negative control slides were obtained by omitting the primary antibody. We calculated the ratios between the areas of myocardiocytes and the length and number of A dark disks and assessed the desmin expression level as the integrated optical density (IOD) and, respectively, the total areas of the signal given by immunolabeling. A Student s t-test has been utilized to assess the differences, p<0.05 deemed significant data. Results: We identified significant decrease in numerical density of dark disks in our cases group compared with controls (p<0.05). Also, the ratios between total cellular area and total length of dark disks and number of dark disks was significantly different between cases and controls (p=0.04). IOD was significantly different between dilative cardiomyopathy cases and controls and also, overall desmin expression area was increased in dilatative cardiomyopathy patients. Conclusions: The identification of different desmin expression and standardization in diseased myocardium may be helpful in stratifying patients and in understanding their evolution, but also in finding new therapeutic targets that aim the alterations in desmin expression.

Corresponding author: Ionica Pirici, Teaching Assistant, MD, PhD; e-mail: danapirici@yahoo.com

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7. Scientific and organizational achievements of Professor of Anatomy Henryk Kadyi - Rector Vigilantissimus Universitatis Leopoliensis

Andrzej Wincewicz, Monika Turek-Pietrzykowska

Henryk Kadyi (1851-1912) was educated in medicine at Jagiellonian and Vienna Universities, who deepened his studies in Leipzig to obtain associate professorship in descriptive anatomy at Alma Mater Cracoviensis, in 1878. He was elected Rector of Lvov University for years 1898-1899. Kadyi organized emerging Academy of Veterinary Medicine and Faculty of Medicine in Lvov. He equipped them with excellent anatomical facilities, e.g., remarkable collections of anatomical specimens. Kadyi worked out plans and such a detailed curriculum of higher studies in veterinary medicine, that it was raised to the ranks of academic discipline. He profoundly described accessory praehyoid and suprahyoid remnants of thyroid tissue and reasoned the anatomic term of arteria radicularis magna for artery of Adamkiewicz. Kadyi s social endeavors enabled women an access to higher education and university employment in 1895. His academic foresight, thrift and vigilance made Kadyi deserve a title of Rector Vigilantissimus.

Corresponding author: Andrzej Wincewicz, MD, PhD, Associate Professor of Pathology; e-mails: ruahpolin@yahoo.com, andwinc@gmail.com

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8. Study on cognitive decline in patients diagnosed with brain tumors

Simona Bondari, Dan Bondari, Mircea Pirscoveanu, Dan-Vasile Morosanu, Anca-Emanuela Musetescu, Valerica Tudorica, Denisa Floriana Vasilica Pirscoveanu

Aim: The purpose of our study was to assess the cognitive performance in patients with primitive brain tumors and to analyze the cognitive status of these patients, correlated with histological type of brain tumors. Patients, Materials and Methods: The study enrolled 52 patients diagnosed with primitive brain tumors, hospitalized in Neuropsychiatry Hospital of Craiova, Romania, from December 2013 to December 2015. According to the histological type of tumors, the patients were classified into three groups: Group A included 22 patients with meningioma, Group B composed of 16 patients diagnosed with glioblastoma, and Group C including 14 patients diagnosed with diffuse astrocytoma. Neurological examination, neuro-imaging assessment [computed tomography (CT) or magnetic resonance imaging (MRI) for skulls] to diagnose primitive brain tumors, then the confirmation of clinical and histopathological diagnoses were performed for these patients. For cognitive assessment performed before surgery, Montreal Cognitive Assessment (MoCA) and Cambridge Cognitive Examination (CAMCOG) scales were used. The results were statistically analyzed using the Student s t-test; p-values less than 0.05 were considered statistically significant. Results: In terms of age, we did not observe statistically significant differences between the three groups of patients. The group of patients with diffuse astrocytoma presented a higher educational level compared to patients with glioblastoma or meningioma. MoCA score obtained in glioblastoma group was 21.7 points, while in the group of patients with diffuse astrocytoma was 23.5 points, and in the group of patients with meningioma 24.2 points. The cognitive assessment using CAMCOG scale led to the following results: group of patients diagnosed with glioblastoma showed an average score of 83.5 points, the diffuse astrocytoma group had an average score of 88.9 points and the group with meningioma an average score of 90.1 points. Conclusions: Patients diagnosed with glioblastoma showed a statistically significant cognitive decline in comparison to patients diagnosed with diffuse astrocytoma (p<0.05). We did not notice statistically significant differences in the cognitive decline of patients with meningioma compared to those diagnosed with diffuse astrocytoma (p>0.05).

Corresponding author: Mircea Pirscoveanu, University Assistant, MD, PhD; e-mail: mircea_pirscoveanu@yahoo.com

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9. Cervical adenocarcinoma generator of procoagulant status and ischemic stroke

Ana-Maria Bumbea, Magdalena-Rodica Traistaru, Stefan-Cristian Dinescu, Bogdan Stefan Bumbea, Dana-Maria Albulescu, Mihaela Niculescu, Boris Marinov Krastev, Anca-Emanuela Musetescu

The procoagulant status of neoplastic patients is well known in medical literature, but in the last years there is attempted a correlation between the histological types of neoplasia and the risk for thrombotic strokes. We present the case of a 44-years-old patient undergoing early menopause, who was diagnosed with cervical tumor of the serous adenocarcinoma type. The patient underwent external radiotherapy, and, in the seventh day of treatment, she suffered a frontal-temporal-parietal ischemic stroke with left hemiplegia. The blood testing highlighted procoagulant products (double fibrinogen compared to normal values, deficit of antithrombin and a high number of thrombocytes). The patient received neurological and rehabilitation treatment, at first with Heparin, followed by the administration of an antiaggregant. During this treatment, the deficit remained unchanged. She continued the neurological and rehabilitation treatment, followed by radiotherapy, with a good evolution. Six months after the stroke, it was decided the surgical tumor ablation of cytoreduction. The post-surgery histological examination highlighted specific changes due to post-surgery radiotherapy, without the presence of any neoplastic cells. The imagistic evaluation, computed tomography (CT) every three months after surgery, did not highlight any suggestive dissemination elements. The occurrence of an ischemic stroke in a patient with endocervical neoplasm of the adenocarcinoma type during radiotherapy imposed the discharge of chemotherapy, with subsequent imaging, biological and histopathological monitoring after surgery. The cause of stroke in this case is determined by the hypercoagulant status in the context of the developed neoplasia, the patient being free of any other risk factors.

Corresponding author: Magdalena-Rodica Traistaru, Associate Professor, MD, PhD; e-mail: rodicatraistru@hotmail.com

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10. The Abelson tyrosine kinase (c-Abl) localization in preimplantation mouse development

Duygu Mutluay, Hakan Oner

The Abelson family member of non-receptor tyrosine kinase, c-Abl, has an important role in regulation of cellular processes like cell polarity, invasion, proliferation, survival and cell motility. In the present study, we investigated the localization of c-Abl protein during preimplantation mouse embryo development in vitro using immunofluorescence confocal microscopy. We have shown that c-Abl protein is expressed throughout all stages of preimplantation development. We found that c-Abl is asymmetrically localized in egg cortex, which suggests possible roles in positioning of the metaphase II spindle. We also observed strong c-Abl staining in external cells, especially enriched at the apical poles in morula stage and at the E3.5 stage blastocysts, cell membrane enrichment of c-Abl in trophectoderm (TE), the tissue responsible for implantation and placentation. The results indicate that c-Abl may play roles in preimplantation embryo development, especially in TE formation and differentiation.

Corresponding author: Duygu Mutluay, Assistant Professor, DVM, PhD; e-mail: duygumutluay@gmail.com

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11. Synaptophysin expression as prognostic factor for survival in colorectal carcinomas

Diana Rodica Tudorascu, Daniel Pirici, Elena-Anca Tartea, Edme Roxana Mustafa, Cristina Florescu, Cristin Constantin Vere, Alina Maria Balea, Ileana Puiu, Georgica-Costinel Tartea, Valeria-Carmen Albu

The aim of this study is to assess the status of synapses in normal colorectal tissue compared to neoplastic colorectal tissue, and to correlate this status with survival in patients with colorectal neoplasia. Our study included 61 patients diagnosed with colorectal adenocarcinoma, representing the study group, and 53 patients diagnosed with benign conditions, that required a resection of a colorectal segment, representing the control group. We performed the immunohistochemical staining by using anti-synaptophysin antibody, which identifies synaptic vesicles and, so, we managed to analyze the expression of synapses in colorectal adenocarcinoma. Regarding both the signal area and integrated optical density (IOD) of the synaptophysin, the univariate analysis with a log-rank (Mantel-Cox) test indicated that patients with a low level of synaptophysin had a better overall survival rate than those with a high-level synaptophysin. Also, we noticed that tumor size, tumor invasion and lymph node metastasis were significantly associated with the overall survival rate, whereas the other clinicopathological features were not. In conclusion, the status of synaptic vesicles evaluated via synaptophysin expression in patients with colorectal cancer positively correlates with the survival rate and it can play a role in the neoplastic therapy process.

Corresponding author: Ileana Puiu, Associate Professor, MD, PhD; e-mail: vipuiu@yahoo.com

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12. Ectopic intracavernous corticotroph microadenoma: case report of an extremely rare pathology

Adrian Florian Balasa, Rares Chinezu, Daniel Mihai Teleanu, Maria Ionela Pascanu, Laura Chinezu, Angela Borda

Ectopic pituitary adenomas (EPAs) are most likely tumors developing from the cellular remnants following the migration of Rathke s pouch. We present the case of a 54-year-old female diagnosed with Cushing s syndrome. Magnetic resonance imaging (MRI) identified an ectopic microadenoma located in the median wall of the cavernous sinus. Microscopic transsphenoidal surgery was performed and the lesion was completely removed without any postoperative surgical complications. Based on characteristic microscopic and immunohistochemical features and on recent clinicopathological prognostic classifications, the histopathological diagnosis was non-proliferative, non-invasive corticotroph pituitary neuroendocrine tumor, grade 1a. Complete remission of disease was achieved postoperatively and was maintained for one year following surgery. MRI showed complete resection, without tumor recurrence at one and two years. Occurrence of an ectopic intracavenous adrenocorticotropic hormone (ACTH)-secreting adenoma is extremely rare and poses difficulties both in the identification, surgery, histopathological grading, and adequate endocrinological treatment and follow-up.

Corresponding author: Rares Chinezu, MD, Consultant Neurosurgeon; e-mail: rchinezu@yahoo.com

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13. Tau protein in neurodegenerative diseases - a review

Denisa Floriana Vasilica Pirscoveanu, Ionica Pirici, Valerica Tudorica, Tudor-Adrian Balseanu, Valeria-Carmen Albu, Simona Bondari, Ana-Maria Bumbea, Mircea Pirscoveanu

The study of rare, inherited forms of different diseases resulted in the discovery of gene defects that cause inherited variants of the respective diseases. The defective genes were found to encode major molecular players leading to the neuropathological lesions or factors that characterize these diseases. The exact role of the tau protein in the neurodegenerative process is still under debate. It is very important to understand the normal biological roles of tau and the specific events that induce tau to become neurotoxic. Tau is the major microtubule-associated protein (MAP) of a mature neuron. The other neuronal MAPs are MAP1 and MAP2. These three MAPs perform similar function, promoting assembly and stability of microtubules. Tau protein was isolated as a microtubule-associated factor in the porcine brain. It was isolated as a protein that co-purified with tubulin and had the ability to promote microtubule assembly in vitro. Normal adult human brain tau contains 2-3 moles phosphate/mole of tau protein. Hyperphosphorylation of tau depress this biological activity of tau. Almost 80 diseases caused by missense mutations and intronic mutations in the tau gene have been found in familial cases of frontotemporal dementia (FTD). In Alzheimer s disease (AD), there are intraneuronal neurofibrillary tangles composed of the microtubule-associated protein tau (MAPT). In other neurodegenerative diseases, there are similar deposits of tau, in the absence of extracellular deposits (progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease, etc.). Tau pathology is also often seen in some forms of Parkinson s disease (PD) and prion diseases. In genetic forms of FTD, mutations in tau implicate abnormal tau as the initiation of neurodegeneration. In FTD, there are deposits especially in temporal and frontal lobes, regions that are very important for behavior and executive function. It is critical to understand how tau becomes pathogenic, in order to consider developing any strategies for treatment.

Corresponding author: Ana-Maria Bumbea, Teaching Assistant, MD, PhD; e-mail: anamariabumbea@yahoo.com

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14. The immunoexpression of EGFR, HER2 and HER3 in malignant serous ovarian tumors

Andreea-Elena Cirstea, Alex Emilian Stepan, Claudiu Margaritescu, Roxana Eugenia Zavoi, Daniel Alin Olimid, Cristiana Eugenia Simionescu

The study of rare, inherited forms of different diseases resulted in the discovery of gene defects that cause inherited variants of the respective diseases. The defective genes were found to encode major molecular players leading to the neuropathological lesions or factors that characterize these diseases. The exact role of the tau protein in the neurodegenerative process is still under debate. It is very important to understand the normal biological roles of tau and the specific events that induce tau to become neurotoxic. Tau is the major microtubule-associated protein (MAP) of a mature neuron. The other neuronal MAPs are MAP1 and MAP2. These three MAPs perform similar function, promoting assembly and stability of microtubules. Tau protein was isolated as a microtubule-associated factor in the porcine brain. It was isolated as a protein that co-purified with tubulin and had the ability to promote microtubule assembly in vitro. Normal adult human brain tau contains 2-3 moles phosphate/mole of tau protein. Hyperphosphorylation of tau depress this biological activity of tau. Almost 80 diseases caused by missense mutations and intronic mutations in the tau gene have been found in familial cases of frontotemporal dementia (FTD). In Alzheimer s disease (AD), there are intraneuronal neurofibrillary tangles composed of the microtubule-associated protein tau (MAPT). In other neurodegenerative diseases, there are similar deposits of tau, in the absence of extracellular deposits (progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease, etc.). Tau pathology is also often seen in some forms of Parkinson s disease (PD) and prion diseases. In genetic forms of FTD, mutations in tau implicate abnormal tau as the initiation of neurodegeneration. In FTD, there are deposits especially in temporal and frontal lobes, regions that are very important for behavior and executive function. It is critical to understand how tau becomes pathogenic, in order to consider developing any strategies for treatment.

Corresponding author: Alex Emilian Stepan, Lecturer, MD, PhD; e-mail: astepan76@yahoo.com

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15. Diagnosis and management of a young woman with acute isolated lateral sinus thrombosis

Dragos Catalin Jianu, Silviana Nina Jianu, Andrei Gheorghe Marius Motoc, Marioara Poenaru, Ligia Petrica, Adrian Vlad, Sorin Ursoniu, Anca Elena Gogu, Traian Flavius Dan

Isolated lateral sinus thrombosis (LST) was mentioned in the past as a complication of middle ear infection. In the recent years, it was not frequently studied. Our patient, a 23-year-old woman who was taking an oral contraceptive pill, displayed 24 hours of migraine, such as headache; her systemic examinations were normal. She underwent neuroimaging examinations in the first 36 hours of admission. Native head computed tomography (CT) revealed hyperdensities along the left tentorium, involving the left lateral sinus (LS). Cranial magnetic resonance imaging (MRI) showed hypointense signal on MRI T2*SW (susceptibility-weighted) in the region of the left LS. MR venography noted the absence of flow-related signal within the left LS. The clinical symptoms, signs and neuroimaging results formulated the diagnosis of left isolated LS thrombosis. Laboratory data demonstrated an elevated D-dimer and homozygosity for the factor V Leiden mutation. She was immediately started on anticoagulation in the form of low-molecular-weight Heparin; then, she was treated with Warfarin for an indefinite duration. The headaches resolved within two days and her neurological examination was also normal. A second MR venography achieved after two weeks demonstrated complete recanalization of the venous sinuses. We did not observe any LST recurrence, deep vein thrombosis or pulmonary embolism during one year of follow-up. The early initialization of anticoagulation produced a favorable evolution. An acute isolated left LST could be identified in her case on the head CT combined with MRI and MR venography.

Corresponding author: Andrei Gheorghe Marius Motoc, Professor, MD, PhD; e-mail: amotoc@umft.ro

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16. Biomechanical and morphological peculiarities of the rectum in patients with obstructed defecation syndrome

Ints Brunenieks, Katrina Pekarska, Vladimir Kasyanov, Valerija Groma

The morphological and biomechanical peculiarities of the rectum observed in obstructed defecation syndrome (ODS) are not completely understood. The biomechanical properties and morphological features of the rectum in patients with ODS in correlation with the status of the enteric nervous system (ENS) were evaluated. Uniaxial tensile tests on the rectum samples of patients with ODS and controls were performed; collagenous constituents were assessed by Reticulin and Masson s trichrome stainings; the expressions of alpha-smooth muscle actin (alpha-SMA), S100 and CD117 labeling of interstitial cells of Cajal (ICCs) were investigated by immunohistochemistry. In both groups, the ultimate stress in the posterior rectal wall was statistically significantly higher compared to the anterior one. The ultimate strain was higher in ODS compared to controls. The tangential modulus of elasticity was significantly higher in the control group than in the ODS one, both in the anterior and posterior walls. A significantly higher density of collagen demonstrated throughout the wall was evidenced in controls compared to ODS. The mucosal muscular compartment was significantly thicker but more disorganized in the patients group. The enteric S100-positive glial cells were significantly reduced in number in the anterior wall, but elevated in the posterior wall of the rectum in ODS simultaneously demonstrating the higher numbers of ICCs within the entire muscular layer and myenteric. The biomechanical and morphological results show that the rectal wall in patients with ODS is more deformable and less rigid compared to controls. The results of biomechanical properties and morphological changes in the human rectum are essential when choosing the method of ODS treatment.

Corresponding author: Vladimir Kasyanov, Professor, PhD, Dr.habil.sc.ing.; e-mail: kasyanov@latnet.lv

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17. Long-term survival in a patient with advanced gastric cancer and metachronous right-sided colon cancer

Anca Sava, Delia Gabriela Ciobanu Apostol, Elena Sapte, Lidia Ionescu, Claudia Florida Costea, Manuela Ciocoiu, Gabriela Florenta Dumitrescu, Cristinel Ionel Stan, Ana Maria Slanina, Roxana Gabriela Cobzaru, Irina Iuliana Costache

Gastrointestinal carcinomas represent the most common cancers worldwide. The coexistence of gastric cancer with metachronous colon cancer represents a rare phenomenon, and the prognosis of the patient is poor. We present here a case of an elderly patient with primary gastric intestinal type well-differentiated adenocarcinoma (pT3N0, stage IIA) who developed a metachronous right-sided colon cancer diagnosed and treated after 11 years from the first surgical intervention. Histopathological and immunohistochemical examination revealed a well-differentiated adenocarcinoma (strongly positive staining for cytokeratin 20 and CDX2), pT3N0 stage IIA. The patient is still alive and active after 16 years from his first surgical intervention, even though no treatment has done after the removal of his second cancer. In conclusion, in any case of gastric cancer, first the surgeon, and then the general practitioner should be alert to recognize a second primary tumor with different origin and to perform complete postoperative control. The correct diagnosis could lead to the patients best prognosis.

Corresponding author: Delia Gabriela Ciobanu Apostol, MD, PhD; e-mail: deliaku@yahoo.com; Elena Sapte, MD, PhD; e-mail: esapte@ymail.com

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