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Retele de comunicare pentru profesionisti

dr. Jan Andi Marin

Majoritatea medicilor participa in diferite programe de comunicare si educatie medicala continua in cadrul conferintelor, simpozioanelor si congreselor,  adevarate platforme de informare si de imbunatatire a cunostintelor pe diverse tematici. Astazi, majoritatea medicilor pot sa se foloseasca in mod eficient de noile mijloace de comunicare media prin internet, unde pot sa sa-si creasca nivelul de cunostinte si sa sa-si exprime liber ideile si opiniile fata de noile descoperiri.

Collateral damage in the fight against prematurityAlex C. VidaeffDivision of Maternal-Fetal Medicine,University of Texas Houston Medical School, USAAs long as preventing preterm birth remains an unachievable goal and children continue to be born too early, the practice of perinatal medicine is limited to prenatal measures of optimizing the neonatal outcome of premature infants, such as the use of antenatal corticosteroids, and the postnatal support and treatment of prematurity. By necessity, we are forced to deal with consequences, instead of preventing them.

Dileme etice in terapia de sustinere vitala a nou-nascutilor prematureCristian Stan 1,Adrian Toma 21. INML Mina Minovici", Bucuresti; 2. Spitalul Clinic de Obstetrica-Ginecologie "Prof. Panait Sarbu"Corespondenta: Cristian Stane-mail: cristi1.stan@yahoo.comAbstract: The paper represents a review of the ethical aspects in the process of care of the premature newborns. It is discussed the decision to support the life of a premature newborn. There are also reivewed the factors that need to be evaluateds in the case of a premature neonate and the prognosis that can be made at delivery. The quality of life in the case of a premature neonate and basing the decision on the best interests of the neonate are also reviewed. A separate chapter is represented by the recomandations regarding the parent-doctor conflicts in these delicate situations. The etical decisions regarding the premature neonates cared in the neonatal intensive care units involve three steps: estabilshing a correct clinical indications for the intensive care, the most accurrate determination of the survival prognosis of the neonate; the estimation of the final result regarding the neurological handicap and the quality of life of the neonate in the future. In conclusion, the sudies show that neither the birth weight , nor the gestational age are predictors for the appearance of the neurological sequelae and this is why a clinical strategy based exclusively on the gestational age or birth weight cannot be sustained though.Keywords: premature, ethic, neurologic, intensive careRezumat: Lucrarea reprezinta o trecere in revista a aspectelor etice care apar in cadrul procesului de ingrijire a nou-nascutilor prematuri. Este discutata decizia de a sustine viata unui nou-nascut prematur. De asemenea sunt trecuti in revista factorii ce trebuie evaluati pentru un nou-nascut premature si prognosticul la nastere. Calitatea vietii la nou-nascutii prematuri si bazarea deciziei pe cele mai bune interese ale copilului sunt de asemenea trecute in revista. Un capitol il reprezinta si recomandarile cu privire la conflictele medici parinti in aceste situatii delicate. Deciziile etice privind nou-nascutii prematuri aflati in sectiile de neonatologie, implica trei etape: stabilirea corecta a indicatiei clinice pentru terapie intensiva, determinarea cat mai exacta a prognosticului de supravietuire al nou-nascutului, estimarea rezultatului final privind handicapul neurologic si calitatea vietii copilului in viitor. In concluzie, studiile arata ca nici greutatea copilului la nastere si nici varsta gestationala nu constituie predictori pentru aparitia sechelelor neurologice la prematuri, de aceea nu poate fi sustinuta existenta unei strategii clinice bazata exclusiv pe varsta de gestatie sau greutatea la nastere in deciziile privind terapia intensiva a prematurilor extremi.Cuvinte-cheie: prematur, etica, neurologic, terapie intensiva

Lungimea colului uterin, determinata ecografic la 18-20 de saptamani de gestatie- factor predictiv pentru nasterea prematuraAnca Stanescu1, Liana Ples1, J. Marin2, Roxana Chiriac11. Clinica de Obstetrica si Ginecologie “Bucur”2. UMF “Carol Davila”, BucurestiCorespndenta:Roxana Chiriace-mail: roxana_chiriac2007@yahoo.comAbstract: Objective: The purpose of this study was to determine the mean cervical length in singleton pregnancies between 18 to 20 weeks and also to asses the cutoff length of the cervix as a preterm birth predictor. Study design: This is a prospective study in which the cervical length was measured weekly in asymptomatic women with singleton pregnancies with transvaginal ultrasonography. The mean cervical length was assessed for every week of gestation from 18 to 20. The relation between cervical length and spontaneous preterm birth was analyzed using contingency table and linear regression. Results: There were 471 women included in this study. The mean cervical length value was 34.9mm. The preterm delivery (before 36 weeks of gestation) was observed in 12.3% (58/471) of cases and late abortion (before 28 weeks) in 6.8% (32/471). The risk for preterm or miscarriage is inversely related to cervical length; it is the highest under 20 mm cervical length. Funnelling also proved to be a predictive factor preterm delivery or miscarriage. Conclusions: The use of ultrasound assessment of cervical length in the screening prenatal programme may help select more specific the pregnancies in riskfor preterm delivery.Keywords: premature spontaneous birth, transvaginal scan, cervical length assessmentRezumat: Obiectiv: Obiectivul studiului este reprezentat de evaluarea lungimii canalului cervical la 18-20 de saptamani cu ajutorul ecografiei transvaginale ca predictor pentru nasterea spontana prematura sau avortul tardiv. Material si metoda: Studiu prospectiv cu evaluarea ecografica transvaginala a lungimii si aspectului canalului cervical in sarcini unice. Masuratorile s-au efectuat saptamanal la gravide cu varsta gestationala intre 18-20 de saptamani. Corelatia dintre lungimea canalului cervical si nasterea spontana prematura a fost evaluata utilizand tabele de contingenta si regresie lineara. Rezultate: Au fost evaluate 471 de sarcini la care lungimea medie a canalului cervical a fost de 34,9 mm in intervalul de varsta gestationala studiat. Din totalul sarcinilor, 12,3% (58/471) au fost nasteri premature (inainte de 36 de saptamani) si 6,8% (32/471) s-au soldat cu avort spontan tardiv (inainte de 28 de saptamani). Riscul de nastere prematura sau avort spontan este invers proportional cu lungimea colului, fiind cel mai crescut la valoarea lungimii colului sub 20 mm. Prezenta funelizarii este un factor predictiv pentru nasterea prematura si pentru avortul spontan. Concluzii: Introducerea masurarii lungimii colului ecografic transvaginal in programul de screening prenatal poate duce la selectarea eficienta si la timp a femeilor cu risc crescut de nastere prematura.Cuvinte-cheie: nastere prematura, ecografie transvaginala, lungimea canalului cervical

Corelatii biochimice si osteodensitometrice in diagnosticul tulburarilor de mineralizare la prematureLigia Blaga1, Gabriela Zaharie1, Carmen Georgescu2, D. Mihu3, Melinda Matyas1, Monica Popa11. Catedra de Neonatologie;2. Catedra de Endocrinologie;3. Catedra de Obstetrica-Ginecologie - Universitatea de Medicina si Farmacie „Iuliu Hatieganu” Cluj-NapocaCorespondenta:Ligia Blagae-mail: blagaligia@yahoo.comAbstract: The incidence of osteopenia of prematurity varies between 30-60%. The biochemical examinations have a high degree of relativity in diagnosis. Radiological changes appear late. Dual energy X-ray absorptiometry allows a better quantification of bone mass. Objective: To evaluate the bone mineral content of premature infants by dual X-ray absorbtiometry and to correlate the values obtained with biochemical values. Method: 55 premature infants and 20 term newborns were included in a prospective study. We measured calcemia, phosphatemia, alkaline phosphatase and total bone mineral content at 40 weeks corrected age for premature infants and 4 days of life for term newborns. Results: 25 premature infants had low DXA parameters. There was a highly positive correlation between hypofosfataemia and DXA values and a highly negative correlation between alkaline phosphatase and DXA values. Conclusions: Biochemical investigations are useful tools for the monitoring of bone mineralizationand diagnosis of metabolic bone disease. Keywords: osteopenia of prematurity, hypophosphatemia, bone mineral content, dual absorptiometryRezumat: Incidenta osteopeniei de prematuritate oscileaza intre 30- 60%. Examinarile biochimice au un grad mare de relativitate pentru diagnosticul bolii. Modificarile radiologice apar tardiv. Absorbtiometria cu energie duala permite o mai buna cuantificare a masei osoase. Obiectiv: Evaluarea continutul mineral osos la premature prin absorbtiometrie cu energie duala si corelarea valorilor obtinute cu parametrii biochimici. Metoda: Au fost luati in studiu prospectiv 55 de prematuri si 20 de nou-nascuti la termen. S-au determinat calcemia, fosfatemia, fosfataza alcalina si continutul mineral la 40 de saptamani, varsta corectata pentru prematuri si patru zile postnatal pentru nou-nascutii la termen. Rezultate: 25 de prematuri au avut valori scazute ale parametrilor osteodensitometrici. Exista o corelatie intens pozitiva intre hipofosfatemie si valorile parametrilor osteodensitometrici si o corelatie intens negativa intre fosfataza alcalina si valorile parametrilor osteodensitometrici. Concluzie: Investigatiile biochimice sunt utile pentru monitorizarea mineralizarii osoase si diagnosticul tulburarilor de mineralizare la copiii cu prematuritate extrema in absenta accesului la investigatia cu energie duala.Cuvinte-cheie: osteopenia prematurului, hipofosfatemie, absorbtiometrie duala, continut mineral

Imunizarea nou-nascutilor proveniti din mame purtatoare de HVBR. Vladareanu1, C. Pop-Began2, Simona Constantinescu31. Universitatea de Medicina si Farmacie “Carol Davila”, Bucuresti, Seful Sectiei de Obstetrica si Ginecologie a Spitalului de Urgenta “Elias”, Bucuresti2. Universitatea de Medicina si Farmacie “Carol Davila”, Bucuresti, Spitalul de Urgenta “Elias”, Bucuresti3. Seful Sectiei de Neonatologie, Spitalul de Urgenta “Elias”, BucurestiCorespondenta:Radu Vladareanue-mail: vladareanu@gmail.comAbstract: To prevent the spread of HBV infection from mother to child in uterine and puerperal life it’s considered opportune the administration of hepatitis B hyperimmune globulin at birth followed by HBV vaccination to those newborns from mother with HBV infection. Also, in highly endemic areas of HBV, universal vaccination of all newborns was established. In order to prevent liver cirrhosis and hepato-cellular carcinoma in later life, it is essential to prevent HBV infection in infants. If the mother is chronically infected with HBV and is also positive for markers which indicate an active replication of this virus (HBeAg), 80 to 90% of the newborns will become chronically infected; whereas if the mother is positive for anti-HBe, only some of the newborns will develop acute hepatitis or fulminant hepatitis. Therefore it is indicated to screen pregnant women for HBsAg in order to prevent mother-to-infant infection of HBV.Keywords: HBV infection, HBeAg, HBsAG, hyper immune globulinRezuzmat: Pentru a preveni transmiterea verticala a infectiei cu virusul hepatitic B (HVB), transmitere ce poate avea loc atat intrauterine cat si in perinatal, se considera oportuna administrarea, imediat dupa nastere, a unei imunoglobuline hyperactive impotriva hepatitei B; urmata de vaccinarea specifica antihepatita B a tuturor nou nascutilor proveniti din mame purtatoare a acestui virus. De asemenea, in zonele endemice pentru HVB, s-a stabilit utilitatea vaccinarii tuturor nou-nascutilor. Este esential sa se previna infectarea nounascutilor cu HVB daca se doreste preventia aparitiei cirozei hepatice si a carcinomului hepato-celular in cazul acestor copii. Daca mama prezinta o infectie cronica cu HVB, iar markerii care indica replicarea virala (HBeAg) sunt pozitivi, riscul de transmitere a infectiei la nou-nascut este de 80 -90%; chiar daca numai o parte dintre acesti nou-nascuti vor dezvolta o hepatita acuta de etiologie virala ori o hepatita fulminanta cu aceeasi etiologie. De aceea, s-a dovedit util screening-ul femeilor gravide in ceea ce priveste prezenta HBsAg in prevenirea infectiei verticale cu acest virus.Cuvinte-cheie: infectie HVB, HBeAg, HBsAG, imuno-globulina hiperactiva

Monitorizarea cardiotocografica externa in suferinta fetala acutaR. Cristea1, A. Ciulcu2, P. Ciulcu3, P. Vartej31. Clinica de Obstetrica Ginecologie, Spitalul Ramnicu Sarat2. Clinica de Obstetrica Ginecologie, Spitalul “Dr. I. Cantacuzino”3. Clinica de Obstetrica Ginecologie, Spitalul Universitar de Urgenta, BucurestiCorespondenta:Prof. Petrache Vartej,e-mail: ancavirtej@hotmail.comAbstract: Objective: To study the relationship between external cardiotocography monitoring (CTG) - intrapartum – for acute fetal distress, in labor abnormalities. Material and method: The study examined a sample of 53 parturient with cesarean for fetal distress - in the Department of Obstetrics - SUUB in 2008. There was assessed the correlation between the pathological changes of fetal heart rate (RCF) and fetal condition at birth. Were included in research labor anomalies as well that generated CTG changes. Results: For the FCR with limited pathogenic significance (tachycardia, early deceleration or simple variables) the correlation with good fetal status at birth (Apgar >7) was 66% in 8 cases (15%) showing moderate deceleration late (6 cases) and severe bradycardia (2 cases) was favorable Apgar score >7. These were predictives records for fetal distress, but inconsistency with the fetal status at birth - which is good - has resulted in making a large number of unnecessary cesareans. Conclusions: CTG monitoring is a modern and non-invasive method for assessing both antepartum and intrapartum fetal status, this method having a clear impact on obstetrical care.Keywords: monitoring, CTG, fetal distressRezumat: Obiectiv: Studiul relatiei monitorizarii cardiotocografice (CTG) externe - intrapartum - privind suferinta fetala acuta, consecutiv anomaliilor de travaliu. Material si metoda: Studiul a analizat un lot de 53 de parturiente la care s-a practicat operatia cezariana pentru suferinta fetala acuta, in Clinica de Obstetrica, SUUB in anul 2008. S-a urmarit concordanta intre modificarile patologice ale ritmului cardiac fetal (RCF) si starea fatului la nastere; au fost incluse in cercetare si anomaliile de travaliu care au generat trasee modificate CTG. Rezultate: In cazul RCF cu semnificatie patogena limitata (tahicardie, deceleratii precoce sau variabile simple), concordanta cu statusul fetal bun la nastere (Apgar >7) a fost de 66%; in 8 cazuri (15%), prezentand deceleratii tardive moderate (6 cazuri) si bradicardie severa (2 cazuri) scorul Apgar a fost favorabil >7; aceste trasee predictive pentru suferinta fetala, dar neconcordante cu statusul fetal la nastere - care este bun - a determinat efectuarea unui mare numar de cezariene inutile. Concluzii: Monitorizarea CTG reprezinta o metoda moderna si neinvaziva de apreciere a starii fetale atat antepartum, cat si intrapartum, metoda avand un impact sesizabil in practica obstetricala. Cuvinte-cheie: monitorizare, CTG, suferinta fetala

Obstetric intensive care admissions: a four-year review in a Tertiary Care CentreFatma Ülger1, Migraci Tosun2, Handan Çelik2, Ahmet Dilek1, Hatice Azar1, Erdal Malatyalioglu2, Haydar Sahinoglu11. Department of Anesthesiology and Reanimation, University of Ondokuz Mayis, School of Medicine, Samsun, Turkey;2. Department of Obstetrics and Gynecology University of Ondokuz Mayis, School of Medicine, Samsun, TurkeyCorrespondence:Handan Çelike-mail: drhandancelik@hotmail.comCondensation: Obstetric patients in intensive care unit.Abstract: Objective: To review of obstetric patients admitted to intensive care unit (ICU) in a tertiary care center and to assess the prevalence, causes and outcome of critically ill obstetric patients in ICU. Methods: In this retrospective study, obstetric ICU admissions in a University hospital over four-year period from January 20005 to April 2009 were analyzed. Results: The incidence of obstetric admissions to the ICU represented 1.6% of deliveries. All of the patients were admitted to the ICU postpartum. Pregnancy induced hypertension (64%) and obstetric hemorrhage (30%) were the two most common reasons for the ICU admission. The most common interventions were magnesium sulphate infusion (53.9%), mechanical ventilation (48%), and blood transfusion (52.9%). Maternal mortality rate was 8.8% with 44% of hemodynamic instability and multiple organ failure and with 44% of acute respiratory distress syndrome as the main causes of death. Conclusion: The most common cause of ICU admission were pregnancy induced hypertension and obstetric hemorrhage. Improved management strategies to these problems and increasing antenatal care may significantly decrease the maternal and fetal mortality rate in obstetric patients admitted to the ICU. Keywords: Intensive care unit, obstetric patient admissions, hypertension, hemorrhage

Rolul depozitelor intracelulare de calciu xestospongina C-sensibile in cadrul contractiei miometriale induse de angiotensina IIOana Sorina Tica1, A.A. Tica1, Erika Dun2, V.I. Tica3, C. Berceanu4, Anca Braila41. Disciplina de Farmacologie, UMF Craiova - Romania; 2. Departamentul de Farmacologie, School of Medicine, Temple University of Philadelphia - SUA;3. Disciplina de Obstetrica si Ginecologie, Facultatea de Medicina, Universitatea “Ovidius” Constanta - Romania; 4. Disciplina de Obstetrica si Ginecologie, UMF Craiova - RomaniaMobilizarea intracelulara a calciului din depozitele intracelulare activate de IP3 reprezinta cea mai importanta etapa in semnalizarea contractiei miometriale induse de angiotensina II, fiind, totodata,implicata si in generarea activitatii contractile spontane. Introducere. Inozitol 1,4,5 trifosfat (IP3), descoperit de Beridge in 1983[1], reprezinta primul mesager secund important, cu rol fundamental in mobilizarea intracelulara a calciului. El este rezultatul hidrolizarii fosfatidil inozitolului 4,5 difosfat (PIP2) membranal, sub actiunea fosfolipazei C (PLC). Corespondenta:Oana Sorina Ticae-mail: oanabanica25@yahoo.comAknowledgements: Experimentele, precum si analizarea rezultatelor au fost realizate in cadrul Departamentului de Farmacologie, din cadrul School of Medicine, Temple University of Philadelphia, SUA. Toate cheltuielile aferente deplasarii autorilor au fost asigurate dintr-o sponzorizare a Laboratoarelor Sunset Molecular Discovery, Santa Fe, New Mexico, SUAAbstract: Objective: The role of inositol 1,4,5 triphosphate (IP3)- sensitive calcium stores on angiotensin II (AG II)-induced uterine contraction was studied by blocking IP3 receptors with xestospongin C (Xe C). This is for the first time when Xe C is used to evaluate the implication of IP3-sensible intracellular calcium stores, during AG II-induced uterine contraction. Study design: We worked on non pregnant rat uterine strips, comparing contractions to AG II 10-7M, before and after Xe C 10-7M administration. Results: Xe C decreased the AG II-induced contraction with 34.12±11%, the amplitude being more inhibited than the frequency, which was decreased with 18.75±5%. Meantime, Xe C reduced also the amplitude of the automatic oscillations with 38.79±8%, but their frequency was not affected. Conclusions: IP3-sensitive calcium stores have a stronger role on force than on frequency of oscillations during AG II-induced contraction. In basal conditions, these calcium stores are partially responsible for the amplitude of automatic uterine contractions, with no impact on spontaneous depolarizing, since frequency is not decreased by Xe C.Keywords: endoplasmic reticulum calcium stores, IP3, myometrium, angiotensin II, xestospongine CRezumat: Obiective: Rolul depozitelor intracelulare de calciu activate de inozitol 1,4,5 trifosfat (IP3), in cadrul contractiei musculaturii netede uterine, induse de angiotensina II (AGII), a fost studiat prin blocarea acestora cu xestospongina C (Xe C). Este pentru prima data cand Xe C este utilizata pentru evaluarea implicarii depozitelor intracelulare de calciu activate de IP3 in contractia uterina indusa de AG II. Material si metoda: S-a lucrat pe fragmente de miometru de sobolan, comparand contractiile uterine obtinute prin administrarea de AG II 10-7M in prezenta, respectiv, in absenta Xe C 10-7M. Rezultate: Xe C inhiba contractia indusa de AG II cu 34,12±11%, efectul fiind mai intens asupra amplitudinii decat asupra frecventei contractiilor miometriale, ultima fiind redusa cu 18,75±5%. In acelasi timp, s-a observat ca Xe C diminueaza si amplitudinea oscilatiilor spontane cu 38,79±8%, fara a influenta frecventa acestora. Concluzii: Calciul mobilizat din depozitele intracelulare activate de IP3 intervine, in special, in generarea fortei si mai putin a frecventei contractiilor uterine, induse de AG II. In conditii bazale, aceste depozite intervin in realizarea componentei tonice a activitatii spontane, aparent, fara nici un impact asupra oscilatiilor automate.Cuvinte-cheie: depozite intracelulare de calciu, IP3, miometru, angiotensina II, xestospongina C

Sequential tibolone versus progestin for premenopausal bleedingZervoudis Stefanos1,2, Iatrakis Georgios1, Peitsidis Panagiotis1, Navrozoglou Iordanis2, Tsikouras Panagiotis3, Galazios Georgios3, Liberis Vasilios3, N. Koutlaki3, J. Marin41. Lito Hospital and ATEI University of Athens, Athens Greece;2. Hospital and University of Ioannina, Ioannina, Greece;3. Hospital and University of Alexandroupolis, Alexandroupolis, Greece;4. University of Medicine and Pharmacy, “Carol Davila”, BucharestCorrespndence:Stefanos Zervoudise-mail: szervoud@otenet.grAbstract: Objective: The aim of this study was to assess the impact of tibolone compared to dydrogesterone on endometrial thickness, breast density, quality of life and lipid profile status. Method: The double blind prospective-randomized study included forty-six perimenopausal women which were randomly assigned for treatment with either tibolone 2.5 mg/day (22 patients) or dydrogesterone 20 mg/day (24 patients) from day 14 to day 25 of the cycle, for 6 months. All women complained for climacteric symptoms and irregular menstrual cycle at least for the last six months. Results:During the 6 cycles of treatment, there was no significant difference between groups regarding the regularity of the cycles. Similarly, no significant difference was observed between groups regarding endometrial thickness, breast density, levels of estradiol, FSH, progesterone and lipid profiles. Regarding vertigo, mood disorder, depression, loss of libido, dryness of skin and vagina, tibolone therapy was found to be much more effective than progestin.Keywords: tibolone, dydrogesterone, premenopausal bleedingValoarea noului imunomarker p16ink4a si corespondenta citologica, colposcopica si histologica in diagnosticul leziunilor cervicaleRuxandra Stanculescu1, Teodora Vladescu2, Manuela Russu3, Zenaida Ceausu2, J. Marin3, Andrei Cucu1, Vasilica Bausic1, Florina Vasilescu4, Mihai Ceausu4, Carmen Ardeleanu41. Departamentul Obstetrica-Ginecologie Spitalul Clinic de Urgenta “Sf. Pantelimon”, Universitatea de Medicina “Carol Davila”, Bucuresti;2. Departamentul Anatomie-Patologica, Spitalul Clinic de Urgenta “Sf. Pantelimon”; 3. Departamentul Obstetrica-Ginecologie Spitalul „Dr I. Cantacuzino”, Universitatea de Medicina “Carol Davila” Bucuresti;4. Departamentul Anatomie-Patologica, Institutul National Cercetare Dezvoltare „V. Babes”, BucurestiGrant support: PNII PC; DC:Biotehnologii; contract 61-44Abrevieri: cancer cervical scuamos (CCS), cancer in situ (CIS), examen histopatologic (ex. HP); valoare scor colposcopic (VSC); citologie ? mediu lichid (CML)Abstract: Objective: The study’s objective is to analyze the correlation between colposcopic score, the histopathological weighted score, the p16ink4a immunomarker investigated by immunocytochemistry method and the cytology as determined from liquid based cytology. Material and method: A prospective study was performed over 60 women with different types of cervical lesions, between September 2008 to September 2009, by using a colposcopic score, a p16ink4a intensity detection by immunocytochemical method and a histopathological weighted score. Data were processed in SPSS 15.0 using the correspondence analysis. Results: The results of correspondence analysis showed a correlation between the results of abnormal cytological categories and colposcopic score, hystopathologic score and also with the intensity score of p16ink4a immunomarker. The study identified the presence of a correlation between the p16ink4a immunomarker score and histopathologic weighted score too. Conclusions: Classical investigations used to assess lesion severity are not mutually exclusive; based on our made out correlations, the current study revealed the presence p16ink4a immunomarker within dysplastic cervical cells and that its overexpression is related to an increased histopathological score. Keywords: imunomarker p16ink4a, liquid based cytology, colposcopic score, histopatologic weighted scoreRezumat: Obiectiv: Analiza corelatiei dintre scorul colposcopic, scorul histopatologic ponderat, imunomarkerul p16ink4a investigat prin metoda imunocitochimica si diagnosticul citologic determinat in citologia din mediu lichid. Material si metoda: Studiul prospectiv cuprinde 60 de femei, cu diferite tipuri de leziuni cervicale diagnosticate in sistemul de raportare Bethesda, care au fost analizate in intervalul septembrie 2008 - septembrie 2009, folosind scorul colposcopic, detectarea imunocitochimica a p16ink4a, scorul histologic ponderat. Datele au fost procesate in SPSS folosindu-se analiza corespondentei. Rezultate: Studiul analizei corespondentelor arata o corelatie intre rezultatele citologiei anormale si scorul colposcopic, scorul histopatologic si intensitatea imunomarkerului p16ink4a . Rezultatele obtinute identifica prezenta unei corelatii intre scorul imunomarkerul p16ink4a si scorul histopatologic ponderat. Concluzii: Investigatiile clasice folosite pentru evaluarea severitatii leziunilor cervicale nu se exclud mutual. In acelasi timp, studiul prezent scoate in evidenta prezenta imunomarkerului p16ink4a in celulele cervicale displazice si faptul ca supraexpresia p16ink4a este corelata cu cresterea scorului histopatologic.Cuvinte-cheie: imunomarker p16ink4a, citologie in mediu lichid, scor colposcopic, scor histopatologic ponderat

Efectul melatoninei la femelele de sobolan ovarectomizate asupra proliferarii endometruluiR. Ciortea1, N. Costin1, Daria Maria Groza1, R. Mocan1, S. Susman2, Cosmina Bondor3, Carmen Mihaela Mihu2, D. Mihu11. Disciplina Obstetrica-Ginecologie II, Universitatea de Medicina si Farmacie ”Iuliu Hatieganu” Cluj-Napoca2. Disciplina Histologie, Universitatea de Medicina si Farmacie ”Iuliu Hatieganu” Cluj-Napoca3. Disciplina Informatica si Biostatstica Medicala, Universitatea de Medicina si Farmacie ”Iuliu Hatieganu” Cluj-NapocaCorespondenta:Dr. Razvan Ciorteae-mail: r_ciortea@yahoo.comPrezentare: La femelele de sobolan ovarectomizate, tratamentul combinat estrogen cu melatonina, comparative cu tratamentul de substitutie hormonala estrogenic, determina o reducere a proliferarii endometriale si previne aparitia atipiilor celulare la nivelul celulelor endometrului.Abstract: In the context of endometrial cancer, visceral obesity as a risk factor is associated with a chronic inflammatory process, confirmed by the increase in inflammatory marker levels. At 14 days post-ovariectomy, a time period required for the post-operative validation of ovarian failure, with the experimental induction of artificial menopause, the animals included in the study received estrogen replacement treatment and combined treatment of estrogen and melatonin. The duration of the administered treatment, with products and doses recommended for veterinary use, was 12 consecutive weeks. The combined treatment of estrogen and melatonin compared to estrogen replacement treatment induces a decrease in endometrial proliferation and prevents the appearance of cellular atypias. The presented results suggest that melatonin supplementation can play an important role in the prophylaxis of endometrial cancer in menopause.Keywords: melatonin, cancer, endometrial proliferation, RatsRezumat: In contextul cancerului de endometru, obezitatea viscerala, ca factor de risc, este asociata unui proces inflamator cronic, confirmat de cresterea nivelului markerilor inflamatori. La 14 zile de la ovarectomie, timp necesar pentru validarea postoperatorie a insuficientei ovariene, cu inducerea experimentala a menopauzei artificiale, la animalele din studiu, s-a introdus tratament medicamentos substitutiv estrogenic si tratament combinat estrogen asociat cu melatonina. Durata tratamentului administrat, cu produse si doze recomandate pentru uz veterinar, este de 12 saptamani consecutiv. Tratamentul combinat estrogen asociat cu melatonina, comparativ cu tratamentul medicamentos substitutiv estrogenic, determina o proliferarea mai redusa a endometrului si impiedica aparitia atipiilor celulare. Rezultatele prezentate sugereaza ca suplimentarea cu melatonina poate juca un rol important in profilaxia cancerului de endometru in menopauza.Cuvinte-cheie: melatonina, cancer, proliferare endometriala, sobolan

Tratamentul herniilor la gravide concomitant cu operatia cezariana - propunere de algoritm terapeutic V. Constantin, L. Bohhaltea, B. Socea, V. Ciofoaia, C. Moculescu, F. PopaSpitalul Clinic de Urgenta “Sf. Pantelimon”, BucurestiAbstract: Background: The possibility of establishing an simultaneous therapeutically approach, through anatomical and clinical correlations, combining cesarean delivery and hernia repair in a pregnant patient has arisen while trying to address the subject of uncomplicated hernia repair in pregnancy. Methods: Medical records of 21 patients treated in Saint Pantelimon Emergency Hospital were retrospectively reviewed, data taken between 2002-2008 and containing clinical, anatomical and laboratory relevant findings. Results: In this study, of the 21 uncomplicated cases operated, 16 (76.19%) were inguinal hernias, and 6 were umbilical hernias; the surgical approach used the same unaesthetic moment with the cesarean delivery and relied on the tension-free mesh technique that is used currently in major clinical surgery hospitals. The cases were more frequent toward the third decade of age, with a good postoperative evolution and almost no complications (low morbidity). There were no relevant connections between the patient origins and residency (urban/rural) and the abdominal wall defects. Conclusions: The therapeutically algorithm - combining the two surgical moments, cesarean section and hernia repair under the same unaesthetic „umbrella“, simple and efficient, may propose a solution for all cases of delivery associated with uncomplicated hernias, hernias that need to be addressed in order to avoid further possible evolutive complications. Keywords: hernia in pregnancy, therapeutic algorithm, concomitant cesarean delivery and mesh herniorraphyRezumat: Obiectiv: Stabilirea prin corelatii anatomo-clinice a oportunitatii rezolvarii concomitente cu parturitia prin operatie cezariana a unui defect parietal abdominalnecomplicat la gravide. Metoda: Studiu retrospectiv de tip observational care analizeaza datele despre 21 de cazuri rezolvate in perioada 2002-2008, date ce cuprind elemente de evolutie clinica si anatomica. Rezultate: Din cele 21 de cazuri operate, 16 (76,19%) au fost reprezentate de hernii inghinale, iar 6 (28,57) hernii ombilicale necomplicate, cu abord chirurgical concomitent cu operatia cezariana si folosind metoda alloplastica „tension-free” in toate cazurile. Cazurile au avut o frecventa crescuta in decada a treia de varsta, nefiind consemnata o conexiune intre mediul de provenienta al pacientei si patologia prezenta. Evolutia postoperatorie imediata si tardiva a fost foarte buna, nefiind inregistrate complicatii la distanta. Toleranta actului operator si a materialului sintetic a fost in toate cazurile foarte buna. Concluzii: Tipul de rezolvare chirurgicala propus, simplu si eficient, reprezinta o solutie pentru cazurile de sarcina la termen asociate cu un defect parietal necomplicat pe parcursul sarcinii, dar cu potential ulterior de agravare necesitand profilaxia complicatiilor.Cuvinte-cheie: hernie la gravida, terapie alloplastica concomitenta parturitiei prin cezariana

Tratamentul medico-chirurgical in fibroamele voluminoase la femeia tanara - prezentare de cazMaria Rodica Cristian, Radu Vladareanu, Claudiu Ionescu, Radu DanClinica de Obstetrica si Ginecologie, Spitalul Universitar de Urgenta “Elias” BucurestiCorespondenta:Maria Rodica Cristianemail ag_cristian@yahoo.comAbstractFibroids uterine at the young women is extremely rare present. Impressive cases like this exceptionally are cited in the literature. In this case a 28 years old woman is presented at hospital having a significant tumor (36/24 cm) which was diagnosed as a uterine fibroid. The therapeutic solution was both medical treatment followed by surgical removal of the tumor with preservation of uterine wall. Preoperative hormonal therapy allowed the fibroid reduction thus facilitating subsequent surgical removal.Keywords: fibroid, diphereline, fertilityRezumat: Fibromul uterin se intalneste extrem de rar la femeile tinere. Prezenta unor formatiuni tumorale fibromatoase de dimensiuni impresionante este relatata in mod exceptional in literature de specialitate. Prezentam cazul clinic al unei tinere in varsta de 28 de ani care prezenta o tumora giganta (36/24 cm) ce a fost diagnosticata ca fibrom uterin si la care solutia terapeutica aplicata a constat in asocierea tratamentului medicamentos cu cel chirurgical de indepartare a tumorii, cu prezervarea in totalitate a uterului. Terapia hormonala preoperatorie a redus semnificativ dimensiunile fibromului, facilitand abordarea chirurgicala si extirparea totala a tumorii, cu pastrarea integritatii morfo-functionale a uterului.Cuvinte-cheie: fibrom, dipherelin, fertilitate

Meningita cu stafilococ coagulazo-negativ: cauza de febra prelungita postrahianestezieMiftode Egidia, Olivia DorneanuDisciplina de Microbiologie UMF, IasiCorespondenta:Miftode Egidiae-mail: emiftode@yahoo.co.ukAbstract: We report a patient with coagulase-negative staphylococcal meningitis developed after spinal anaesthesia performed for the correction of a cystocele. She has a two week course of post-operative fever without signs of meningeal irritation but after the diagnosis was established she responded well to vancomycin plus meropenem.Keywords: spinal anesthesia, meningitisRezumat: Prezentam cazul unei paciente cu meningita cu stafilococ coagulazonegativ survenita dupa rahianestezia efectuata in vederea interventiei chirurgicale pentru cura unui cistocel. Evolutia postoperatorie s-a caracterizat prin prezenta unui sindrom febril cu durata de doua saptamani, in absenta semnelor de iritatie meningeana. Dupa efectuarea punctiei lombare si stabilirea diagnosticului s-a initiat tratament cu vancomicina si meropenem care au condus la vindecarea pacientei.Cuvinte-cheie: rahianestezie, meningita stafilococica

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