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Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients., Aims: The objective of this paper is to study the importance of HLA-B27 antigen in the development of reactive arthritis., Patients and Methods: The transversal, observational study was conducted in the Rheumatology Clinic of the University of Medicine and Pharmacy of Craiova during the period 2012-2015 and included 112 patients. They were divided into three groups, as follows: group I (52 reactive arthritis cases), group II (30 other spondyloarthritis cases), group III (40 osteoarthritis cases). ELISA and PCR techniques were used to determine the antigen., Results: Those whom had this genetic marker present, the number of enthesitis almost doubled highlighting a possible correlation between the antigen and these imaging changes. We can confirm the same thing for the erosions as well. Unlike enthesitis, erosions occurred also in group III (37.5%), but if we refer to the first two groups, we will observe a significant relationship regarding HLA-B27. More specifically, in HLA-B27 positive patients (68.97%), erosions were found to be twice as numerous than in HLA-B27 negative patients (31.03%). In group I we identified stage 2 sacroiliitis in 68% of HLA-B27 positive patients and 32% in HLA-B27 negative, which shows another link to this antigen with both joint destruction and a possible unfavorable evolution of reactive arthritis., Conclusions: This antigen specific to the seronegative group of spondyloarthritis determines the acceleration of articular destruction, translated by erosion, and the evolution of sacroiliitis to a more advanced stage., (Copyright © 2019, Medical University Publishing House Craiova.)

The complex regional pain syndrome (CRPS) is a neuropathic disorder, often precipitated by a fracture, injury of the soft tissue or a surgical procedure followed by extended immobilization. Clinical signs and symptoms of this syndrome include abnormalities of pain processing (mechanical and thermal allodynia, hyperalgesia and hyperpathia), skin changes regarding local temperature and the presence of erythema, cyanosis or mottled appearance, neurogenic edema, motor and trophic disorders. The CRPS has three evolutionary stages-acute, dystrophic and atrophic, and it is divided into two types, reflecting the absence or presence of nerve damage. The patient presented in this study was a female with a history of metabolic syndrome, diagnosed with polyarticular chronic gout, which despite the specific drug treatment administered, had multiple predisposing factors for the development of CRPS consecutive to the fracture of both bones of the right forearm. It is evident that the recovery period after injury is slightly different in each individual and depends on the severity of the injury and patient factors such as age, general condition and the presence of other comorbidities. The delay between the onset of symptoms and her presentation to the physician, conferred a poor prognosis for the developing pathology, with important functional and motor impairment., (Copyright © 2019, Medical University Publishing House Craiova.)

Introduction: Psoriatic arthritis (PsA) is an inflammatory arthritis, usually involving peripheral joints, associated with cutaneous psoriasis, in the absence of rheumatoid factor and anti-citrullinated protein antibodies., Material and Methods: The study included 28 patients diagnosed with psoriatic arthritis according to CASPAR criteria, presenting pain or swelling of the small joints of the hands and wrists, hospitalized in the Department of Rheumatology of the Emergency Clinical County Hospital of Craiova during 2016-2018., Results: In the 28 patients, a total of 840 joints were examined clinically and by ultrasound. From the clinical point of view, out of the total, 32 joints were swollen while 59 joints were tender. Dactylitis was evidenced in 20/280 examined digits upon physical examination. MUS revealed the presence of synovial proliferation in 108/840 sites (12.85%), with grade 1 synovitis in 4 joints (3.7%), grade 2 in 94 joints (87.03%) and grade 3 in 10 joints (9.25%). Out of 280 examined fingers 5.71% presented dactylitis, the third digit being the most commonly targeted. Grade 2 tenosynovitis was found in 40 of the examined tendons, whereas 8 tendons presented with grade 3 tenosynovitis. The most frequently involved were the flexor tendons of the digits (38 out of 40 tendons with inflammatory changes), followed by the extensor carpi ulnaris and flexor carpi radialis tendons., Conclusions: Ultrasound has proven its utility in assessing joint and tendon inflammation to a higher extent that clinically expected. Thus, MUS examination of hand joints may aid the clinician in diagnosing PsA, in evaluating the prognosis and the course of treatment., (Copyright © 2019, Medical University Publishing House Craiova.)

The aim of our study was to identify the cardiovascular risk factors present in patients with left main coronary artery disease (LMCAD), which influenced the progression of these patients in both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). We performed a clinical observational descriptive study in which, during three years, we followed the evolution of 81 patients who were diagnosed with left main coronary artery disease and who were treated either by interventional revascularization by stent implantation, by surgical revascularization by performing an aortic-coronary bypass. In our study the risk factors according to which the evolution of the patients was observed were represented by diabetes, smoking, age and gender. The primary endpoint was mortality from any cause and other clinical endpoints were the reduction of left ventricular ejection fraction, symptomatic ischemic heart disease manifested by angina pectoris, non-procedural myocardial infarction or need for repeated revascularization. In our study diabetes was the risk factor that negatively influenced the evolution of patients with LMCAD treated either by PCI or by CABG for the most part, followed by smoking, male gender and age over 65 years.

The purpose of our study was to compare the 3-year of follow-up clinical outcomes in patients suffering from left main coronary artery disease (LMCAD) treated either by percutaneous coronary intervention (PCI) or by coronary artery bypass grafting (CABG) depending on SYNTAX score tertiles. The primary end point of the study was all-cause mortality for the PCI arm versus CABG arm depending on SYNTAX score tertiles. The secondary end points were the recurrence of angina pectoris following revascularization, the acute nonfatal myocardial infarction, the reduction of the left ventricular ejection fraction or the need for myocardial revascularization. With regard to patients with LMCAD, at low risk (SYNTAX score 0-22) there was no difference in the frequency of end-point occurrence among patients treated by PCI compared to CABG. Also, the tendency to increase end point occurrence in patients with LMCAD treated by PCI compared to patients treated by CABG was more evident in patients at intermediate risk, but the significant statistical difference was recorded only in the occurrence of acute myocardial infarction. Regarding the patients with LMCAD at high risk (SYNTAX score over 33) the endpoint occurrence was significantly increased, statistically significant differences were recorded in all evaluated endpoints. In conclusion, coronary artery bypass grafting remains the standard treatment for high-risk patients with complex lesions, while for patients with LMCAD at low or intermediate risk, percutaneous coronary intervention by stent implantation remains an alternative that does not pose significant risks.

Introduction: Spondyloarthritis (SpA) is a group of chronic inflammatory disorders which includes ankylosing spondylitis (SA), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD) and undifferentiated spondyloarthritis (uSpA). The enthesis, the area of insertion of the tendon, ligament or joint capsule onto the bone, can be characterized as a central feature in PsA., Material and Methods: The study included a number of 28 patients, 18 females and 10 males, with PsA hospitalized during 2016-2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. All the patients were diagnosed with psoriatic arthritis according to CASPAR criteria and had a history of entheseal pain, mandatory criteria for inclusion in the study. All patients underwent clinical examination, laboratory tests and musculoskeletal ultrasonography (MSUS)., Results: The Belgrade Ultrasound Enthesitis Score (BUSES) was not significantly associated either with ESR (p=0.536) or CRP (p=0.965) values. Furthermore, the clinical evaluation through the LEEDS enthesitis index (LEI) showed no significant association with ESR (p=0.067) or CRP (p=0.206). Despite MSUS and clinical findings, there was no significant correlation between disease activity in psoriatic arthritis (DAPSA) and BUSES (p=0,549) or LEI (p=0,197). However, clinical and echographic scores (BUSES and LEI) were significantly associated (p=0.001)., Conclusions: Our study proved a significant correlation between LEI and BUSES, although in literature the evidence is contrasting. This is probably due to the fact that the majority of the patients had high disease activity which made the clinical assessment similar to the US. Further studies on more numerous groups of patients have to be conducted in order to debate the inconsistencies related to clinical and US examinations in patients with PsA.

Dermatomyositis (DM) is part of a heterogeneous group of systemic diseases called idiopathic inflammatory myopathies. As in other autoimmune connective tissue diseases (CTD), abnormalities of hematopoietic tissue and/or peripheral blood cells may develop and represent an important prognostic factor. Most common CTD associated with thrombocytopenia (TP) are systemic lupus erythematosus and antiphospholipid syndrome. DM-related TP is less frequent and may develop in the context of an underlying malignancy. Severe TP related to myositis is a very rare occurrence. We report a case of a male patient diagnosed with acute DM, debilitating muscle weakness and rapid development of severe TP.

Currently incurable, Charcot-Marie-Tooth (CMT) disease is the most commonly inherited neurological disorder, which affects a small percentage of the population. The most common cause of CMT is the duplication of a region on the short arm of chromosome 17, which includes the gene PMP22. We report a thirty-seven-year-old man with CMT disease having sleep, memory and attention disorders characterized by brief retrograde amnesia at early age. The patient has no genetic disease in the family, but was diagnosed with diabetes mellitus, which emphasizes the sensory loss and prolonged infections. Diabetes mellitus emphasizes the sensory symptomatology and predisposes to the development of infections with delayed healing.

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. As a group feature, enthesitis is defined as inflammation in bone insertions of tendons, ligaments and muscular fascia. Aims: the main object of this study was to demonstrate the importance of musculoskeletal ultrasonography in Achilles tendon evaluation in patients with reactive arthritis. Patients and methods: we designed a transversal, retrospective study which included 15 patients diagnosed, based on ESSG criteria, with reactive arthritis (ReA), in Rheumatology Department, Emergency County Hospital. From those 15 patients, 9 were positive for a genital infection with Chlamydia trachomatis and 6 patients with enteral infection, 2 with Shigella, respectively 4 with Yersinia. Healthy control group included 15 patients, with no inflammatory joint diseases. After clinical examination, all patients and controls underwent ultrasound (US) evaluation for Achilles tendon changes, using an Esaote MyLab 25 machine, with a linear high frequency probe (10-18 MHz), using EULAR recommendations and OMERACT definitions for enthesitis, tendinitis and erosions. The cutoff value for the Achilles tendon thickness was 5.29mm, as described by Balint et al. Results: We examined 30 Achilles tendons in 15 patients, with a mean age of 35,2years±10,19 standard deviation (SD) and 30 tendons in 15 controls with a mean age of 35,8 years ±12,00 SD. In both groups sex prevalence showed more males than females (66,66% males in controls vs. 60,00% in patients group). We found a statistic significant higher ESR and CRP in patients group, compared to controls (24,86mm/h vs. 11,8mm/h; 18.90mg/dl vs. 6.22mg/dl). Most frequent finding in patients group was retrocalcaneal bursitis (56.66%), followed by tendon thickening (46.66%), compared to control group in which we found more frequently osteophytes (36.66%) and calcifications (23.33%). Tendon thickness was significantly higher in the patients group compared to control group 5.30mm±1.39SD vs. 4.42mm±0.77SD, p=0.008). When compared to clinical examination, US found at least one change in all patients (100% vs. 40.0%). Conclusions: A higher prevalence of retrocalcaneal bursitis and tendon thickening were found in reactive arthritis patients compared to control group. The US found more changes compared to clinical examination and manage to discriminate between the types of changes found more frequently in inflammatory conditions.

The objectives proposed were the evaluation of the endothelial dysfunction by ultrasonographic with examination in patients with (AS), the evaluation of the lipid profile of these patients and the identification of some correlations with certain clinical and biological parameters., Material and Method: The study has a prospective nature, type case-control, and took place in the Rheumatology Clinic of Emergency County Hospital Craiova and was performed on 140 patients, who were divided in two groups, patients from the population of patients suffering from ankylosing spondylitis and non-inflammatory rheumatic affections assisted in the same period of the research. Study design involved: patients' with AS registration, duration of the disease, type of joint damage (axial or peripheral), progression of the disease, activity indices (BASDAI), mobility (BASFI) and severity, therapeutic protocol, complete physical examination, ESR, hs-CRP, level of the glucose in the blood, creatinine, uric acid, complete lipid profile, bonejoint radiological examination, ultrasound examination (2D+Doppler) of the carotid arteries., Results and Discussions: endothelial dysfunction was more important in patients with AS and was significantly associated with the inflammatory status-especially with hs-CRP, age, duration and severity of the disease. Results of the study show that patients suffering from AS are included in a high risk class due to the chronic inflammatory status and to the pro-atherogenic lipid profile, mutually reinforcing variables., Conclusions: Patients with AS have a pro-atherogenic status and early atherosclerotic lesions.

Over the past decades, management of rheumatic diseases improved both due to development of new drugs and to new imaging techniques., Objective: The aim of this study was to evaluate the type and frequency of different structures involvement in the hand of patients with rheumatoid arthritis, psoriatic arthritis and gout compared to patients with osteoarthritis of the hand Methods: We designed an observational, transverse study, which included 110 consecutive patients evaluated in the Rheumatology Department, Emergency County Hospital Craiova, during one year 2014-2015, from which 50 were diagnosed with rheumatoid arthritis, 20 with psoriatic arthritis, 20 with gout and 20 with osteoarthritis. All patients uderwent clinical, biological and US examination., Results: The global prevalence showed any US abnormalities at the hand level in 47 (94%) RA patients with respect to 17 (85%) patients in PsA group, 15 (75%) patients with gout and 12 (60%) patients in OA group (p=0.01) (Table 1). In all groups, except PsA patients, the tendon involvement (Figure 3a,b) was present in less than 30% of the patients, the high global prevalence being explained by the joint involvement (Figure 3c,d). In most of the patients with tendon involvement, we found joint involvement too., Conclusions: In conclusion, although further studies are needed, with more patients and more homogenous population, the study reveals some US involvement pattern depending on the patient's disease.

Rhythm disorders in young people are often reported and when they are persistent, repetitive or with a severity degree, an ethiopathgenical assessment of arrhythmogenic risk factors and their implications is required., Purpose: Arrhythmogenic risk factors evaluation and the possibility of determining oxidative stress in the arrhythmic pathology in young people., Material and Methods: The study was conducted on 184 young subjects, aged 16-26 years old; the points of interest were: the presence or absence of cardiac dysrhythmias, the existence of proarrhythmogenic risk factors and determination of oxidative stress status modifications., Results: Of the studied young subjects, 39% presented heart rhythm disturbances, repetitive or persistent (atrial extrasystolic arrhythmia, sinus tachycardia, ventricular extrasystolic arrhythmia, paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, associated dysrhythmias, atrial flutter, sinus bradycardia), which have been associated with the following risk factors: coffee consumption 82%, stress 80%, physical effort 72%, energy drinks consumption 72%, hyperlipidic diet 69%, familial predisposition 69%, alcohol intake 53%, frequent sleep deprivation 50%, smoking 31%, overweight 31%. The observed risk factors may be involved in the increasing of oxidative stress level, and, for this reason, the determination of oxidative stress biomarkers is required. The association of arrhythmogenic risk factors, with the expression of oxidative stress markers and the existence of enzymatic genetic polymorphism of redox systems, requires proper monitoring for the further risk of endothelial lesions induction, leading to aterosclerosis., Conclusions: Arrhythmogenic risk factors and biomarkers of oxidative stress are important, especially in young people cases, for monitoring the cardiovascular risk, for primary prevention and early treatment.

Overlap syndrome is often defined as an entity that satisfies the classification criteria for at least two distinct connective tissue disease. We present the case of a female patient, 39 years old, hospitalized in the Dermatology clinic of Emergency County Hospital in september 2014, for ulcerative lesions on the left hallux and the second and third left toes, associated with pain and difficulties in walking. After performing the clinical exam and paraclinical tests, we decided for both intravenous synthetic analogue of prostacyclin PGI2-iloprost and local therapeutic measures, with a favourable outcome of the ulcerations. Due to the fact that overlap syndrome is an entity with several visceral involvement and unpredictable evolution, we must not disregard the skin manifestation, so that we can prevent a severe evolution and improve the outcome. The case represents a permanent challenge for the multidisciplinary team that examine, survey and periodically adjust the treatment, based on the biological status and predominant symptoms.

Purpose: to assess synovial inflammation using musculoskeletal ultrasonography, in a cohort of patients with early rheumatoid arthritis, and establish the correlations with disease activity score., Material and Methods: We enrolled 29 patients diagnosed with early RA, according to ACR-EULAR 2010 classification criteria, in Rheumatology Clinic, Emergency County Hospital Craiova, between September 2013-August 2014. We performed clinical evaluation, assessed laboratory tests and performed US for all the patients. Musculoskeletal ultrasonography was performed using an ESAOTE MyLab 25 ultrasound, by the same examiner, with multi-frequency linear array transducers (7-12Mh). The presence of synovitis was assessed both in grey scale (GSUS) and power-Doppler (PDUS), according to OMERACT-EULAR consent., Results: Assessment of synovial inflammatory activity by ultrasound examination, using both grey scale and PDUS, has shown active synovitis in all patients, with a mean number of joints with active synovitis of 5. Evaluating the grade, using PDUS, we found grade 1 in all patients, 2 in 14 and grade 3 in 3 patients. Inflammatory markers correlated significant with both GSUS and PDUS. Analysis of correlation between GSUS examination parameters and disease activity score, found a positive, moderate inter-relation, results found also for PD score., Conclusion: our results sustain the role of US for detecting inflammatory activity in early RA patients, and, in addition with clinical and biological assessment, represents a sensitive, reliable and reproducible method, easily approached, that should be included in our routine evaluation.

Background: Early inflammatory arthritis (EIA) a condition defined by joint swelling, with or without morning stiffness, and/or swelling of metacarpophalangeal and/or metatarsophalangeal joints. Nail fold video-capillaroscopy (NVC) is important for the evaluation of microcirculation in vivo. There are limited data about the role of NVC in EIA., Objectives: To study the capillaroscopic pattern in patients with EIA., Patients and Methods: 27 patients with EIA - 21 women, 6 men, mean age of 41.6±4.2 yrs, mean disease duration of 6.9±3.1 months. Anamnesis and clinical examination were perform to identify clinical signs associated with connective tissue diseases. All the patients were nonsmokers and had no personal medical history of diabetes or non-immune mediated occlusive vascular disease. Blood and urine samples were collected for bio-chemical and immunological evaluation. All the patients were interrogated by NVC., Results: Raynaud's phenomenon was found in 9 patients, puffy fingers in 2 pts, telangiectasia in 2 pts, Sicca symptoms in 6 pts, malar rash in 2 pts, photosensitivity and psoriasis plaque in one patient. Combined information from clinical exam, NVC and immunological assessment allowed a specific diagnosis in 5 patients., Conclusions: Nail fold capillaroscopy assessment can provide further information and has diagnostic value in some cases of early arthritis. Nail fold capillaroscopy assessment contribution to the differential diagnosis in patients with early arthritis is sometimes significant, especially in poorly clinical and immunological defined cases.

Purpose: The goal of this study is to identify the predictive factors involved in the evolution of the reactive arthritis to ankylosing spondylitis by following the presence and degree of sacroiliitis and also the appeareance of acute anterior uveitis., Material and Methods: The study was performed between 01.01.2011- 31.12.2014 on 112 patients, aged between 17 and 47 years old, in evidence of the Rheumatology Clinic of the Clinical Hospital Emergency Craiova. The patients were divided in 2 lots according to the radiological criteria: the first lot included 52 patients diagnosed with reactive arthritis, with the determination of the pathogen agent involved and the demonstration of sacroiliitis first degree by Nuclear Magnetic Resonance (IRM). The second lot included a number of 60 patients diagnosed with reactive arthritis, without presenting significant changes in the sacroiliac joints and at the cervico-dorsal- lumbar spine., Results: In the first batch, the performance of the IRM and monitoring the patients every 6 months over 3 years revealed the progression of sacroiliitis from first degree in which it was at the moment of diagnosing at second degree in a 6 month period. Three years after initiation of therapy for reactive arthritis, the patients from the second batch responded favorably to treatment, the performance of imaging not revealing signs of sacroiliitis., Conclusion: Association of sacroiliitis at baseline proved to be a negative prognostic factor in reactive arthritis, which can suggest the evolution to ankylosing spondylitis, monitoring these patients being necessary for at least 3 years from the point of diagnosing.

Purpose: Angiogenesis is an important step in the process of cancer growth. The purpose of this study was to determine the neoangiogenesis with CD31, CD34 and CD105, and tried to observe the differences between these three antibodies., Material/methods: The blood vessels stained with CD31, CD 34 and CD105 were counted, and we reported their number per square millimeter to obtain microvascular density (MVD). For angiogenesis quantification we determined the neoformation blood vessels with CD105. The CD31 and CD34 were used as control markers, in order to observe the difference between neoformation blood vessels and mature vessels., Results: Comparing the average effective vessels marked with the 3 markers, Student t test showed that the mean number of blood vessels market with CD 34 is higher than blood vessels market with CD31 and CD 105. The value of the Student t test was highly significant in all three cases (p<0.001). By calculating the Pearson correlation coefficient for the relationship CD31-CD105 we obtained a value r = 0.440, which corresponds to p = 0.0013 < 0.05, indicating a statistically significant direct correlation between the two factors., Conclusions: An important number of vessels (around 40%) that can be found in tumor area are neoformation vessels, this concept being an important assessment for the choice of the correct and effective treatment in colorectal adenocarcinoma.

Purpose: to assess the incidence of osteoporosis in a cohort of SLE patients and to determine the possible correlations with disease activity, organ damage and glucocorticoid therapy., Material and Methods: We analyzed a cohort that included 25 consecutive SLE patients, diagnosed according to ACR revised criteria, and 21 controls, with the same demographic characteristics. We assessed demographic, life style related, clinical, biologic and immunologic data; also, we registered information about the treatment and calculated disease activity and damage scores. Bone mineral density was measured both in lumbar spine and total hip, using dual-energy X-ray absorptiometry., Results: Evaluation of T score profile, both in lumbar spine and total hip, established a percentage of 36 (9) patients with osteoporosis, 40 (10) patients with osteopenia and 24 (6) cases with normal values. Mean T score in lumbar spine was -1.28+1.31 SD and for the total hip -1.21+1.34 SD. Analysis of correlation between T score, both in lumbar spine and total hip, and SLEDAI, established a moderate, negative correlation; for SDI we obtained a moderate correlation, both for lumbar spine and total hip, statistically significant., Conclusions: our results show an increased percentage of osteoporosis among SLE patients and a relation to disease and treatment variables, imposing a periodic evaluation, in order to establish an early diagnosis, the proper therapeutic measures, and to prevent the major consequence, vertebral and non-vertebral fractures.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is extremely versatile. We present the case of a 52 years old patient referred for inflammatory pain of the left knee and ankle of recent onset with intense inflammatory syndrome that mimics rheumatoid arthritis. Musculoskeletal ultrasound was able to detect effusion, hyperechoic crystals within the cartilage and fibrocartilage, inside tendons, suggestive for CPPD disease and to guide fluid aspiration as well as in sustaining a rapid diagnosis corroborating images suggestive for CPPD disease to biological data - hypercalcemia and hyperparathyroidism in finding the predisposing condition, the parathyroid adenoma.

Background: Systemic lupus erythematosus (SLE) is an inflammatory disease caused by autoimmune dysregulation, which mainly affects young women, usually free from atherosclerosis. Accelerated atherosclerosis is a well established complication of SLE and it cannot be explained by Framingham risk factors alone, and has been attributed to complex interactions between traditional risk factors and factors associated with the disease per se, or its treatment. Arterial stiffness and endothelium function may serve as a valuable measure to be counted in the follow-up of these patients prior to a potential cardiovascular event. The aim of the study was to evaluate atherosclerosis, inflammatory process, immune mediated, using imaging techniques and to identify the role of molecules known to be involved in inflammation, hsCRP, homocysteine, IL-6, ESR and fibrinogen, in the development and perpetuation of atherosclerosis in patients with systemic lupus erythematosus. Methods Our prospective study included 53 patients diagnosed with systemic lupus erythematosus and fulfilled the revised ACR (American College of Rheumatology) criteria for the classification of SLE. Exclusion criteria were <18 years of age, history of CVD, infections, diabetes mellitus, dyslipidemia., Results: We enrolled 53 patients with SLE, 50 (94%) women and 3 (6%) men, with a mean age of 31,92 years (SD 5,55; limits 22-44) with no significant difference between sex (31,65±3,4 years in women and 37,33±4,05 years in men). The measurement of inflammation markers revealed increased values for all the variables: ESR had a mean value of 69,19± 14,18mm, fibrinogen 445,66 ±4,56mg%; IL-6 had a mean value of 11,209 ±1,56pg/ml; homocysteine 17,721±2,5374 µmol/l and for hs CRP the mean value was 3,493±1,12 mg/l. The assesement of arterial stiffness showed a mean value of 23,32% (SD 5,82; 95%CI 21,716 - 24,925) for AIx and 9,1m/s (SD 0,49; 95%CI 8,971 - 9,244) for cfPWV. There was a positive, significant correlation between AIx and hsCRP (r=0,612; 95%CI 0,4104 - 0,7576; p<0,001), (r=0,526; 95% CI 0,2979 to 0,6971; p=0,0001), for AIx and homocysteine (r=0,526; 95%CI 0,2979 to 0,6971; p=0,0001). The correlation coefficient with AIx was similar for ESR and fibrinogen (r=0,63 and 0,60). IL-6 and AIx correlated correlated positively, (r=0,369; 95%CI 0,1097 - 0,5813), statistically significant (p=0,006), but the correlation was not powerful. hsCRP and cfPWV were related (r=0,652; 95%CI 0,4677-0,7862; p<0,001); cfPWV also correlated with IL-6 (r=0,6552; 95%CI 0,4677- 0,7862; p<0,0001), homocysteine (r=0,9174; 95%CI 0,8606- 0,9517; p<0,0001), ESR (r=0,74) and fibrinogen (r=0,64)., Conclusions: In summary, our data suggest that arterial stiffness is related to the level of systemic inflammation, and that inflammation is involved in the early alteration of arterial wall. Increase in arterial stiffness can be detected by applanation tonometry, and may serve as an important predictor of future cardiovascular events, since an early diagnosis may have a significant value in preventing the development of major vascular disease.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the industrialized and in the developing countries. Chronic bronchitis (CB) is one the three COPD clinico-pathological entities that in 2009 were estimated to be diagnosed in 9.9 million Americans. It is characterized by inflammation of the "bronchial tree" that results in tissue swelling and excessive secretions of mucus into the bronchi, with progressive airflow limitation. Our study aims to reveal the main morphological aspects of CB in our casuistry and to evaluate their correlation with major clinico-epidemiological parameters. Thus, we performed a retrospective clinical and morphological study on a group of 17 smoker patients with symptoms of chronic bronchitis, eight non-smokers diagnosed with chronic bronchitis and five non-smokers and asymptomatic subjects. We observed that CB developed especially in men of 65-year-old or older, especially in smokers with a median FEV1% at around 71. Histopathologically, patients with symptoms of CB, regardless of smoking status, presented on bronchial biopsies with focal squamous metaplastic change, goblet cell hyperplasia and enlargement of the bronchial gland mass because of the inflammatory process, consisting predominantly of mononuclear cells in the bronchial wall. The statistical testing proved a significant correlation between the densities of different inflammatory cell classes (with the exception of mast cells in the bronchial epithelium) and FEV1% values on epithelium and submucosa regions in all investigated groups.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the industrialized and in the developing countries. It is believe, at least in part, that some of the structural changes that occur in COPD would be a result of epidermal growth factors (EGFs) and their receptors. Therefore, our study aims was to examine the expression patterns of EGF and their receptors (EGFR1 and c-erbB2) in the bronchial mucosa from the biopsy specimens harvested from smoking and non-smoking CB patients, compared with their expression in normal controls. The statistical analysis proved that for both EGF and EGFR1 reactivity were significant correlation with smoking status and FEV1% scores. Thus, we found that the highest levels of its expression were recorded in smoker CB patients with higher FEV1% scores. Regarding cellular localization and staining pattern, we noticed a cytoplasmic and nuclear immunostaining for EGF in bronchial epithelium both for control and CB subjects at the level of basal and ciliated cells. For the receptors, reactions were at the membrane level especially at the lower lateral junctions between ciliated cells and their junctions with basal cells. This reactivity proved the pathogenic implication of the EGF and their receptors in patients with CB and suggests that blockade of the EGFR pathway can be an alternative successful therapy.

Background: Systemic lupus erythematosus (SLE) is the prototype of autoimmune connective tissue diseases. Renal disease is a frequent manifestation of SLE that influences the outcome of the patients. The aim of the current study was to determine and analyze the clinical features and subsequent outcome of 70 patients with LN, followed in our department over the past 5 years, focusing on the impact of cardiovascular risk factors in the renal outcome and mortality., Patients and Methods: Our prospective study included 70 patients with SLE and LN and 70 patients with SLE without signs of renal involvement, all patients fulfilled the revised ACR (American College of Rheumatology) criteria for the classification of SLE. Demographical data, risk factors and comorbidities were recorded., Results: Patients with lupus nephritis had a mean age of 37 years (range 15-65, SD 1.8). During the study, we had a rate of drop off of 15 patients with lupus nephritis (21%) and 19 patients without nephritis (26%). Patients with LN had a higher prevalence of positive anti-dsDNA antibodies (85.4% vs 49%, p<0.001, RR=2.2) and a lower percent of rheumatoid factor (FR) positive (5.45% vs 15.68%, p=0.03, RR=0.34) compared with the controls, a higher prevalence of corticosteroid treatment (65.45% vs 7.83%, p<0.001, RR=2.1) and immunosuppressive treatment (AZA 27.27% vs 3.92%, p=0.01, RR=1.71, CFM 34.54% vs 0%, p<0.001, RR=2.16), a higher frequency of hypertension (47.27% vs 9.8%, p<0.001, RR=2.4), hyperlipidaemia (49.09% vs 1.96%, p<0.001, RR=1.81) and anti-PL antibodies (49.09% vs 20%, p=0.001, RR=2.70),and a higher mortality (16% vs 2%, p=0.02, RR=1.76). 20 patients (36.36%) from the survival group (55 patients), evoluated to renal failure, 9.09% of these with end -stage renal failure, results that are similar with the ones in other studies., Conclusions: The study reveals the fact that cardiovascular risk factors such as hypertension, hyperlipidaemia and antiphospholipid syndrome are associated with a higer rate of mortality and an evolution to end-stage renal disease.

Objective: To detect synovitis is important in both the diagnosis and outcome assessment of early rheumatoid arthritis. This study was meant to assess the validity and reproducibility of ultrasonography (US) as a mean of detection for the knee synovitis, by comparing US findings with clinical examination and histopathological findings in synovial membrane., Methods: The study group included 65 patients with early rheumatoid arthritis - below 12 months from the debut, naive for DMARDs, in whom demographic data - gender, age, disease duration, the number of tender and swollen joints, HAQ score (Health Assessment Questionnaire) and serum samples for CRP, RF, anti-CCP2 antibodies (ELISA, QUANTA LiteTM, CCP IgG, INOVA Diagnostics Inc, USA), VEGF (ELISA, VEGF2, DRG International, IRC, USA) determination were recorded. Disease Activity Score for 28 joints (DAS28) was calculated. PDS signal was scored from 0 to 3 according to the overall expression of PDS findings at the knees. A sample of synovial tissue was obtained in 35 patients during the arthroscopy, and the vascularisation of the synovial tissue was evaluated by immunohistochemistry and was analyzed qualitatively by a pathologist who was unaware of the PDS findings. Written, informed consent was obtained from each patient before entering the study. They all had active synovitis of the knee, ultrasonographically confirmed, with the identification of the target biopsy sites. The study was approved by the Ethics Committee of the University of Medicine and Pharmacy of Craiova., Results: Angiogenesis was evaluated and quantified by immunohistochemical evaluation of synovial VEGF, one of the most specific endothelial growing factors, that proved to correlate significantly with the serum levels of VEGF, DAS28 as well as with the power Doppler sonography (PDS) score., Conclusions: The statistical analysis of the data showed that PDS could be used as non-invasive marker with predictive value regarding synovial inflammation and disease progression in early forms of the disease as well as a useful method in the assessment of the therapeutic response.

Osgood-Schlatter disease is a condition that is caused by traction of the muscle-tendon unit at tibial tuberosity, which affects adolescents who exercise. The predisposing factors include rapid growth and physical activity, particularly running and jumping. Osgood- Schlatter disease causes intermittent pain, which can be aggravated by running, cycling and climbing stairs. We present the case of a young boy, soccer player, which presented for pain at the level of the tibial tuberosity. Ultrasonography showed changes at the distal part of the patellar tendon and at the tibial tuberosity, consistent with Osgood-Schlatter disease.

Objective: The objective of the study was to analyze several immunohistochemical, histological, and morphometrical aspects of angiogenesis in early rheumatoid arthritis synovium. We aimed to identify possible correlations between the histological and immunohistochemical patterns and the serum levels of VEGF, as well as with clinical and biological markers of disease activity., Methods: 35 patients with early rheumatoid arthritis below 12 months from the onset, naive for DMARDs, underwent clinical standard examination as well as serum determinations for CRP, RF. anti-CCP2 antibodies and VEGF. DAS28 value has been determined for each patient in order to assess the disease activity. We performed biopsy sampling through arthroscopy, the synovium fragments beeing histopathologically processed, in order to elaborate a total histological score. Immunohistochemical analysis has been performed with quantification of synovial VEGF, VEGF-R1 and CD34 expression. Standard and activated microvascular density (sMVD and aMVD) have been evaluated through double immunostaining (CD34/ VEGF-R1)., Results: VEGF and VEGF-R1 have been identified with high prevalence in endothelial cells, in lining and sublining synovial cells, as well as in inflammatory cells. The study focuses on the analysis of aMVD, a valuable parameter, representative for active angiogenesis, which proved to correlate significantly with the serum levels of VEGF, the composite histological score as well as with VEGF-R1 and DAS28., Conclusion: The statistic analysis of the data support VEGF-R1 and aMVD as markers with predictive value regarding activity and progression in early stages of rheumatoid arthritis. The validation of preliminary conclusions oblige to continuous research through extending the study group and inclusion of several others biomarkers involved in synovial angiogenesis.

This study represents a descriptive epidemiologic analysis of the morbidity and mortality incidence by lung cancer in Dolj. The usual processing of the registered values in primary evidences (report of the new cases to 100,000 residents) is in accordance with the literature about the variation of the incidence depending on residential environment and sex greater values in urban environment and at man, beginning from the fifth decade of life. The epidemiologic analysis by indirect standardisation of the mortality and the morbidity emphasizes in Dolj higher incidence up to the media of the Dolj, specially in the rural environment, aspects that suggest the intervention of the environmental factors and behaviour factors in the etiology of the lung cancer.

The study carried out during 1991-1995 concerns 50 subjects with lung cancer confirmed by microscopy registered in the Oncology Department of Craiova University Hospital. The patients were studied on terms of clinical stage which indicated the regime of treatment associations: surgery + chemotherapy + radiotherapy, chemo-radiotherapy, chemo-immunotherapy, in order to improve surviving. The treatment results were assayed for each group of patients according to the international criteria of treatment response evaluation. The efficiency of various cytostatics associations according to histopathologic form was finally evaluated on terms of asymptomatic period and survival duration.

Chronic alcoholic hepatitis (CAH) has been included, in the last 10 years, among the disease accompanied by particular changes of IgA (primary glomerulonephritis with mesangial deposits of IgA, Berger; Henoch-Schonlein's purpura with IgA deposits in dermatic capillaries and herpetiform dermatitis, with deposits of IgA in dermatic papillae). The characteristics of IgA involvement in CAH are: The whole IgA system is changed, at its 3 levels: circulatory, tissular, formative. at the circulatory level, the IgA2 monomeric fraction increases characteristically; in hepatic parenchyma, perisinusoidal linear deposits of IgA are formed; they have a great significance for the alcoholic etiology, the length of time and seriousness of alcoholism.