VARIATIONS OF ADIPOKINE PROFILE IN PATIENTS DIAGNOSED WITH RECTAL CARCINOMA.

BACKGROUND: Adipokine secretion is influenced by various disease conditions. PURPOSE: We wanted to check the impact of rectal carcinoma (RC) on adipokine profile. PATIENTS AND METHODS: We evaluated serum leptin and adiponectin levels in 24 RC patients (12 males and 12 females) as well as in the same number of age, sex and weight-matched healthy controls. RESULTS: Adipokines were oppositely correlated with body weight (BW) in controls and RC patients. Women had higher adipokine levels than men. Healthy controls had higher leptin (37.6.±7.8 vs. 7.9±2.6 ng/mL in women and 11.9±4.6 vs. 1.4±0.34 ng/mL in men, p=0.0016 and 0.043) and lower adiponectin levels (9.3±1.1 vs. 14.9±1.1 µg/mL in women and 7.9±0.9 vs. 11.1±0.9 µg/mL in men, p=0.012 and 0.017) than RC patients. CONCLUSION: Adipokine profiles of patients with RC differ from the healthy population, possibly reflecting an adaptation to the disease rather than a triggering factor. These differences may find clinical applications for the prognosis of disease evolution.

RETINAL MICROCIRCULATION INVESTIGATION IN TYPE I AND II DIABETIC PATIENTS WITHOUT RETINOPATHY USING AN ADAPTIVE OPTICS RETINAL CAMERA.

CONTEXT: State of art imaging techniques might be a useful tool to early detect the retinal vessels lesions in diabetes. OBJECTIVE AND DESIGN: This analytical observational study investigates the retinal microcirculation changes in type I and II diabetic patients without retinopathy using adaptive optics ophthalmoscopy (AOO) and optical coherence ophthalmoscopy angiography (OCTA). SUBJECTS AND METHODS: Fifty-five subjects were included in this study and were divided in three groups: type I diabetic group (n=16), type II diabetic group (n=19) and control group (n=20). An adaptive optics retinal camera was used to assess the parameters of the temporal superior retinal arterioles. Moreover, vessel density of the superficial capillary plexus across the parafoveal area was measured with OCT-A. All cases were investigated once, in a cross-sectional design. RESULTS: Diabetic patients from both groups had a higher wall-to-lumen-ratio compared to the controls (p=0.01 and 0.01, respectively). Interestingly, no significant differences were found between the two diabetic groups (p=0.69). Moreover, the vessel density was smaller in the type I diabetic group than in the control group (p=0.001). CONCLUSION: AOO might be a useful tool to detect early retinal vascular changes in diabetes before any clinical signs and together with OCTA it might bring important information on the prognostic and pathophysiology of the disease.

CALCITONIN REVISITED IN 2020.

Calcitonin (CT) is a polypeptidic hormone specifically secreted by the thyroid parafollicular cells (C cells) and tangentially involved in human phosphocalcic and bone metabolism. CT from other species (e.g. salmon) is more potent than human CT and has limited therapeutic applications. The neoplastic proliferation of C cells leads to medullary thyroid carcinoma (MTC) generally characterized by an increase of CT secretion. Serum CT is therefore the ideal marker for MTC and can confirm its presence at an early stage, as well as the follow up of its remission or progression/relapse/survival after surgery. There are, however, controversies such as the necessity of CT screening in patients with thyroid nodules, or particular situations causing false positive or false negative results. Our minireview also deals with an up-to-date of surgical procedures for MTC, as well as with non-surgical therapy.

Comparative efficacy of oral contraceptive versus local treatment versus intense pulsed light combined with vacuum in endocrine acne in women.

Acne is the most common affection of adolescents, although it can be also found in adult women. Our study was aimed at the comparative assessment of three different therapies over a three-month period, applied to women with moderate comedogenic and papulo-pustular endocrine acne. In the study 116 female patients with endocrine localized face acne were included and divided into three groups: group I with 42 patients was treated with a combination of contraceptive pill + local treatment + pulsed-vacuum light; group II with 38 patients was treated with contraceptives and pulsed-vacuum light and group III with 36 patients was treated only with local treatment. The acne evaluation was made using the Global Acne Grading System (GAGS). Statistical data processing was carried out using the STATA software. For the comedogenic form of acne, the good and very good results were superior in group I vs group II and III (83.33% vs 31.58% vs 5.56%) at the end of the three months of treatment. For the papulo-pustulous form of acne, good and very good results were similar in groups I and II (92.86% vs 73.68%) both after the first month of treatment and at the end of the study, well above the local treatment group (13.99%). Our study highlighted the superiority of laser treatment combined with hormonal treatment, compared to hormonal and local treatment in the comedogenic form of acne, and the superiority of hormonal treatment combined (or not) with laser treatment in the papulo-pustular form compared to local treatment.

Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men.

PURPOSE: Current fracture risk assessment options in men call for improved evaluation strategies. Recent research directed towards non-classic bone mass determinants have often yielded scarce and conflicting results. We aimed at investigating the impact of novel potential bone mass regulators together with classic determinants of bone status in healthy young and middle-aged men. METHODS: Anthropometric measurements, all-site bone mineral density (BMD) and body composition parameters assessed by dual-energy X-ray absorptiometry and also serum concentrations of (1) the adipokines leptin and resistin, (2) vitamin D and parathormone (PTH), (3) sex hormone binding globulin (SHBG), total testosterone and estradiol (free testosterone was also calculated) and (4) C-terminal telopeptide of type I collagen (CTx) were obtained from 30 apparently healthy male volunteers aged 20-65 years enrolled in this cross-sectional study. RESULTS: Only lean mass (LM) and total estradiol independently predicted BMD in men in multiple regression analysis, together explaining 49% (p ≤ 0.001) of whole-body BMD variance. Hierarchical regression analysis with whole-body BMD as outcome variable demonstrated that the body mass index (BMI) beta coefficient became nonsignificant when LM was added to the model. Adipokines, fat parameters, testosterone (total and free), SHBG, PTH and vitamin D were not independently associated with BMD or CTx. CONCLUSIONS: The present study shows that LM and sex hormones-namely estradiol-are the main determinants of bone mass in young and middle-aged men. The effects of BMI upon BMD seem to be largely mediated by LM. Lifestyle interventions should focus on preserving LM in men for improved bone outcomes.

[Light-based inflammatory acne treatments]. / Phototherapie der entzündlichen Akne.

Light-based acne treatments may represent a new emerging treatment for acne that does not increase the risk of bacterial resistance and they may be potentially effective with a favorable safety profile. Current data show that photodynamic therapy reduces inflammatory lesions and significantly improves acne. However, there is no consensus on the optimal implementation in the treatment of acne. In addition to topically applied photodynamic therapy, intense pulsed light, pulsed dye lasers, potassium-titanyl-phosphate lasers, infrared diode lasers, broad-spectrum continuous-wave light sources (red light, blue-red light) have been introduced as alternative treatments. Since well-designed studies to evaluate their efficacy versus traditional medical therapies are lacking and standardized regimens have not been agreed upon, procedures including laser, intense pulsed light, and photodynamic therapy should currently not be considered first-line treatment for inflammatory acne.

THE VOLUME OF SOLITARY PARATHYROID ADENOMA IS RELATED TO PREOPERATIVE PTH AND 25OH-D3, BUT NOT TO CALCIUM LEVELS.

PURPOSE: To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). PATIENTS AND METHODS: Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. RESULTS: We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). CONCLUSIONS: The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.

POTENTIAL NEW ROLES OF LEPTIN IN HEALTH AND DISEASE.

Leptin is an adipose-tissue specific cytokine described 20 years ago and classically thought to be involved in regulation of food intake and energy homeostasis. More recently, leptin was proven to exert other multiple roles in carbohydrate and lipid metabolism, reproductive system, and inflammatory and immune reactions. Emerging data propose leptin to be a modulator of bone mass. In some particular circumstances leptin synthesis follow specific patterns in inflammation and sepsis, not being proportional with fat mass. Therefore, it may be used as diagnostic or prognostic marker for critical illness.

Ethiopatogenic Hypotheses in Lichen Planus.

Lichen planus is a mucocutaneous inflammatory dermatosis characterized by a papular rash; the disease is self-limited, has several clinical subtypes and follows a chronic or subacute clinical course. This article presents some etiological hypotheses: stress, genetic predisposition, systemic diseases, viral infections, materials used in dentistry. Also, medicines or contact allergens can cause lichenoid reactions, which are the main differential diagnosis. Autoimmune hypothesis can be supported by the association with other autoimmune diseases, such as ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosus, myasthenia gravis. This disease seems to be mediated through an antigenic mechanism of cytotoxic T lymphocyte activation, and production of proinflammatory cytokines, cascade of events that causes apoptosis of basal keratinocytes. A good understanding of the pathogenesis, clinical presentation and early diagnosis of lichen planus is critical in determining the appropriate therapeutic management. This present article aims to present and discuss the various etiopathogenetic concepts of lichen planus.

ATYPICAL PRIMARY HYPERPARATHYROIDISM DUE TO HYPOVITAMINOSIS D.

Vitamin D deficiency is nowadays very common in the general population and also in patients with primary hyperparathyroidism. Hypovitaminosis D may modify the clinical features and the severity of primary hyperparathyroidism. We present the case of a 75-year-old woman with a 10 year history of nephrolithiasis and severe osteoporosis, with multiple fragility fractures. Her bone and kidney status required a more thorough metabolic assessment. Despite minimal changes in serum calcium and phosphate levels, parathyroid hormone (PTH) level was markedly elevated. Ultrasound and specific Sesta-MIBI scintigraphy diagnosed and localized a left parathyroid adenoma. Vitamin D assessment showed levels in the range of hypovitaminosis. Vitamin D deficiency may mask hypercalcemia despite high serum PTH levels, and does not seem to diminish but on the contrary increases the risk of kidney lithiasis, as well as the deleterious effects of hyperparathyroidism on bone.

Erythema multiforme--etiopathogenic, clinical and therapeutic aspects.

AIM: To present the epidemiological, etiopathogenic, clinical and therapeutic aspects in Erythema multiforme (EM). MATERIAL AND METHODS: This is a 3-year retrospective study based on medical records of patients with EM admitted to the Dermatology Clinic. Forty patients were included in this study. The obtained data allowed the classification of patients according to their distribution by sex, age group, area of residence, etiology, clinical aspects, and type of administered treatment. RESULTS: The prevalence of EM during the 3 study years was 0.4%. EM prevailed among the rural population, more frequently in women. The minimum age at which EM was diagnosed was 12 years and maximum age 78 years, with a peak incidence between 20-40 years old (37.5% cases). In 42.50% of the cases EM was drug-induced, and in 17.50% of cases it was caused by infection with herpes simplex virus (HSV). There were 18 cases of erythemotous-papular EM (45%), 14 cases of erythematous--vesiculobullous EM (35%) and 8 cases of recurrent EM (20%). All patients received treatment with antihistamines and nonspecific desensitizing agents. Systemic corticotherapy was used in 22 cases. Three patients received treatment with acyclovir. CONCLUSIONS: Erythema multiforme is a rare skin condition, easily diagnosed based on its characteristic clinical appearance, but remains a challenge for the physician in terms of establishing its causal agent.

Clinical-epidemiological trends of herpes zoster: a 5-year study.

UNLABELLED: Herpes zoster (shingles) is a neurocutaneous viral disease, in recent years its incidence increasing throughout the world. AIM: To study the incidence of herpes zoster among Iasi county patients requiring hospital admission and to analyze the clinical and epidemiological features and socioeconomic status of the study group. MATERIAL AND METHODS: Retrospective study of 158 patients admitted to the largest clinical dermatology department in North-eastern Romania, the Clinical Dermatology Department of the Iasi "Sf. Spiridon" University Emergency Hospital. The study was conducted over a period of five years and included the analysis of epidemiological data, socioeconomic status, clinical forms of disease, associated diseases, pathology reports for skin biopsy fragments, administered treatment, and disease course. RESULTS: This study confirms that shingles is not a sex-specific disease, the female/male ratio being 1.22: 1. Most patients belonged to the age group 70-80 years, accounting for about 35% of all patients, followed by the age group 60-70 years (24.6% of cases). A slight increase in the number of cases was recorded in autumn and summer in patients living in rural areas. 1.3% of the cases were diagnosed both with the disseminated form of disease, and complications (eczematization, bacterial superinfection, skin necrosis). 7.6% of patients presented additional skin disorders (pityriasis versicolor, impetigo, psoriasis vulgaris, mucocutaneous candidiasis), which raised the suspicion of an immune deficiency predisposing to shingles. The absence or late initiation of specific antiviral therapy correlated with prolonged hospital stay up to 4-6 days. We found an association between the erythematous form of shingles and young age, while the hemorrhagic or necrotic forms were present in the elderly and/or ill patients. The course was favorable and the length of illness was significantly shortened when the treatment adequate to the clinical form was administered. Associated comorbidities (essential hypertension 38.6%, dyslipidemia 24.6%, diabetes, mellitus 9.49%, chronic venous disease, other skin diseases) represent a factor complicating the development of herpes zoster by the cumulative stress the body is exposed to. CONCLUSIONS: The main statistically significant epidemiological data in the study group are: older age (over 60 years), associated diseases (which by the marked imbalances induced in the body increase the risk of varicella zoster virus reactivation) intense psychological stress. The following parameters did not change the risk of developing shingles: area of origin, sex, the season at disease onset, number of hospital days, and administered treatment. Early diagnosis and treatment of this disease is important for maintaining a good quality of life, to avoid complications, to limit the extent of the disease and its transmission to others.

Possible progression of subacute lupus erythematosus--case report.

Subacute lupus erythematosus (SLE) is a specific form of lupus erythematosus characterized by prevalently cutaneous manifestations usually with a good prognosis. It is more common in patients aged 15 to 70 years, and there is a female predilection. This form accounts for 10% of all lupus erythematosus cases. We present the case of a 57-year-old male patient diagnosed at age 35 with chronic psoriasiform subacute lupus erythematosus, pathologically confirmed at the Iasi Dermatology Clinic. At the age of 54 years he had multiple ischemic strokes, followed by deterioration of general status, and at 56 years deep vein thrombosis in the right leg. The patient presented the erythematous-squamous lesions specific to psoriasiform SLE localized both on the upper third of the body and knees and associated with submucosal lesions of the lower lip, oral mucosa and appendages. The patient also presented hypo- and hyperpigmentated atrophic scar-like lesions. Laboratory tests performed during the last two admissions showed the presence of anti-ds DNA and antiphospholipid antibodies, inflammatory syndrome, and nitrogen retention syndrome. Treatment consisted of systemic and local dermatocorticoids and associated medication, emollient lotions and creams with SPF 50+, with slowly favorable progression. The peculiarity of the case lies in the chronic progression without significant systemic involvement for 19 years, and then in 2 years the antiphospholipid antibody syndrome and a shift to systemic lupus erythematosus to occur.

[The results of intravitreal bevacizumab in subretinal neovascularisation in angioid streaks]. / Rezultatele tratamentului cu bevacizumab intravitrean în neovascularizatia subretiniana din striurile angioide.

PURPOSE: To assess the anatomical and functional results after intravitreal bevacizumab administration in choroidal neovascularization (CNV) due to angioid streaks; To assess the safety and results stability; METHODS: Prospective, nonrandomized, interventional case study on choroidal neovascularization due to angioid streaks treated with intravitreal bevacizumab (AVASTIN). Intravitreal injection was repeated, if needed, at 4-6 weeks until leakage stopped. In all cases fluorescein angiograms and Spectral 3D OCTs were performed. Visual acuity was measured with ETDRS optotype. Cases were followed-up at least 6 months. Statistical analysis was performed using ANOVA and Wilcoxon tests. RESULTS: 8 cases with CNV associated to angioid streaks were evaluated between January 2007 and January 2013. Mean age of patients in the study was 52,36 +/- 4,33 years (ranging 42-64 years). The mean number of intravitreal injections was 4.64 +/- 0,42 (ranging between 3-8 injections). Mean visual acuity improved significantly in all cases after 3 intravitreal injections with a gain of more than 15 letters in 6 out of 8 cases (75%). OCT confirmed reduced depth of lesion and also a reduced lesion volume after treatment. No major local or systemic side-effects were noted. At 6 months follow-up the CNV reoccurred in 5 out of 8 cases (62.5%) requiring additional treatment. 3 out of 8 cases finally lost more than 5 letters due to subretinal fibrosis. CONCLUSIONS: These results confirm the efficacy and safety of intravitreal bevacizumab in controlling the CNV due to angioid streaks. High recurrence rate and quick lesion progression to subretinal fibrosis might be responsible for long-term poor functional results in this type of CNVs. More cases are needed for validation.

Alopecia--a challenge for dermatologists.

Alopecia is a loss of hair in the areas where it normally grows. It has to be distinguished from atrichia, the congenital absence of hair due to the absence of hair follicles, and hipotrichosis, scarcity or absence of hair in some congenital diseases. Alopecia is either scarring, when the skin appears atrophic, scaling, and smooth and the hair follicles are absent, or nonscarring, when hair loss is not accompanied by the destruction of hair follicles. This paper is a review of all types of alopecia and their features in an attempt to make them easier to identify and differentiate.

Early dynamics of leptin plasma level in surgical critically ill patients. a prospective comparative study.

BACKGROUND: Leptin (LPT), a hormone secreted by adipocytes,plays a role in inflammation and infection. Our study aimed to characterize the early dynamics of LPT in comparison with CRP and IL-6 during systemic inflammatory response syndrome(SIRS) and sepsis in surgical patients. METHODS: Sixty patients were assigned into 3 equal groups:SIRS (SI) group with major abdominal elective surgery;sepsis (SE) group with community-acquired complicated intra-abdominal infection and controls (C). LPT, CRP and IL-6 were measured initially in all groups and repeated in groups SI and SE within 5 days after surgery (9 samples - 4 day 1, 2 day 2, 1 next 3 days). RESULTS: LPT increased at 12-24 hours in SI group, but stayed within normal range in SE group. CRP and IL-6 had higher values in SE group versus SI group with an early peak for IL-6 and a late peak for CRP. CONCLUSIONS: LPT has a different early dynamics during SIRS and sepsis. LPT measurement in association with CRP or IL-6 may be useful in the differential diagnosis and prognosis of surgical critical illness at different time courses.

Cutaneous manifestations associated with thyroid disease.

AIM: To present the clinical and laboratory features of patients with dermatologic disorders associated with thyroid diseases, diagnostic criteria, type of administered treatment and its effectiveness. MATERIAL AND METHODS: This study is a retrospective study based on the medical records of patients with thyroid diseases admitted to the Dermato venereology Clinic of the Iasi "Sf. Spiridon" University Emergency Hospital between January 1, 2012-December 31, 2013. Data on clinical manifestations, methods of investigation, therapeutic approach, and associated dermatologic and systemic diseases were reviewed. RESULTS: A total of 38 patients were enrolled in this study of which 36 females and two males. An high incidence of cases with autoimmune thyroiditis (63%), followed by polynodular goiter (26.3%) and hypothyroidism (10.7%) was found during the study. The identified dermatologic disorders associated with thyroid diseases were in order of frequency alopecia areata (22%), followed by lichen planus (18%). CONCLUSIONS: This study demonstrates that there is a significant association between certain dermatologic disorders and thyroid diseases, requiring periodic thyroid function tests.

Napkin psoriasis--case report.

Psoriasis is a chronic inflammatory disease that can affect up to 1% of children. Genetic (family history of psoriasis) and environmental factors (bacterial or viral infections, stress, and trauma) are frequently involved in its occurrence. Napkin psoriasis is a particular form of psoriasis affecting mainly children younger than 2 years of age and can be classified together with other diseases under diaper rash. We present the case of a 4-month-old infant, born at term, naturally, weight and height within the normal range, who was brought to the Dermatology Clinic for the occurrence of erythematosquamous lesions in the anogenital area, buttocks and upper third of the thighs, with subsequent dissemination of lesions. The onset of symptoms began a few days after a respiratory tract infection. Initially he received treatment with systemic antibiotic and topical corticosteroid and antibiotic with unfavorable outcome. Laboratory tests revealed iron-deficiency anemia, leukocytosis, thrombocytosis, accelerated ESR, marked hepatic cytolysis, hyperphosphatemia and nasal carriage of Staphylococcus aureus. A systemic antihistamine and nonspecific desensitization treatment was administered. Topical treatment consisted in the removal of predisposing factors and irritants (diaper, urine) by rigorous hygiene, application of topical non-fluorinated cortico-steroid and use of emollients, with favorable course of the lesions. The peculiarity of the case is that the diagnosis of psoriasis was based on history, physical examination and laboratory tests, in the absence of a pathology examination to confirm the diagnosis. Pathology examination could not be performed due to patient's age as biopsy required general anesthesia.

[Macular serpiginous choroiditis complicated by macular hole]. / COROIDITA SERPIGINOASA MACULARA COMPLICATA CU GAURA MACULARA.

Macular serpiginouschoroiditis is a rare variant of serpiginous choroiditis characterized by a severe recurrent inflammation of both central choroid and retinal pigment epithelium. Visual prognosis is severe due to subsequent distruction of retinal structures. Permanent central visual loss is the consequence of retinal pigment epithelium hyper or hypoplasia and/or subretinal neovascularization leading to fibrous scarring. This article reports the unusual case of rapid development of a macular hole soon after the onset of characteristic clinical features. Despite anti-inflammatory treatment and successful macular hole surgery the visual function remained significantly impaired by secondary central retinal pigment epithelium changes.

[Macular surgery in a new point of view]. / Chirurgia suprafetei maculare într-o noua perspectiva.

PURPOSE: To reveal the differences in anatomical and functional results following standard 20-gauge vitrectomy and modern transconjunctival sutureless vitrectomy in macular surface pathology. MATERIALS AND METHODS: Retrospective, interventional, comparative evaluation of macular pathology cases operated by standard 20-gauge vitrectomy and transconjunctival 23 G sutureless vitrectomy. In evaluation were included a comparable number of epiretinal membranes (both idiopathic and secondary) and stage 3 and 4 macular holes. A postoperative anatomical and functional analysis was performed and also the incidence of pre-and postoperative complications was noted. RESULTS: Transconjunctival sutureless vitrectomy was associated with a shorter operating time and quicker anatomical and functional results. If in epiretinal membranes there was no significant difference in final results, in macular holes anatomical and functional results were better with sutureless vitrectomy. CONCLUSIONS: These results confirm the efficacy and safety of both surgical procedures in macular surface pathology. Better anatomical and functional results in macular holes and quicker functional rehabilitation in all cases promote sutureless vitrectomy as new standard procedure in these cases.