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Background. Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) have become a feasible and efficient alternative to coronary artery bypass surgery, especially in patients with acute coronary syndrome (ACS). There are limited data regarding early and late outcomes after ULMCAD PCI in patients with ACS and stable angina. The aim of this study was to compare early and four-year clinical outcomes in patients with ULMCAD PCI presenting as ACS or stable angina in a high-volume PCI center. Methods. We conducted a single center retrospective observational study, which included 146 patients with ULMCAD undergoing PCI between 2014 and 2018. Patients were divided in two groups: Group A included patients with stable angina (n = 70, 47.9%) and Group B patients with ACS (n = 76, 52.1%). Results. 30-day mortality was 8.22% overall, lower in Group A (1.43% vs 14.47%, p = 0.02). Mortality and major adverse cardiac events (MACE) rates at 4 years were significantly lower in Group A (9.64% vs 33.25%, p = 0.001, and 24.06% vs 40.11%, p = 0.012, respectively). Target lesion revascularization (TLR) at 4 year did not differ between groups (15% in Group A vs 12.76% in Group B, p = 0.5). Conclusions. In our study patients with ULMCAD and ACS undergoing PCI had higher early and long-term mortality and MACE rates compared to patients with stable angina, with similar TLR rate at 4-year follow-up.

Introduction – Most reports on left main bifurcation lesions have demonstrated that treatment with a singlestent strategy is superior to a two-stent strategy but have excluded patients with acute coronary syndromes (ACS). Aims – The aim of the current study was to compare the four year outcomes of patients with unprotected left main coronary artery disease (ULMCAD) treated by percutaneous coronary intervention (PCI) with a one-stent or two-stent strategies in a population including those presenting as ACS. Methods – A total of 135 patients with ULMCAD treated by PCI were included, of which 75 (55.6%) had a one-stent strategy (Group A) and 60 (44.4%) had a two-stent strategy (Group B). Results – Fewer patients in Group A had a TIMI III flow at the end of the procedure (89.4% vs 100%, p=0.03) and complete revascularization (65.3% vs 88.3%, p=0.002). We found a higher early mortality in Group A without reaching statistical significance (13.4% vs 3.3%, p=0.1). Mortality rate at 4-year follow up was higher with Group A after multivariable analysis (adjusted HR 0.36, CI 0.15-0.85, p=0.02). We found no significant differences between the groups in terms of major adverse cardiac event (MACE) (adjusted HR 0.85, CI 0.34-1.48, p=0.7) or target lesion revascularization (TLR) (adjusted HR 1.37, CI 0.42-4.47, p=0.6) at 4-year follow up. Conclusions – Among unselected patients with ULMCAD PCI, with or without ACS, the early mortality rate is similar between one and two-stent strategy. Although, 4 year TLR and MACE rates were similar between the two groups, the 4-year all-cause mortality rate was lower in the two-stent strategy group.

We performed a meta-analysis of published data to investigate the diagnostic value of artificial intelligence for pancreatic cancer. Systematic research was conducted in the following databases: PubMed, Embase, and Web of Science to identify relevant studies up to October 2021. We extracted or calculated the number of true positives, false positives true negatives, and false negatives from the selected publications. In total, 10 studies, featuring 1871 patients, met our inclusion criteria. The risk of bias in the included studies was assessed using the QUADAS-2 tool. R and RevMan 5.4.1 software were used for calculations and statistical analysis. The studies included in the meta-analysis did not show an overall heterogeneity (I2 = 0%), and no significant differences were found from the subgroup analysis. The pooled diagnostic sensitivity and specificity were 0.92 (95% CI, 0.89–0.95) and 0.9 (95% CI, 0.83–0.94), respectively. The area under the summary receiver operating characteristics curve was 0.95, and the diagnostic odds ratio was 128.9 (95% CI, 71.2–233.8), indicating very good diagnostic accuracy for the detection of pancreatic cancer. Based on these promising preliminary results and further testing on a larger dataset, artificial intelligence-assisted endoscopic ultrasound could become an important tool for the computer-aided diagnosis of pancreatic cancer.

Climate change has led to drought, the expansion of desertification, loss of wetlands, loss of biodiversity, declining agricultural output and productivity. In the area of sandy soils in the southwest of Romania, where, compared to the multiannual average, the average air temperature in the May-August period increased by 1.010C and the precipitations recorded insignificant increases (5.97 mm), being very low (227. 82 mm) and unevenly distributed in relation to plant requirements. In these conditions, it is necessary to cultivate some species of plants resistant to drought and to preserve and improve some genetic resources adapted to the arid climate. For the efficient use of the microclimate in the sandy soils areas at the Dabuleni Research & Development Station for Plant Culture on Sands, three genotypes of Aura 26, Ofelia, Doljana were developed, which were studied in a comparison comparative culture with Jiana variety. The production potential of the new varieties (2120-2706 kg / ha) was clearly superior to the control variety, the production differences being significant and very significant.

The pedo-climatic conditions specific to sandy soils in southwest Oltenia determine differences in performing different phenophases of growth and development of plants, both between varieties and in the physiological behavior of the same variety under different yield conditions. Therefore, at the Dăbuleni Research and Development Station for Plant Culture on Sands, research was carried out on some physiological, biochemical and production processes at five varieties of bell peppers cultivated in the open fields and solar. Determinations of photosynthesis, foliar transpiration, the biochemical composition of fruits, quantity, and quality of bell pepper production were performed. The physiological and biochemical processes studied were influenced by the environmental conditions specific to each cultivation method, but also by the studied variables. Of the 5 varieties studied, the best results on the biochemical composition of the fruits were recorded at the Artim variety (8.83% total dry substance, 4.60% soluble dry substance, 0.19% acidity, 3.80% carbohydrate and 36.96% vitamin C). The production was between 15,387 t / ha for open-field plants and 108,574 t / ha for plants grown in the solar, the differences between the two cultivation methods being statistically assured as distinctly significant.

Sweet potato Ipomoea batatas (L) Lam is a drought resistant species with vigorous growth and high productivity adapted to the conditions of sandy soils (Iamandei Maria et al., 2014, Diaconu Aurelia et al., 2016). In terms of Romania, sweet potato are reproduces by shoots obtained under solar. In this respect, the research carried out at CCDCPN Dabuleni between 2016-2017 aimed at obtaining sweet potato shoots in a trifactorial experience, as follows: Factor A - Planting time in the solar (15 March, 25 March), Factor B - Variety (KSP 1 and KSC 1), Factor C - Diameter of tubers (2, 3, 4 cm). The results obtained on the monitoring of solar microclimate influence on growth and development of sweet potato shoots and plant physiological processes (photosynthesis, perspiration, chlorophyll content) underline the importance of the planting period and the quality of the biological material planted in the solar. Observations and determinations of growth rate they have a slow pace in April, when climatic factors have fluctuated greatly from night to day, which increased in the first decade of May, when the shoots saw the optimal planting size of 35-40 cm. The best results were obtained by planting in the solar on March 25, using tuberous roots 3-4 cm in diameter, when there was an intense physiological activity and a large number of shoots on the tuber (9.125-9.980 shoots).

The present paper describes a standard C algorithm (mathematical equations + software implementation) for making analog sensors Plug & Play over TCP/IP - Ethernet protocol. This algorithm represents a beginning step for creating a prototype of smart transducer system according to IEEE 1451 family of standards. The sensors are connected to the Analog Input Ports of a microcontroller (MCU) development board. The standard C program running on the microcontroller will automatically detect the connected sensors and will send a list of sensor information over TCP/IP - Ethernet to a remote location. The MCU algorithm is able to detect when a sensor is connected to any of its I/O Analog Ports by monitoring some external and internal parameters like: the default I/O port voltage value, the voltage value of a port when a sensor is connected to that port, the influence between analog ports when connecting a sensor to a port. The microcontroller development board is partially programmed to be an HTML Web Server. In a Web Browser will be displayed the status of all Analog Input Ports. When a sensor is detected, a text file containing sensor data will be created on a local micro-SD card (data logging capabilities). The sensor data can be accessed through a Web Browser by using the IP address of the Web Server.

Pacienti s těžkou stenozou kmene leve koronarni tepny (left main stem, LMS) jsou vzhledem k rozsahu postiženi myokardu ve velmi vysokem riziku zavažných kardiovaskularnich přihod. Po třech letech dosahuje mortalita farmakologicky lecených nemocných s významnou stenozou LMS 50 %. Za zlatý standard lecby významne stenozy LMS, zvlastě při soucasnem postiženi několika koronarnich tepen, je považovan aortokoronarni bypass (CABG). Řada studii prokazala, že perkutanni koronarni intervence (PCI) může u pacientů peclivě vybraných týmem kardiologů a kardiochirurgů představovat bezpecnou a ucinnou alternativu CABG, s podobnou výslednou mortalitou. Výsledky PCI na LMS se diky neustale dale vyvijeným technikam PCI a použivanim novějsich generaci lekových stentů trvale zlepsuji. Tyto výsledky mohou navic dale zlepsovat nově zavaděne různe invazivni zobrazovaci metody (intravaskularni ultrazvuk nebo opticka koherencni tomografie), připadně různe způsoby vysetřeni hemodynamických poměrů (frakcni průtokova rezerva). Tyto novinky v oblasti PCI LMS mohou v budoucnu vest ke změnam soucasných doporucených postupů v lecbě postiženi kmene leve koronarni tepny.

The area of psamosols in southern Oltenia is characterized by thermohydraulic stress, accentuated by the thermal resources recorded and by the poor hydrophysical properties of the soil. Higher capitalization of these lands has been an important concern both in the world and in our country, and the choice of plant species with increased drought resistance and low water consumption is a measure to counteract the negative effects of the drought. The humidity analysis of a psamosol, on the 0-125 cm profile, indicates a momentary supply of reduced water and a water deficit compared to the field capacity of -34.4 ... -65.5 m3 / ha. In order to obtain economic results on these soils, it is necessary to cultivate low-water plants, such as a cowpea (Vigna unguiculata L. Walp) that consumes about 4160 m3 / ha, compared to soybeans that have almost double consumption. The results obtained in 4 genotypes of cowpea highlight the daily average values of the plant's foliar sweating, in the blooming phase, ranging between 4.05 -5.23 mmol H2O / m2 / s, which correlated negatively with the level of grain production.

We report the case of a 55-year-old-male with a large cell metastatic pancreatic neuroendocrine carcinoma treated for 14 months with lanreotide autogel having a stable disease (SD) and not responding to chemotherapy. The somatostatin analogues (SSA) were introduced after an episode of diarrhea and controlled the disease. Progression-free survival (PFS) as determined by Computerized Tomography (CT) scans was obtained for 14 months. After more than a year, the patient's health state deteriorated along with progressive disease. The capecitabine-temozolomide regimen was challenged, but after three cycles, a rapid clinical decline was noted. Conclusion This unexpected event (diarrhea) in the course of the disease could represent the beginning of carcinoid syndrome. While the lanreotide autogel helped the episode of diarrhea pass, it also helped gain control over the disease itself.

Sorghum bicolor L. Moench is a herbaceous annual C4-type plant, with a high ecological plasticity because it can be grown in tropical, subtropical, temperate and semi-arid regions, harnessing soils with reduced natural fertility, from the category of sandy soils. Studies on 5 sweet sorghum hybrids studied under psamosols in southern Oltenia highlight a bioenergy potential in the milk-wax phase of the grain, ranging from 60847.4-89338.65 Mcal / ha, with a maximum in the hybrid Shaşm 2, which achieved a distinctly significant difference in production, compared to the average production of hybrids. The results recorded in sugar sorghum production were positively correlated, significantly distinct with leaf index determined during the flowering of the plants (r = 0.9854**).

Intense oxidative stress, increased glycated hemoglobin and mineral imbalance represent risk factors for complications in diabetic patients. Cardiovascular complications are most common in these patients, including nephropathy. This study was conducted in 2015 at the Procardia Laboratory in Tîrgu Mureș, Romania on 40 type 2 diabetic adults. Routine biochemical tests were performed on the Konleab 20XTi analyzer (serum glucose, total cholesterol, LDL and HDL cholesterol, triglyceride, creatinine, urea). We also measured serum uric acid, magnesium and calcium concentration by photometric procedures, potassium, sodium and chloride by ion selective electrode, and chromium by atomic absorption spectrometry in a group of patients. Glycated hemoglobin (HbA1c) dosage was made by reflectometry. Urine analysis was performed using the HandUReader equipment. The level of oxidative stress was measured by serum malondialdehyde dosage using the thiobarbituric acid reactive substances method. MDRD (Modification of Diet in Renal Disease) formula was applied for calculation of creatinine-derived glomerular filtration rate. GraphPad InStat software was used for statistical analysis of the data. The diabetic subject included in the study presented high MDA concentrations, showing intense oxidative stress. Calcium was deficient in 5% of the patients, chromium deficiency was present in 28%. The atherogenic cholesterol fraction was elevated in 13% of the patients. Positive correlation was found between creatinine and MDRD-creatinine values (p, {"references":["Rochette, L., Zeller, M., Cottin, Y. and Vergely, C.: Diabetes, oxidative stress and therapeutic strategies. Biochimica et Biophysica Acta (BBA)-General Subjects, 2014, 1840(9), pp. 2709-2729","Nathan, D.M., McGee, P., Steffes, M.W., Lachin, J.M. and DCCT/EDIC research group: \"Relationship of glycated albumin to blood glucose and glycated hemoglobin (HbA1C) values and to retinopathy, nephropathy and cardiovascular outcomes in the DCCT/EDIC study.\" Diabetes, 2013, pp. 1-39","Piarulli, F., Sartore, G. and Lapolla, A.: Glyco-oxidation and cardiovascular complications in type 2 diabetes: a clinical update. Acta diabetologica, 2013, 50(2), pp. 101-110","Bauman, W. A., Shaw, S., Jayatilleke, E., Spungen, A. M., & Herbert, V.: Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes care, 2000, 23(9), pp. 1227-1231","Cheng, Hwee Ming. \"Potassium and Calcium Balance.\" Physiology Question-Based Learning. Springer International Publishing, 2015, pp. 119-126","Guessous, I., Ponte, B., Marques-Vidal, P., Paccaud, F., Gaspoz, J. M., Burnier, M., & Bochud, M.: Clinical and Biological Determinants of Kidney Outcomes in a Population-Based Cohort Study. Kidney and Blood Pressure Research, 2014, 39(1), pp. 74-85","National Institute of Health: Office of Dietary Supplements: Chromium: Dietary supplement fact sheet, 2013","Rabinovitz H, Friedensohn A, Leibovitz A, Gabay G, Rocas C, Habot B: Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients. Int J Vitam Nutr Res 2004,74(3), pp. 178–82","Yin, Raynold V., and Olivia J. Phung. \"Effect of chromium supplementation on glycated hemoglobin and fasting plasma glucose in patients with diabetes mellitus.\" Nutrition journal, 2015, 14(1):1\n[10]\tJeon, Y.K., Kim, M.R., Huh, J.E., Mok, J.Y., Song, S.H., Kim, S.S., Kim, B.H., Lee, S.H., Kim, Y.K. and Kim, I.J., 2011. Cystatin C as an early biomarker of nephropathy in patients with type 2 diabetes. Journal of Korean medical science, 26(2), pp.258-263\n[11]\tKrolewski, A.S., Niewczas, M.A., Skupien, J., Gohda, T., Smiles, A., Eckfeldt, J.H., Doria, A. and Warram, J.H., 2014. Early progressive renal decline precedes the onset of microalbuminuria and its progression to macroalbuminuria. Diabetes care, 37(1), pp.226-234\n[12]\tVanessa Fiorentino T, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Current pharmaceutical design. 2013 Oct 1;19(32):5695-703\n[13]\tSalem, M., S. Kholoussi, N. Kholoussi, and R. Fawzy. \"Malondialdehyde and trace element levels in patients with type 2 diabetes mellitus.\" Arch Hellenic Med 28, no. Suppl 1 (2011): 83-8\n[14]\tChang, C.L., Lin, Y., Bartolome, A.P., Chen, Y.C., Chiu, S.C. and Yang, W.C.: Herbal therapies for type 2 diabetes mellitus: chemistry, biology, and potential application of selected plants and compounds. Evidence-Based Complementary and Alternative Medicine, 2013\n[15]\tAjala, O., English, P. and Pinkney, J.: Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. The American journal of clinical nutrition, 97(3), 2013, pp.505-516 \n[16]\tOhtsubo, K. and Taniguchi, N.: Physiological relevance of protein-glycosylation to pathogenesis of diabetes. The Journal of Physical Fitness and Sports Medicine, 2014, 3(2), pp.223-228."]}

Instead of classical or rapid thermal annealing, KrF excimer laser irradiation has been successfully applied to crystallize dried SnO2:Sb films elaborated by a sol-gel process. The penetration of the crystallization front below the film surface, as imaged by transmission electron microscopy, is controlled by the laser fluence and the number of pulses and can thus be confined in the film itself without affecting sensitive substrates. All films laser irradiated at fluences higher than 40 mJ/cm2 become conductive. At constant laser fluence, the electrical sheet resistance goes through a minimum with increasing number of pulses. The consequence of film's densification and morphology on electrical properties is discussed.

Objective.—To report 4 cases of hybrid carcinoma and to review the literature on these rare neoplasms of the salivary gland. Methods.—Hematoxylin-eosin–stained, formalin-fixed, paraffin-embedded tissue sections from 3 parotid tumors and 1 palate tumor were examined. Results.—The cases were classified as adenoid cystic and mucoepidermoid carcinoma, adenoid cystic and epithelial-myoepithelial carcinoma, epithelial-myoepithelial and salivary duct carcinoma, and adenoid cystic and salivary duct carcinoma. All patients were men, 28 to 71 years old; 3 patients presented with parotid mass, and 1 patient presented with palatal mass. One patient presented with facial nerve paralysis and pain. The soft palatal tumor was a slowly growing mass with maxillary sinus involvement at the time of the diagnosis. All patients were treated with surgery and radiotherapy. Conclusions.—Correct identification of 2 or more neoplastic entities will help assess the aggressiveness and metastatic potential of the tumor and influence the clinical course and treatment.

Renal artery stenosis (RAS) is associated with increased cardiovascular mortality and morbidity and may constitute a treatable cause of secondary hypertension. Fibromuscular dysplasia is frequently affecting children as the main cause of RAS, but is very rare in adults. We present the case of a 19-year-old overweight patient, with no known pathological conditions in her medical history or family background, admitted for severe, pulsing headaches during the past 3 months and increased blood pressure (BP) values for about a month (maximum BP 220/140 mmHg). The initial clinical exam and first-line imagistic methods did not provide a high suspicion for RAS. However, the invasive methods established the diagnosis of right renal artery medial dysplasia. Balloon angioplasty was the treatment of choice.

Mesenteric ischemia is caused by a reduction in intestinal blood flow with potential catastrophic clinical consequences: sepsis, bowel infarction, and death. In the recent years, the incidence of mesenteric ischemia increased, now accounting for 0.1% of hospital admissions. Among the multiple factors responsible for this change is the heightened awareness for the diagnoses, the advanced mean age of the population and the increasing number of critically ill patients. Acute mesenteric ischemia is a potentially fatal vascular emergency, with overall mortality of 60-80%; prompt diagnosis and treatment are paramount. A high index of suspicion in the setting of a compatible history and physical examination serves as the cornerstone to early diagnosis of mesenteric ischemia. Restoration of intestinal blood flow, as rapidly as possible, is the main goal of treatment in patients with acute mesenteric ischemia. This may be achieved by medical means, endovascular procedures and by surgery. Chronic mesenteric ischemia is an uncommon process that occurs only when severe atherosclerotic narrowing of a major splanchnic vessel exists in association with occlusion of one or two of the remaining vessels. Its diagnosis is mainly based on the characteristic clinical picture, on the presence of an occlusive lesion in the splanchnic vessels and on the absence of other common causes of abdominal pain. The means available for mesenteric revascularization are the surgical techniques of flow restoration and the more recently developed percutaneous transluminal procedures.

The studies in the literature of the past years have noticed the particular characteristics of the ischemic heart disease in women, who seem to be lacking early diagnosis and invasive treatment of coronary heart disease. They especially emphasize that the evolution, complications and mortality in myocardial infarction in women are more severe.The evaluation of clinical, investigational and therapeutic aspects in a lot of women with acute myocardial infarction (AMI) versus a lot of men with the same pathology, hospitalised in the same period.78 women hospitalised in the Emergency Institute of Cardiovascular Diseases between 1st January 1999 and 30th October 2001 with acute myocardial infarction. 109 men hospitalised in the Emergency Institute of Cardiovascular Diseases with acute myocardial infarction in the same period.acute myocardial infarction, coronary angiography +/=left ventriculography. The lot of study and the witness lot were divided into 3 subgroups based on the severity of coronary lesions: Group I: left main stenoses, Group II: stenoses60% on the other epicardial coronary vessels, Group III: stenoses60% on the other epicardial coronary vessels. The risk factors, clinical data, cardiac performance indices and medical and invasive treatment were compared between the two groups.The women hospitalised with AMI were older than men, had more diabetes and hypertension as main risk factors than men, with the exception of smoking, had more frequent heart failure and diastolic dysfunction of left ventricle. The favorite invasive treatment in women was the angioplasty with application of stent and in men--coronary bypass.

BACKGROUND: Defective DNA repair has a causal role in hereditary colorectal cancer (CRC). Defects in the base excision repair gene MUTYH are responsible for MUTYH-associated polyposis and CRC predisposition as an autosomal recessive trait. Numerous reports have suggested MUTYH mono-allelic variants to be low penetrance risk alleles. We report a large collaborative meta-analysis to assess and refine CRC risk estimates associated with bi-allelic and mono-allelic MUTYH variants and investigate age and sex influence on risk.METHODS: MUTYH genotype data were included from 20 565 cases and 15 524 controls. Three logistic regression models were tested: a crude model; adjusted for age and sex; adjusted for age, sex and study.RESULTS: All three models produced very similar results. MUTYH bi-allelic carriers demonstrated a 28-fold increase in risk (95% confidence interval (CI): 6.95-115). Significant bi-allelic effects were also observed for G396D and Y179C/G396D compound heterozygotes and a marginal mono-allelic effect for variant Y179C (odds ratio (OR) = 1.34; 95% CI: 1.00-1.80). A pooled meta-analysis of all published and unpublished datasets submitted showed bi-allelic effects for MUTYH, G396D and Y179C (OR = 10.8, 95% CI: 5.02-23.2; OR = 6.47, 95% CI: 2.33-18.0; OR = 3.35, 95% CI: 1.14-9.89) and marginal mono-allelic effect for variants MUTYH (OR = 1.16, 95% CI: 1.00-1.34) and Y179C alone (OR = 1.34, 95% CI: 1.01-1.77).CONCLUSIONS: Overall, this large study refines estimates of disease risk associated with mono-allelic and bi-allelic MUTYH carriers. British Journal of Cancer (2010) 103, 1875-1884. doi:10.1038/sj.bjc.6605966 www.bjcancer.com Published online 9 November 2010 (C) 2010 Cancer Research UK

Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases.Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients).The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

Myasthenia gravis is an autoimmune neuromuscular disorder characterized by skeletal muscle involvement, causing muscle weakness and fatigue. The prevalence of the disease is approximately 1:7500 with a maximal prevalence during the second and third decade in women and the fifth and sixth decade in men, although it may appear at any age. The disease has a slight female preponderance, with a sex ratio of 3:2. Cardiac involvement in myasthenia gravis may take several forms, ranging from asymptomatic ECG changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure and sudden death. We hereby report two cases of patients with myasthenia gravis who developed signs and symptoms of cardiovascular involvement, requiring admission in a cardiology ward for further investigation and treatment. The particular characteristics of the first case may be summarized by the symptomatic conduction disturbances with frequent episodes of syncope in a patient with myasthenia gravis who necessitated permanent pacing and the difficulties we encountered in the establishment of conduction disturbancies etiology (due to the disease or due to the treatment with acetylcolinesterase inhibitors). The second case shows a different kind of cardiac involvement in myasthenia gravis--the ECG changes (giant diffuse T waves in a patient with cardiovascular risk factors) which needed further investigation and long term surveillance.

Use of qualitative assessment of coronary artery flow (TIMI), although widely spread, represents a subjective method, a quantitative assessment (CTFC) being necessary in order to standardize and facilitate comparisons and communications of angiographic trials. This study aims at appreciating whether myocardial infarction represents a global phenomenon that affects the whole myocardium, also affecting the coronary artery flow in non-culprit arteries.66 patients that underwent primary PCI with stent and 66 patients with normal angiographic coronary arteries were studied. The number of frames necessary for the dye to reach certain standardized landmarks was registered, in order to objectively assess the coronary artery flow as a continuous variable. The statistical evaluations revealed that the quantitative assessment of the coronary flow through CTFC (corrected TIMI frame count) pins up a difference between the flow on non-culprit coronary arteries (23.54+/-9.235) and the flow on normal angiographic coronary arteries (17.46+/-4.1) (p0.005), the result being also valid for each of the three coronary arteries separately analyzed: LAD (23.88+/-8.08 vs. 18.575+/-4.59 - p0.005), CX (20.7+/-7.34 vs. 15.62+/-3.35 - p0.005) and RCA (26.45+/-11.91 vs. 18.2+/-3.69 - p0.005).There are significant differences regarding the flow on non-culprit coronary arteries in patients that suffered acute myocardial infarction (AMI) and the flow on the coronary arteries of the patients with normal angiographic results; these data might be the expression of global myocardial suffering.

Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en las regiones de Navarra, Gipuzkoa y La Rioja. Pacientes y metodos. Estudio retrospectivo y multicentrico de pacientes con esclerosis multiple recurrente tratados con fingolimod, siguiendo la ficha tecnica. Se evaluo la tasa anualizada de brotes (TAB), el porcentaje de pacientes libres de brotes, la discapacidad usando la escala expandida del estado de discapacidad (EDSS) y el porcentaje de pacientes sin lesiones captantes de gadolinio. Resultados. Un total de 113 pacientes fueron tratados con fingolimod: el 6%, naive, y el 58% y 35%, pacientes tratados previamente con inmunomodulador y natalizumab, respectivamente. El fingolimod disminuyo la TAB tras el primer (67%; 1 a 0,3; p < 0,0001) y segundo (89%; 1 a 0,1; p < 0,0001) ano de tratamiento, y aumento asi el porcentaje de pacientes libres de brotes durante el tratamiento. La EDSS basal fue 3 y despues del tratamiento con fingolimod fue 2,5 en ambos anos. El porcentaje de pacientes sin lesiones captantes de gadolinio tras el primer ano de tratamiento fue del 77%. Resultados similares se observaron en los pacientes naive y en los tratados previamente con inmunomodulador. En los pacientes tratados previamente con natalizumab no se observaron cambios tras el tratamiento. Conclusiones. El uso del fingolimod en la practica clinica mostro una efectividad similar a la eficacia observada en ensayos clinicos. No hubo cambios en la TAB al cambiar desde natalizumab, y solo un paciente tras suspender el natalizumab presento ‘rebrote’. El fingolimod se comporta como un farmaco seguro, con escasos efectos adversos y con un bajo porcentaje de abandonos.

Objective Aneurysms are twice more frequent in TSC (Tuberous Sclerosis Complex) compared with general population. We present a TSC case with 2 aneurysms of the right upper limb (brachial and subclavian artery) aiming to prove TSC causality of the aneurysm and not random association. Methods A 26 year old TSC male developed 2 aneurysms of the right upper limb at 13 and respectively 16 years of age. He was opperated for both. Pathology analysis consisted of: optic microscopy using Hematoxilin Eosin, Elastic van Gieson, Smooth Muscle Actin, and CD34 stains. The structure of the aneurysmal wall, aspect and quantity of elastin and smooth muscle fibers were evaluated and compared to normal vessel structure, TSC and non-TSC aneurysmal changes. Results Pathology examination revealed disorganization of the aneurysmal wall structure with elastin fragmentation, smooth muscle cell proliferation and neoformation vessels with thick walls with smooth muscle cell proliferation. Conclusion and discussion Based on the pathology TSC etiopathogenesis was demonstrated for the two aneurysms. Speculation on Everolimus treatment efficacy is aneurysms is made (with no existing data in the literature yet) and whether TSC patients should be systematically investigated for aneurysms. This is a rare case with only two other cases with similar localisation of the aneurysms described in the literature.

We analyze the experience of the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest, Romania) regarding orthotopic liver transplantation (OLT) in adult recipients, with whole liver grafts from cadaveric donors, between April 2000 (when the first successful LT was performed in Romania) and December 2004. This series includes 37 OLTs in adult recipients (16 women and 21 men, aged between 29-57 years--average 46 years). Other two LT with whole liver cadaveric grafts and two reduced-size LT were performed in children; also, in the same period, due to the acute organ shortage, other methods of LT were performed in 28 patients (21 living donor LT, 6 split LT and one "do mino" LT), that were not included in the present series. The indications for OLT were HBV cirrhosis--10, HBV+HDV cirrhosis--4, HCV cirrhosis--11, HBV+HCV cirrhosis--2, biliary cirrhosis--5, Wilson disease--2, alcoholic cirrhosis--1, non-alcoholic liver disease--1, autoimmune cirrhosis--1. With three exceptions, in which the classical transplantation technique was used, the liver was grafted following the technique described by Belghiti. Local postoperative complications occurred in 15 patients (41%) and general complications in 17 (46%); late complications were registered in 18 patients (49%) and recurrence of the initial disease in 6 patients (16%). Intrao- and postoperative mortality was 8% (3/37). There were two patients (5%) who died because of immunosuppressive drug neurotoxicity at more than 30 days following LT. Four patients (11%) died lately because of PTLD, liver venoocclusive disease, recurrent autoimmune hepatitis and liver venoocclusive disease, myocardial infarction, respectively. Thirty-four patients survived the postoperative period (92%); according to Kaplan-Meier analysis, actuarial patient-survival rate at month 31 was 75%.

Histiocytoid carcinoma is a rare type of invasive breast carcinoma. It has been considered to be a variant of lobular carcinoma, a variant of apocrine ductal carcinoma, and an apocrine variant of lobular carcinoma and to resemble lipid-rich carcinoma. In attempts to elucidate its histogenesis, investigators have used mucin and oil red O histochemical analysis and GCDFP-15 immunostaining. E-cadherin is a relatively recent addition to the armamentarium of immunohistochemical markers used for cell differentiation and is a member of a family of transmembrane glycoproteins that has been shown to have a strong correlation with the histologic phenotypes of breast carcinoma. Most ductal carcinomas show diffuse membrane expression of E-cadherin, and lobular carcinomas are characterized by complete lack of membrane staining of E-cadherin. The object of this study was to use E-cadherin immunohistochemical analysis to help clarify the histogenesis of histiocytoid carcinoma. Fourteen cases containing the diagnosis of histiocytoid carcinoma of the breast were identified at M. D. Anderson Cancer Center (Houston, TX) from 1988 to 2001. All cases were rereviewed, histologic features were evaluated, and immunohistochemical staining with E-cadherin and GCDFP-15 was performed. Clinical information was extracted from the patients' medical records. Eleven cases met published histologic criteria for histiocytoid carcinoma. The remaining three cases were apocrine carcinoma. The pattern of tumor infiltration was solid, without secondary lumen formation in all cases of histiocytoid carcinoma. Lobular carcinoma in situ was identified in eight cases, but was absent in three. There was no E-cadherin immunohistochemical staining in eight of the 11 cases of histiocytoid carcinoma (72.7%). GCDFP-15 was immunoreactive in all 10 cases of histiocytoid carcinoma where it was performed. Follow-up data was available for nine of the 11 cases of histiocytoid carcinoma: six patients were alive with disease at 1.5 to 48 months, one patient had died of disease at 60 months, and two patients had no evidence of disease at 32 and 45 months. We conclude that histiocytoid carcinoma has an immunophenotypical profile consistent with both ductal and lobular differentiation. Moreover, the lack of consistent morphologic features, a specific clinical profile, and a distinct immunohistochemical pattern lead us to hypothesize that histiocytoid carcinoma is not a special type of breast cancer.

The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation.Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min.In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min.The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

To report 4 cases of hybrid carcinoma and to review the literature on these rare neoplasms of the salivary gland.Hematoxylin-eosin-stained, formalin-fixed, paraffin-embedded tissue sections from 3 parotid tumors and 1 palate tumor were examined.The cases were classified as adenoid cystic and mucoepidermoid carcinoma, adenoid cystic and epithelial-myoepithelial carcinoma, epithelial-myoepithelial and salivary duct carcinoma, and adenoid cystic and salivary duct carcinoma. All patients were men, 28 to 71 years old; 3 patients presented with parotid mass, and 1 patient presented with palatal mass. One patient presented with facial nerve paralysis and pain. The soft palatal tumor was a slowly growing mass with maxillary sinus involvement at the time of the diagnosis. All patients were treated with surgery and radiotherapy.Correct identification of 2 or more neoplastic entities will help assess the aggressiveness and metastatic potential of the tumor and influence the clinical course and treatment.

Enteric vaccines are currently administered in man either orally or parenterally, each vaccination route having its advantages and disadvantages. In an attempt to cumulate the favourable effects of the two immunization methods a combined (oral-intradermal) anti-S.typhimurium and anti-S.typhi vaccination scheme was applied in mice. For comparison reasons, the oral (one or two immunization cycles) and the parenteral (one or two vaccine doses intradermally administered) vaccinations were used. The results obtained showed that mixed (oral-intradermal) vaccination induces a higher protective effect to infection with S.typhimurium or S.typhi, as compared to the single oral vaccination (one or two cycles) and a protective effect which does not differ from that obtained by intradermal vaccination.

Prolonged mechanical ventilation of critically ill patients may be complicated by formation of post-intubation tracheal stenosis (PITS) with respiratory disorders of different grades. Critical post-intubation tracheal stenosis (CPITS) may create life-threatening conditions. However, organized teamwork on the ground in the ICU may give positive results.

In an attempt to accelerate the antitetanic vaccine-induced immune response necessary particularly in subjects with tetanigenic wounds, groups of guinea pigs or rabbits were i.d. or s.c. immunized with a nonadsorbed purified and concentrated toxoid. Concomitantly, lots of control animals were i.m. immunized with tetanic vaccine adsorbed on aluminium phosphate. The immune response was estimated by testing the serum antitetanus antitoxic titre and the resistance of guinea pigs to tetanic intoxication. The results obtained revealed a variety of responses to vaccination in which differed terms of the species of animals and the applied immunization schedule. When single vaccine doses were used the protective antitetanus limit was reached in seven days in rabbits and after ten days in guinea pigs; the adsorbed vaccine induced a stronger immune response than the non-adsorbed vaccine. When multiple immunization doses were used the non-adsorbed tetanus vaccine induced, especially in rabbits, a more rapid response that the adsorbed vaccine. The vaccination schedules used in laboratory animals and which have yielded the best results in this experiment will be analysed and checked on human subjects in a further study.