[Erysipelothrix rhusiopathiae endocarditis]. / Endocardita cu Erysipelothrix rhusiopathiae.

Erysipelothrix rhusiopathiae is a thin, non-sporulating, gram-positive rod found worldwide and hosted by many domestic or savage animals, birds, fish, and shell/fish. It is extremely resistant in the external environment (soil, surface waters). Human infection is prevalently related to occupational exposure to sick or infected contaminated animals (anthropozoonosis). Frequently, the disease manifests itself as an acute cellulitis on the skin around the gate of entry. Systemic infection is uncommon, most commonly involving the endocardium or joints. We present a case of subacute E. rhusiopathiae endocarditis in a male patient at occupational hazard for this infection (animal genitor in a zoo). The patient was treated with cefoperazone, the course being favorable. Later on, he required mitral valvuloplasty.

[Acute myocardial infarction with neurological symptoms: clinical and pathologic aspects]. / Infarctul miocardic acut cu manifestari predominant neurologice: aspecte clinice si anatomo-patologice.

A variety neurological symptoms can be the onset of an acute myocardial infarction. The study includes 96 patients who have undergone necropsies (from 1978 to 2003), hospitalized at the "Sfânta Treime" University Hospital, Iasi, in the Neurology Clinic. They were admitted for various neurological manifestations: hemiparesis, hemiplegia, aphasia, coma of the 1st degree up to the 4th. Death of these patients was due to acute myocardial infarction in the cases of most of them, even those with significant brain damage. We have taken into account the anatomic pathology of the heart, brain, kidneys and lungs. The prevalence of the factors of cardiovascular risk was considered in our study, as well as the topography of the myocardial infarction. Patients with acute myocardial infarction can present major neurological symptoms with no significant cardiovascular clinical symptoms.

[HDL-cholesterol--active or passive participant in the pathogenesis of atherosclerosis? (II)]. / HDL-colesterolul--participant activ sau pasiv in patogenia aterosclerozei? (II).

It is known that high sanguin levels of cholesterol and LDL-cholesterol (LDLc) have an important role in the pathogenesis of atherosclerosis. The treatment of hypercholesterolemia with statins and/or with fibrates have had beneficial effects on coronary heart disease and on other localization of atherosclerosis. The decreased of cholesterol and LDL-cholesterol is the most important effect of this treatment. The epidemiological studies have revealed that the treatment with statins and/or with fibrates produce an increase of HDL-cholesterol (HDLc), which is also very important in the regression of atherosclerosis. We tried in this review to explain the mechanisms of the increase of HDL-cholesterol, in concordance with the data from literature.

[Implications of some risk factors in degenerative valvular heart diseases]. / Studiu asupra implicarii unor factori de risc în valvulopatiile degenerative.

UNLABELLED: A retrospective study on 223 patients diagnosed with degenerative heart valvular lesions: 124 women with an average of 74.9 years old and 99 men with an average of 70.1 years old with the lower limit under 50 years old (one woman and one man) and upper limit over 80 years old (22 women and 11 men) revealed that 109 patients (48.8%) had arterial hypertension, 30 patients (13.4%) had diabetes mellitus, and 16 patients (7%) had obesity. Chronic alcoholism was present at 89 patients (39.9%), chronic tobacco consumption at 54 patients (24.2%), cholesterol value over 200mg/dl in 99 patients (44%) and triglycerides value over 150 mg/dl in 15 patients (6.6%). In the 15 patients with a sever form of aortic stenosis was discovered cholesterol value over 200 mg/dl as well as chronic tobacco use and alcoholism. CONCLUSION: Degenerative heart valvular disease represents a different process from arteriosclerosis, therefore the conventional risk factors of arteriosclerosis, can not be considered as having the same significance for degenerative heart diseases.

[Some aspects of degenerative mitral valve lesions encountered in medical practice]. / Date despre leziunile valvulare mitrale degenerative întâlnite în practica medicalâ.

In recent years, degenerative valvular heart diseases have the tendency to be equal in frequency with rheumatic valvular diseases. The maximum attention has been paid on the degenerative aortic stenosis as being a lesion with maximum frequency and a severe evolution. This study, given on the 18,391 admissions in the period 1997-2001, is a retrospective analysis and it is concerned with the degenerative mitral valvular lesions. Of the 223 patients with degenerative valvular heart lesions, 139 patients (62.3%) had degenerative aortic stenosis and 96 patients (38.5%) were diagnosed with degenerative mitral valvular lesions from which 30 patients have had no association with aortic valvular lesions while 66 patients have had such an association. The pointed out types of mitral lesions were: the mitral insufficiency in 59 patients, the mitral annular calcification without hemodynamic disease in 19 patients, the mitral stenosis in 9 patients and the mitral disease in 9 patients, too. The women were affected nearly 1.7 times more frequent than the men, with a maximum average age greater with four years for women but with a low minimal average age at 60 years for women and 52 years for men. The detailed analysis of this 96 cases had shown the presence of a cholesterol value over 200 mg/dl in 50 patients (52%), the diabetes mellitus of type II in 12 patients (12.5%), an association with HTA in 42 patients (43.7%), the cardiac insufficiency in 68 patients (70.8%), a permanent atrial fibrillation in 24 patients (25%), chronic myocardial infarct in 19 patients (19.7%) and disorders in the transmission of stimuli in 8 patients (8.3%). The degenerative mitral valvular lesions had occurred more and more frequently realizing more complex features under the mitral insufficiency predominance. Its frequent association with the degenerative valvular lesions determines the evolutive and therapeutic particulars that are dominated by the high gravity prognostic.

[Some aspects regarding degenerative mitral valvular lesions encountered in medical practice]. / Aspecte ale leziunilor valvulare degenerative mitrale întâlnite în practica medicala.

In the last years, the degenerative valvular heart diseases have the tendency to equalize in frequency the rheumatismal valvular diseases. The maximum attention has been paid on the degenerative aortic stenosis as being a lesion with maximum frequency and a severe evolution. This study, given on the 18391 admissions in the period 1997-2001, is a retrospective analyse and it is concerned with the degenerative mitral valvular lesions. Of the 223 patients with degenerative valvular heart lesions, 139 patients (62.3%) had degenerative aortic stenosis and 96 patients (38.5%) were diagnosed with degenerative mitral valvular lesions from which 30 patients have had no association with aortic valvular lesions while 66 patients have had such an association. The pointed out types of mitral lesions were: the mitral insufficiency in 59 patients, the mitral annular calcification without hemodynamic disease in 19 patients, the mitral stenosis in 9 patients and the mitral disease in 9 patients, too. The women was affected nearly 1.7 times more frequent than the men, with a maximum average age greater with four years for women but with a low minimal average age at 60 years for women and 52 years for men. The detailed analyse of this 96 cases had shown the presence of a cholesterol value over 200 mg/dl in 50 patients (52%), the diabetic mellitus of type II in 12 patients (12.5%), an association with HTA in 42 patients (43.7%), the cardiac insufficiency in 68 patients (70.8%), a permanent atrial fibrillation in 24 patients (25%), the chronical myocardiac infarct in 19 patients (19.7%) and disorders in the transmission of stimuli in 8 patients (8.3%). The degenerative mitral valvular lesions had occurred more and more frequently realizing more complex features under the mitral insufficiency predominance. Its frequent association with the degenerative valvular lesions determines the evolutive and therapeutic particularities that are dominated by the high gravity prognostic.

[Myocardial remodeling]. / Remodelarea miocardica (I).

Chamber remodeling and myocardial systolic dysfunction play an important role in the development of cardiac failure after myocardial infarction. The process is accompanied by qualitative and quantitative changes in the expression and reexpression of genes regulating cell growth and contractile function. The article tries to explain some of the mechanisms of the myocardial remodeling that permit the modifications and adaptation of the heart to normal and pathological conditions from a clinical point of view and, in the same time, from a molecular point of view.

[Analysis of some clinical aspects of degenerative valvular heart diseases in medical practice]. / Analiza unor aspecte clinice ale valvulopatilor degenerative întâlnite în practica medicala.

UNLABELLED: In a period of 5 years there were 18,391 admissions; out of them 1129 cases were diagnosed with valvular lesions: 223 (19.7%) were degenerative valvular heart disease, 608 (53.8%) had rheumatismal valvular lesions, 7 (0.6%) had congenital valvular lesions and 291 cases (25.7%) had valvular lesions of other etiologies. Out of the 223 cases with degenerative valvular lesions, 99 cases (44.4%) were men with an average age of 70.1 years old and 129 were women (55%) with an average age of 74.9 years old. The calcific aortic valve stenosis was encountered in 139 patients (62.3%), the aortic insufficiency was diagnosed in 19 patients (8.5%), the mitral insufficiency 49 patients (21.9%) and the mitral stenosis in 10 patients (4.4%) the other patients having either aortic or mitral valvular disease. The combination of an aortic stenosis with a mitral insufficiency was diagnosed in 46 cases (20.6%) from the 223. Only 14 patients were asymptomatic, most of them having heart failure (namely, 178 patients i.e. 78%) with or without angine pectoris or effort vertigo, or they had only effort angina, vertigo or effort sincope. Rhythm disorders happened in 59 patients (26.4%) while disorders in the transmission of the stimuli were diagnosed in 14 patients (5.2%). Two patients died due to cardiac causes. CONCLUSION: Rheumatismal valve disease are nearly 2.5 times more frequent than degenerative valve disease and they became a practical reality, which is claimed by its continuously increasing frequency, by a variety of lesional aspects and by implications on the heart, and by it, presence in an age group were arteriosclerosis cumulates its risk factors.

[Cardio-thoracic index: marker of the clinical course of alcoholic dilated cardiomyopathy]. / Indicele cardiotoracic--marker al evolutiei cardiomiopatiei dilatative alcoolice.

Alcoholic cardiomyopathy (ACM), a principal form of secondary dilated cardiomyopathy, can ensue from heavy consumption of alcohol over a long period of time. In harmful consumption, alcohol and its metabolites has a toxic effect on heart muscle cells. The clinical features include dilatation of the left ventricle, poor myocardial contractility and symptoms of heart failure. The heart and lung X-ray examination is required in all disease stages. The information gathered from this cheap and noninvasive investigation method, are very important in the diagnosis algorithm. In the ACM stages beginning, before the installation of the heart failure symptoms, it is possible to found normal dimensions of the heart, which is compatible with the alcoholic cardiomyopathy diagnosis. Specific for dilated alcoholic cardiomyopathy is the reversible character of cardiomegaly, objectified through the reduction of the cardio-thoracic index in conditions of alcohol abstinence and adequate treatment of the heart failure.

[The implications of thromboembolism in chronic heart failure]. / Implicatiile tromboembolismului în insuficienta cardiaca cronica (ICC).

The goal of investigation was to determine whether long-term anticoagulant therapy influences the mortality rate in CHF. The method consisted in the calculation of the annual death rate of the patients with CHF class III-IV NYHA: group A (controls)--who did not receive anticoagulant or antiplatelet therapy; group B--treated with Acenocumarol or Aspirin. The results show in group A, which included 150 patients, during the 5-year interval under study 30 deaths, representing an annual death rate of 4%. In group B, which included 325 patients of which 75 treated with Acenocumarol and 250 patients with aspirin, 20 deaths were recorded during the same 5-year interval, representing an annual death rate of 1.2%. Thus, the mortality risk proved to be 70% lower in group B than in the control group. It came out that the main mechanism of death in CHF is thrombembolism and in this circumstance anticoagulant or antiplatelet therapy would be essential.

[Undesirable effects and interaction to angiotensin converting enzyme inhibitors therapy]. / Efecte indezirabile si interactiuni medicamentoase la tratamentul cu inhibitori de enzima de conversie a angiotensinei.

UNLABELLED: By their intervention upon the mechanisms regulating the vascular tone, renal plasma flow and direct actions of chemical structures, angiotensin-converting enzyme (ACE) inhibitors may determine undesirable effects. These effects formed the object of a 5-year retrospective study (1995-1999) carried out at the IIIrd Medical Clinic of Iasi. During this interval ACE inhibitors were administrated to 2178 patients with hypertensive and coronary disorders or heart failure of various causes. Different generations of ACE inhibitors were used, but captopril, enalapril and lysinopril were the most commonly administered. Undesirable effects were recorded in 161 patients (7.3%). The following side-effects, single or associated, were recorded: 38 patients (23.6%) had increasing blood pressure proportional with ACEI dose, 80 patients (49.7%) had decreasing blood pressure at low doses ACEI, 23 patients (14.4%) had kidney failure, 2 patients (1.2%) had both increasing blood pressure and kidney failure, 3 patients (1.9%) had both decreasing blood pressure and kidney failure, 6 patients (3.8%) had dry cough, one patient (0.6%) had kidney failure with decrease blood pressure and allergic dermatitis, 4 patients (2.4%) had allergic dermatitis, and 4 patients (2.4%) had headache, vertigo, paresthesia. CONCLUSIONS: The treatment with ACE inhibitors has to be carefully initiated under strict clinical and biological monitoring, preferably in hospital setting. No drug associations that favor the undesirable effects of ACE inhibitors were reported.

[Enzymatic markers in the alcoholic cardiomyopathy]. / Markeri enzimatici în cardiomiopatia alcoolica.

Alcoholic cardiomyopathy can ensue from heavy consumption of alcohol over a long period of time. The clinical features include dilatation of the left ventricle, poor myocardial contractility with reduced left ventricular ejection volume, raised tissue enzymes. In numerous experimental data has been observed increased generation of oxygen and ethanol free radicals, indicate that free radicals are implied in myocardial and hepatic damage. Ethanol administration also elicits hepatic disturbances in the availability of antioxidant defense. The resulting antioxidative stress leads to enhanced lipid peroxidation and can also affect other important cellular component.

[Nebivolol treatment in essential arterial hypertension]. / Tratamentul cu nebivolol în hipertensiunea arteriala esentiala.

Nebivolol is a lipophilic beta 1-blocker. It is devoid of intrinsic sympathomimetic or membrane stabilising activity but appears to have nitric oxide-mediated vasodilatory effects. Nebivolol 5 mg once daily is well tolerated in patients with hypertension. Adverse events are infrequent, transient and mild to moderate. Those reported most often include headache, fatigue, paraesthesias and dizziness. Several studies reported no signs of orthostatic hypotension with Nebivolol.

[Hemorrhagic risk factors during beta-lactam antibiotics therapy]. / Factori de risc hemoragipari din cursul antibioterapiei cu beta-lactamine.

Any type hemorrhagic manifestation may occur 12 hours to 5 weeks after the administration of beta-lactam antibiotics. The mechanisms of blood losses proved to be by: 1) immunologic thrombocytopenia (penicillins); 2) alteration of platelet functions (semisynthetic penicillins); 3) hypoprothrombinemia (cephalosporins). The risk factors for the occurrence of hemorrhage under beta-lactam antibiotics therapy are: concomitant administration of cytostatics for a neoplastic malignancy; b) acute or chronic renal failure; c) concomitant treatment for duodenal and gastric ulcer; d) malnutrition; e) dosage and duration of antibiotic administration. The frequency of bleeding under beta-lactams is not determined as yet. A severe case diagnosed at the IIIrd Medical Clinic of Iasi presenting spontaneous daily nasal bleedings that occurred 24 hours after the initiation of the treatment with cephalosporins (Kefurox) is presented. In this patient the risk factor was chronic renal failure.

[The cardiovascular significance of nitric oxide]. / Implicatiile cardio-vasculare ale oxidului nitric.

Nitric oxide (NO) synthesized from L-arginine is a ubiquitous intercellular chemical messenger involved in signal transduction in diverse mammalian cells. The isolation of molecular clones for NO synthases has permitted the characterization of several distinct enzyme isoforms. NO synthesized in vascular endothelial cells plays an important role in the control of vascular tonus and platelet aggregation, through the activation of guanylate-cyclase activity in target tissues mediated by NO. Nitric oxide which is produced by cytokine activated mononuclear cells plays an important role in inflammation and immunity as a cytotoxic effector molecule and as a transducer molecule in immune cells and in oxidative stress as a potential source of intracellular free radicals. An increase in reactive oxygen species can produce damage to lipids, proteins and DNA and induce necrosis or apoptosis. The implication of NO in different pathological processes, such as atherosclerosis, diabetes, ischaemia and reperfusion, or during inflammatory processes and the generation of free radicals contributing to the endothelial injury associated to these processes.

[The evolutionary characteristics of the hypereosinophilic syndrome]. / Particularitati evolutive ale sindromului hipereozinofilic.

The case here described is a young male aged 21 years who met all diagnostic criteria for HES: (1) persistent eosinophilia of over 1500/cubic millimeter (19.904-26.070/cubic millimeter) for longer than 6 month (12 month in our patient); (2) lack of evidence of other known causes of secondary hypereosinophilia (SH); (3) multiple organ involvement. The peculiar aspects found in our case are related to organ involvement: occurrence 2 months after HES onset of chronic myocardial infarction in four locations (apical, anteroseptal and posteroseptal, inferior, left ventricular) demonstrated by electrocardiographic and scintigraphic studies; early global cardiac insufficiency (6 months after the onset); acute renal failure (since HES onset) followed by chronic renal failure. The multiple and severe involvement of the nervous system (up to coma) were not a life threat. It is suggested that a possible explanation for the multiple organ involvement could be the chronic disseminated intravascular coagulation.

[Neurological manifestations on collagenoses]. / Manifestari neurologice în colagenoze.

Collagen diseases are precipitated by very different etiologic factors, but have a common pathogenic mechanism--autoimmune, which evolves chronically and progressively involving new territories. The initial and main pathologic lesions are vascular arterial ischemic (and, according to the prevalently involved territory, the type of disease results: PAN--medium-sized and small arterioles; scleroderma--small arterioles and capillaries), and the secondary ones are the result of ischemia with plurivisceral involvement. Neurological dysfunctions were detected in about 50% of collagen diseases diagnosed during a 25 year interval in the IIIrd Medical Clinic of Iasi. The neurological manifestations were inaugural in 10% (in SLE) to 46.4% (in PAN) of the cases, the remainder occurring during the course of collagenosis, more commonly at 3-5 years and before death. Peripheral nervous system involvement (mainly polyneuritis) has prevailed, the central nervous system involvement being more rare and often fatal. Long-term corticosteroid therapy was followed by full or partial remission of peripheral nervous dysfunctions, but had transient effects or was ineffective on the central nervous ones.

Cardiovascular effects of L-arginine as physiological precursor of nitric oxide.

In this study the cardiovascular effects of L-arginine were investigated. Perfusion with sorbitol L-arginine 5% solution induced a significant decrease of the systolic blood pressure in the human arterial hypertension. The hypotensive effects of L-arginine are accompanied by an increase of the ventricular ejection fraction. In vitro, L-arginine as physiologic precursor of nitric oxide induced a smooth muscle relaxation more evident in the coronary vessels than in the thoracic aorta rings. Selective inhibition of NO-synthetise with L-NAME reduced the L-arginine vasodilation and intensified the vasoconstrictor effect of phenylephrine.

[Therapeutic means and methods in recurrent pleurisy]. / Mijloace si metode de tratament în pleureziile recidivante.

During a 10-year interval (1981-1991), at the IIIrd Medical Clinic of Iasi 960 cases with pleural effusion, of which 768 (80%) non-recurrent and 192 (20%) recurrent, were diagnosed. The etiology in the latter cases was malignant (40%) and non-malignant (60%). Proper treatment methods for limiting or suppressing the recurrent pleurisies proved to be imperative. Thoracocenteses cause protein and electrolyte depletion which aggravate the general state and hasten the unfavourable evolution of the etiological affection. This is the reason why besides the general etiopathogenic treatment, a local pathogenic treatment (cytostatic, anti-inflammatory) and especially pleurodesis are compulsory. The intrapleural administration of cortisone is efficient in the case of recurrent autoimmune pleural effusions but is worthless in the malignant ones. In the latter situation, the intrapleural cytostatic treatment should be first attempted and, in case of failure, the development of pleural symphysis by external radiotherapy or injecting talc into the pleural space should be made. In the terminal stage of cardiac insufficiency or liver cirrhosis with recurrent pleural effusion, the pleurosymphysation is not indicated; a sever edematous-ascitic attack may occur or become aggravated by the pleural irritative process due to this method.