Volume 8, Issue 6

Background. Cancer in childhood is rare, but nevertheless one of the most frequent causes of disease related death. Initial symptoms are often unspecific, frequently leading to a delay of cancer diagnosis. As a timely diagnosis can be crucial for the clinical outcome, our aim is to point out when unspecific symptoms should be considered suspect of being associated with specific cancer entities. Data sources. A systematic literature research in PubMed and current biliographies, as well as an evaluation of published epidemiologic data was performed. Results. This article reviews the typical presenting features and epidemiologic characteristics of the more common childhood malignancies, elucidates when specific and virtually unspecific symptoms require further evaluation, and gives advice how to start a rational diagnostic workup. Furthermore, genetic syndromes requiring increased watchfulness for cancer in childhood are demonstrated. Conclusion. Patients showing suspect symptoms should early be referred to specialized centres to assure optimal diagnostic and therapeutic capabilities.

Although most cases of acute pharyngitis are viral in origin, antibiotics are overused in its treatment. Streptococcus pyogenes (group A streptococcus, GAS), the principal bacterial pathogen of acute sore throat, is responsible for merely 5–30% of cases. Moreover, GAS pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore the differentiation between GAS pharyngitis and that of viral etiology is crucial. Accordingly, scientific societies as well as respected advisory bodies in Europe and North America, issued guidelines for the management of acute pharyngitis with the aim of minimizing unnecessary antibiotic prescriptions in its treatment. The aim of this review work is to confront the state of the art in acute GAS pharyngitis diagnosis and treatment with different approaches to its management represented by current European and North American guidelines. Although based on scientific evidence, international guidelines differ substantially in opinions whether GAS pharyngitis diagnosis should be based on microbiological testing, clinical algorithm or a combination of both. On the other hand, some European guidelines consider GAS pharyngitis to be a mild, self-limiting disease that does not require a specific diagnosis or antimicrobial treatment except in high-risk patients. There is an agreement among guidelines that if antibiotic therapy is indicated, phenoxymethyl penicillin should be the drug of choice to treat GAS pharyngitis.

Nervous system disorders are among the most severe disorders. Significant breakthroughs in contemporary clinical practice may provide brain-computer interfaces (BCIs) and neuroprostheses (NPs). The aim of this article is to investigate the extent to which the ethical considerations in the clinical application of brain-computer interfaces and associated threats are being identified. Ethical considerations and implications may significantly influence further development of BCIs and NPs. Moreover, there is significant public interest in supervising this development. Awareness of BCIs’ and NPs’ threats and limitations allow for wise planning and management in further clinical practice, especially in the area of long-term neurorehabilitation and care.

The spectrum of orbital inflammatory diseases ranges broadly from specific diseases as connective tissue disorders, thyroid ophthalmopathy to non-specific inflammations, which may involve one or multiple structures of the orbit and/ or the surrounding sinus. Idiopathic orbital myositis (IOM) may be a localized process or it can be secondary to systemic diseases. We report 4 patients affected by IOM; in all relapsing diplopia was the main complaint, associated with orbital pain in 3 and with abnormal visual evoked responses in 2. Computed tomography (CT), magnetic resonance imaging (MRI) supported the diagnosis revealing enlargement, altered signal intensity of affected muscles. Repeated MRI scans and extensive laboratory examinations comprising of the search for a remote malignacy, lymproliferative, connective tissue diseases, thyroid ophthalmopathy were necessary to confirm the diagnosis. Oral or/and intravenous steroids were main treatments; relapses often occurred when steroid was tapered down. Intravenous immuneglobulins and azathioprine was used in one refractory case

The prevalence of Diabetes mellitus has increased around the world in the last decade. Anyone with diabetes is at risk of diabetic eye complications. The aim of the study was to compare effects of standardized Ginkgo biloba (Ginkgo biloba L.) dry extract (Ex.Gb) with the placebo on the microcirculation lesions of the eye in randomized double-blind placebo-controlled trial. 44 patients with type 2 diabetes mellitus were randomized to Ex.Gb 160 mg per day or placebo, and were followed up for nine months. Dose of Ex.Gb was increased to 240 mg in next nine months. Total Antioxidant Status (TAS) of plasma was measured using the Trolox equivalent antioxidant capacity assay. Ophthalmologic examination was performed by the biomicroscopic method. Vascular, intravascular and perivascular alterations were evaluated, and total conjunctival index was calculated. Though the values of the total conjunctival index and its constituent decreased (P<0.05) during the study in Ex.Gb group, there were no significant differences between these parameters as compared with placebo group. Evaluation of plasma TAS showed gradually increment, although insignificant and very small, in Ex.Gb group. The significance of Ex.Gb on development of the alterations of eye microcirculation, especially in elder patients needs to be explored further.

The aim of this study was to determine the prevalence of thyroid dysfunction and its association with cardiovascular risk factors in an adult Bulgarian population. 2402 subjects were studied, 1347 female, 20–94y (median: 48.0y) and 1055 male, 20–91y (median: 45.5y). Body weight, height, waist circumference, arterial blood pressure, TSH, FT4 and lipids were measured. Known hypothyroidism was reported by 53 subjects (2.2%) and hyperthyroidism by 20 (0.8%). New hypothyroidism was found in 98 (4.1%), [subclinical (3.2%), overt (0.9%)]. New hyperthyroidism was found in 68 (2.9%), [subclinical (2.5%), overt (0.4%)]. New diagnosis of hypothyroidism and hyperthyroidism was entered in 84% and 87% in male subjects and 60% and 65% in the females respectively. Arterial hypertension was present in 40% of the women and in 47% of the men (p<0.001) and was more prevalent in hypothyroidism. Abdominal obesity and dyslipidemia were more prevalent in males and hypothyroid subjects. Arterial hypertension depended on age, gender and lipid status but not on thyroid function. CHD history depended on thyroid function and age. Conclusion: Most cases of thyroid dysfunction were undiagnosed, especially in the males. CV risk factors were more prevalent in the males with thyroid dysfunction a major determinant of CHD, but not hypertension.

The aim of this research was to quantify the number of corpora amylacea and lipofuscin-bearing neurons in the parahippocampal region of the brain. Right parahippocampal gyrus specimens of 30 cadavers were used as material for histological and morphometric analyses. A combined Alcian Blue and Periodic Acid-Schiff technique was used for identification and quantification of corpora amylacea and lipofuscin-bearing neurons. Immunohistochemistry was performed using S100 polyclonal, neuron-specific enolase and glial fibrillary acidic protein monoclonal antibodies for differentiation of corpora amylacea and other spherical inclusions of the aging brain. Cluster analysis of obtained data showed the presence of three age groups (median age: I = 41.5, II = 68, III = 71.5). The second group was characterized by a significantly higher numerical density of subcortical corpora amylacea and number of lipofuscin-bearing neurons than other two groups. Values of the latter cited parameters in the third group were insignificantly higher than the first younger group. Linear regression showed that number of parahippocampal lipofuscin-bearing neurons significantly predicts numerical density of subcortical corpora amylacea. The above results suggest that more numerous parahippocampal region corpora amylacea and lipofuscin-bearing neurons in some older cases might represent signs of its’ neurons quantitatively-altered metabolism.

Down syndrome (DS) is the most common chromosomal disorder. It is featured by intellectual disability and is caused by trisomy 21. People with DS can develop some traits of Alzheimer disease at an earlier age than subjects without trisomy 21. Apoptosis is a programmed cell death process under both normal physiological and pathological conditions. Poly (ADP-ribose) polymerase 1 is a mediator of programmed-necrotic cell death and appears to be also involved in the apoptosis. The aim of the present work was to detect the intracellular distribution of PARP-1 protein using immunofluorescence techniques and the expression of PARP-1 mRNA in culture of fibroblasts of DS subjects. The analysis of the intracellular distribution of PARP-1 show a signal at the nuclear level in about 75 % of the cells of DS subjects with a slight uniformly fluorescent cytoplasm. In contrast, in about 65% of the analyzed fibroblasts of the normal subjects only a slight fluorescent was found. These observations have been confirmed by PARP-1 gene mRNA expression evaluation. The data obtained from this study strengthen the hypothesis that the over-expression of PARP-1 gene could have a role in the activation of the apoptotic pathways acting in the neurodegenerative processes in DS.

Cyclophosphamide (CP) treatment is associated with the risk of haemorrhagic cystitis (HC). Moreover, CP-induced HC is complicated by autonomic nervous system (ANS) dysfunction. Pemirolast is thought to be a mast cell stabiliser that inhibits the release of many inflammatory mediators and sensory neuropeptides, and thus, it may be considered a potential chemoprotective HC agent. The aim of the study was to indirectly estimate the effect of pemirolast in experimental HC by measuring ANS activity with the heart rate variability (HRV) method. In CP-treated rats, we found a decreasing trend of overall autonomic activity, together with an imbalance between the main components, and a dominant very low frequency (VLF) power component. Pemirolast treatment did not improve the total HRV power value or the main non-normalized HRV components. Moreover, CP-HC animals treated with pemirolast displayed a different disproportion of normalized spectral components as compared to both control and CP-HC animals without pemirolast treatment, with the balance between normalized low frequency (nLF) and normalized high frequency (nHF) shifted towards nLF. This finding, together with a relatively high VLF tension, indicates that the pemirolast treatment resulted in high sympathetic activity that may contribute to HC exacerbation; thus, this agent seems to be ineffective in CP-induced HC.

Streptococcus pneumoniae is an uncommon cause of infective endocarditis; it often requires prolonged antibacterial treatment and involves a high mortality rate. We report a rare case of pneumococcal endocarditis manifesting with unusual complications — meningitis and endophthalmitis. Streptococcus pneumoniae species grew from the cerebrospinal fluid. The diagnosis of native aortic valve infective endocarditis was confirmed after some delay by transesophageal echocardiography. The patient’s eye was lost because of infective complications, but his life was saved following an aggressive antibacterial therapy in combination with an immediate aortic valve replacement.

Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases, their association in the same patient being rarely described. Here, we report a case of SLE in a 19-year-old girl who within 2 years of the diagnosis of SLE developed MG, and underwent thymectomy for a benign thymoma immediately thereafter.

Introduction. Bilateral posterior dislocation of the shoulder is a rare injury, accounted for about 2–5% of all shoulder dislocations. Main courses are electrical shock, epilepsy or extreme trauma with uncontrolled muscle forces. We report about a case of bilateral posterior shoulder dislocation without additional fractures but with a concomitant acromioclavicular joint dislocation. Case presentation. A 46-year-old Caucasian motorcyclist presented to our facility after a fall on slippery ground. He claimed pain in both shoulders with limited range of motion. The initial X-rays were inconclusive, clinical examination showed typical findings of a Rockwood injury with an additional limited external rotation so that a posterior shoulder dislocation was suspected. The CT scan confirmed the clinical suspicion. A closed reduction was performed followed by immobilization in a shoulder abduction pillow for 4 weeks and continuous physiotherapy. Upon follow up normal function with full range of motion was observed. Conclusion. A bilateral posterior shoulder dislocation can be caused by trauma and results in a limited range of motion with often additional injuries. Due to the unusually presentation the risk of missing the injury is increased. Therefore it is most important to consider this rare diagnosis and in case of clinical suspicion perform a careful algorithm of diagnostic.

Rupture of the upper ankle joint ligaments is a common injury. Therapy in patients with Ehlers Danlos Syndrome (EDS) is a challenge due to the autosomal-dominant collagenopathy. Therapeutic recommendations and long term results in treatment of patients with EDS are rare. Therefore uncertainty exists. We present a case of clinical and radiologic long term results after ligament rupture of the upper ankle joint in a patient with EDS. A literature review tries to reveal current therapeutic strategies in patients with EDS.

Advanced glycation end products (AGEs) and the receptor RAGE interaction is involved in nonalcoholic fatty liver disease (NAFLD). Although exogenously administered soluble RAGE (sRAGE) has been shown to block the harmful effects of AGEs in animal models, there is still controversy about the role of sRAGE in humans. We examined here which anthropometric, metabolic and clinical variables were independent correlates of sRAGE levels in NAFLD patients. The study involved 77 biopsy-proven, unmedictaed NAFLD patients (44 male and 33 female) with a mean age of 43.4±13.0 years old. We examined which anthropometric, metabolic and clinical variables, including liver steatosis and fibrosis markers, are independently associated with serum levels of sRAGE. Mean serum levels of sRAGE were 710.7±290.2 pg/mL. Univariate analysis revealed that waist circumference (inversely), hemoglobin (inversely), number of white blood cells (inversely), total-bilirubin (inversely), free fatty acid (inversely), ferritin (inversely), and HbA1c (inversely) were significantly correlated with serum levels of sRAGE. In multiple stepwise regression analysis, waist circumference (p<0.01, inversely) and hemoglobin (p<0.01, inversely) were independently associated with serum levels of sRAGE (R2=0.176). The present study reveals that low serum levels of sRAGE are independently associated with waist circumference and hemoglobin in patients with NAFLD.

This paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at first had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confirmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confirmed by analysis of the computerised tomography pulmonary angiogram.

The purpose of this study is to determine the pattern of drug related deaths in Romania between 2008 and 2011 by analyzing the medical-legal cases, from a significant proportion of Romanian Counties (out of 41 plus the capital), in which the direct causal link between drug overdose and death was drug related. Material and methods. 446 forensic toxicology cases were analyzed in a four year period, obtained from more than two thirds of the counties in Romania. Results. 54.26% yielded a positive toxicological analysis, most often with benzodiazepines, opiates, barbiturates and cannabinoids. Males around 31 years old represented the most affected group. Illegal drug related deaths were more frequent in males and non-illegal drug related deaths were proportionally more frequent in females. Discussions and conclusions. The pattern of consumption is similar to the one obtained by similar studies in neighboring countries. The city capital has a very distinct pattern of consumption compared to other cities/counties.