THE MULTIFARIOUS CUSHING'S - LESSONS FROM A CASE SERIES.

Endogenous Cushing's syndrome is rare, with an incidence of 0.7-2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients. We report a series of 6 endogenous Cushing's syndromes of different etiologies (4 Cushing's disease and 2 adrenal Cushing's syndrome) assessed in our endocrine department over a decade (2009-2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing's disease, the Pseudo Cushing's, the elusive Cushing's disease, the mild autonomous cortisol hypersecretion, Cushing's syndrome in pregnancy and Cushing's disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed.

Scientific investigation of the Imperial Gates belonging to the wooden church from Sacel, Turda County, Romania.

Cultural heritage objects have a major contribution to the historical patrimony of every country. In Romania, wooden churches are famous, they are mostly dated in between the XVth and XXth century, but unfortunately many of them have been destroyed, by natural or anthropic means. Therefore, the necessity of conservation and restoration has appeared, to the ones that still exist, as legacy for the future generations. In the present article, an Imperial Gate from a wooden church in Cluj County, Romania, has been investigated, using scientific techniques (FTIR and XRF). A 3D reconstruction has been performed, using similar colors with the original artwork, as resulted from the scientific investigation of the painting materials. A limited number of constituent materials have been used for this artwork, and the wood species used was lime, due to the ease of carving.

Phenotypic spectrum and hormonal profile in hypogonadotropic hypogonadism.

BACKGROUND: Hypogonadotropic hypogonadism (HH) is characterized by inappropriately low serum concentration of LH (luteinizing hormone) and FSH (follicle-stimulated hormone) in the setting of hypogonadism. A number of pathologic processes cause Hypogonadotropic hypogonadism but it can also occur as a part of various congenital syndromes. Objectives. To characterize the morphotypes and the hormonal profile of the HH patients enrolled in the COST Action BM1105 within "C.I. Parhon" National Institute of Endocrinology from May 2012 onward. Methods. The eligible patients were selected by using a general protocol that included: a detailed familial and personal history; a clinical evaluation focusing on genital development; a hormonal evaluation that aimed to exclude the acquired causes of HH and to characterize the basal/stimulated (triptoreline) profile of gonadotropins; a DNA extraction for genetic studies. RESULTS: We examinated the medical records of patients admitted in our institute with the diagnosis of hypogonadotropic hypogonadism from May 2012 onward. There were 19 patients: 12 males and 7 females, age at diagnosis 28.03 ± 11.45 years (13.4-56 years). The phenotypic expressions were variable and the hormonal evaluation showed low values of basal and stimulated gonadotropins. CONCLUSIONS: Although hypogonadotropic hypogonadism is a rare disease, the monospeciality profile of National Institute of Endocrinology enable the enrolment of a high number of patients in order to create clinical guidelines for evaluation/diagnosis and for treating GnRH deficient patients.

Microwave heating device for internal heating convection experiments, applied to Earth's mantle dynamics.

We report the design, construction, and performances of a microwave (MW) heating device for laboratory experiments with non-contact, homogeneous internal heating. The device generates MW radiation at 2.47 GHz from a commercial magnetron supplied by a pulsed current inverter using proprietary, feedback based command and control hardware and software. Specially designed MW launchers direct the MW radiation into the sample through a MW homogenizer, devised to even the MW power distribution into the sample's volume. An adjustable MW circuit adapts the MW generator to the load (i.e., the sample) placed in the experiment chamber. Dedicated heatsinks maintain the MW circuits at constant temperature throughout the experiment. Openings for laser scanning for image acquisition with a CCD camera and for the cooling circuits are protected by special MW filters. The performances of the device are analyzed in terms of heating uniformity, long term output power stability, and load matching. The device is used for small scale experiments simulating Earth's mantle convection. The 30 × 30 × 5 cm(3) convection tank is filled with a water­based viscous fluid. A uniform and constant temperature is maintained at the upper boundary by an aluminum heat exchanger and adiabatic conditions apply at the tank base. We characterize the geometry of the convective regime as well as its bulk thermal evolution by measuring the velocity field by Particle Image Velocimetry and the temperature field by using Thermochromic Liquid Crystals.

Infrarenal abdominal aorta approach through median minilaparotomy.

Classically, infrarenal aortic exposure is achieved by xyphopubic or xypho-infraumbilical laparotomy, in transperitoneal approach, or through a left abdominal incision, in retroperitoneal approach. The transperitoneal approach is associated with longer intestinal activity resumption time and incisional hernias on long term, due to intestinal extracavitary mobilization and long incision. These disadvantages disappear in laparoscopic approach, but this method is extremely laborious, requires an extended period for dissection, and elicits increased difficulty in performing the anastomosis on the aorta. The purpose of the study is to evaluate the infrarenal abdominal aorta approach through median minilaparotomy, a method that combines the excellent exposure of xypho-pubic incision with the low morbidity of laparoscopic approach. Between 07.01.2010 - 07.01.2011, we performed 37 revascularization surgeries in 36 patients with aorto-iliac occlusive disease (one patient required reintervention due to graft thrombosis), approaching the infrarenal aorta through median minilaparotomy. The sex distribution was 35 men and one woman. The average age was 61.1 years. There have been 25 aorto-bifemoral bypasses, 11 aorto-unifemoral bypasses, and one aorto-biiliac bypass. The mean aorta clamping time was 15 minutes. Average operating time was 150 minutes. We used 26 bifurcated Dacron prostheses and 11 linear ePTFEprostheses. The average intestinal activity resumption time was 32 hours. All patients included in the study were mobilized 24 hours after surgery. The average length of hospitalization was 7.7 days. 5 patients experienced complications during hospitalization and 3 patients suffered long term complications. Infrarenal abdominal aorta approach through median minilaparotomy is a viable alternative to conventional surgical techniques used in aortoiliac occlusive disease.

[Accessory renal allotransplantation with internal or external urinary drainage. An experimental model in pig]. / Allotransplantarea renala accesorie cu drenaj urinar intern sau extern. Model experimental la porc.

This study describes an experimental model of accessory renal allotransplantation in the big laboratory animal (pig). A total of 24 common-breed pigs were used. All allografts were transplanted in an accessory manner and revascularized at the level of the infrarenal abdominal aorta and inferior vena cava. The urinary drainage was performed either through a nexternal uretheroneostomy at the ipsilateral lumbar region (Group A--n=8) or by internal uretheroneocystostomy (Group B--n=8). All transplants were monitored for 8 days postoperatively using translumbar ultrasound-guided biopsies at 1, 4, 7 days. A total of 16 transplants were performed. 1 ectopic donor kidney was found and transplanted in the same fashion. Mean operative time was 125 minutes, immediate postoperative survival was 100% and at 72 hours, 87.5%. The onset of acute rejection was at day 4, by massive lymphocyte infiltration and was directly correlated with the abrupt decrease of the allograft diuresis in Group A, at day 3. At day 7, the rejection was complete. Both methods of urinary drainage are functional and can be employed. This experimental model is a useful tool for training of the transplant surgeons or for transplantation research. The surgical technique for accessory renal allotransplantation in pig is easy to learn and offers the possibility for allograft monitoring until complete rejection without influencing the receptor health condition.

[The first NOTE (Natural Orifice Translumenal Endoscopic) cholecystectomy in Romania: an experimental model in pig]. / Prima colecistectomie NOTES din România: model experimental.

NOTES (Natural Orifice Translumenal Endoscopic Surgery) represents a very new acquisition in the field of gastrointestinal endoscopy, which uses common flexible endoscopes in order to perform intraperitoneal surgical procedures. This procedure offers a very good visualisation of the peritoneal cavity, as well as the possibility of performing surgical procedures. The aim of the study is to report our experience--the first of its kind in Romania--in performing per os, transgastric procedures, emphasizing the technical challenges and the possible complications associated with this method. This is an experimental study, using pigs (tri-hybrid PIC strain), in which peritoneoscopy and cholecystectomy were performed via a hybrid-NOTES approach (a 5 mm laparoscopic port has been used, placed in the right upper quadrant). The transgastric approach of the peritoneal cavity proved to be easy, allowing simple surgical procedures. The results of the study show the feasibility of the method. During surgery, no serious complications occurred, the minor incidents being managed without conversion to classical or laparoscopic surgery.

Simultaneous characterization of optical and thermal parameters of liquid-crystal nanocolloids with high-temperature resolution.

We report on the high-temperature resolution measurements of the optical and thermal parameters of a liquid-crystal-silica nanoparticle colloid, as well as its video inspection, simultaneously performed in an upgraded photopyroelectric calorimeter. Over the nematic-isotropic coexistence region, the determined nematic correlation length, obtained from turbidity measurements, showed the characteristic two-step nematic nucleation process previously reported only for the specific heat.

New technical approaches in stereotaxic catheterization of cerebral ventriculi: implications for the L-arginine/NO synthase/nitric oxide cascade.

In order to study the actions of certain substances at cerebral level, a stereotactic device for ensuring a precise catheterization of points in certain cerebral areas was used. For the operation technique was used a stereotaxic atlas specifically designed for rat brain (G. Paxinos, C. Watson, 1998), which offers all the necessary information for the identification of the trepanation. Stereotaxic implantation of cannules in the brain is useful for microinjecting solutions containing various substances (in amounts of microl), directly and targeted in the anatomical structures of the brain. The technique described can use either metalic or silastic cannules, that have variable lumen (usually for adapting a Hamilton syringe). The cannules can be implanted at cerebroventricular level, having the possibility to target all the cerebral ventricles. The intracerebroventricular (icv) administration of L-arginine induces a significant increase of response latency for mechano-algesic test. The most obvious changes are induced following the administration of the association of L-NAME with L-arginine, situation when is manifested an important increase of the response latency, starting with 5 minutes post-administration and continuing up to 45 minutes determination. The increase is significantly higher compared with the results obtained with L-arginine alone. A similar evolution is registered in the case of the plantar test.

Possible involvement of L-arginine-nitric oxide pathway in the modulation of stress-induced analgesia.

The possible participation of NO in the pain modulation and stress analgesia was studied in Wistar adult rats. Cerebral citruline as a stoichiometric coproduct of NO from L-arginine increased from the mean value 5.6 +/- 0.4 nM/mg.Pt. to 8.9 +/- 0.5 nM/mg.Pt. in acute immobilization stress. Intraperitoneal administration of L-arginine caused only in high doses (50 mg/kg body weight) a small transient decrease of tail-flick latencies to the thermoalgesic stimulus, without significant changes of the stress analgesia induced by the restraint stress. In the pretreated animals with L-NAME a progressive increase of latency time was obtained and the increased latencies induced by acute immobilization appeared significantly potentiated. These results offer new indirect evidence in favour of the modulatory role of NO in the thermoalgesic sensitivity and stress induced analgesia.

Abortion prohibition and acute renal failure: the tragic Romanian experience.

During the period 1966-1989, pregnancy interruption was severely punished in Romania. However, natality rose only temporarily, while illegal abortions reached at least 3.36%/year and became the main etiology of ARF. From the 653 patients hemodialyzed for ARF during 1979-1989 in Cluj, 131 (20.07%) had abortions; during 1990-1993 only 3 (1.52%) had this diagnosis. Of the women with postabortion ARF, 71.64% were oligoanuric. The average duration of oligoanuria was 18.9 days, the longest reversible oligoanuria 89 days, the mean schedule of dialysis 1/2.98 days. Hysterectomy was performed in 44.3%; chronic renal failure occurred in 8.21% of the patients. Mortality rate averaged 14.92%, being greater in hysterectomized women (18.64%) and in those with a BUN over 150 mg% at admission. The survivors had to face the menace of imprisonment and the interrogation of prosecutors already in the hospital, regardless of their health problems.

Possible involvement of the L-arginine-nitric oxide pathway in the modulation of stress-induced analgesia.

The possible participation of nitric oxide (NO) in pain modulation and stress analgesia was studied in adult Wistar rats. Cerebral citruline as a coproduct of NO from L-arginine increased from the mean value 5.6 +/- 0.4 nM/mg.Pt. to 8.9 +/- 0.5 nM/mg.Pt. in acute restraint stress. In high doses (50 mg/kg body weight), intraperitoneal administration of L-arginine caused a small and transient decrease of the tail-flick latencies to the thermal stimulus, without significant changes of the stress analgesia induced by restraint stress. In animals pretreated with N-nitro-L-arginine methyl ester (NAME) a progressive increase of the latency time was obtained and the increased latencies induced by acute immobilization appeared significantly potentiated. These results offer new indirect evidence in favour of the modulatory role of NO in thermoalgesic sensitivity and stress-induced analgesia.

Evidence of the involvement of cerebral renin-angiotensin in stress analgesia.

Studies concerning the variations of the central renin-angiotensin system (RAS) during the immobilization stress in rats have shown a significant increase of the renin-like activity in the hypothalamus and the fronto-parietal cortex together with a manifest decrease in hypophysis and pineal gland. The resulted stress, analgesia, is blocked by the previous administration of naloxone and saralasin. The intracerebral administration of renin and angiotensin II increases the latency time to thermoalgesic stimuli which is reduced, as in the immobilisation stress, by naloxone and saralasin. The chemical hypophysectomy obtained by chronic treatment with dexamethasone, also inhibits the stress-induced analgesia. Epiphysectomy reduces all the same the analgesic effects of the immobilisation stress. The obtained experimental data argue in favour of the participation of the cerebral RAS in stress analgesia through the indirect mechanism of release of opioid peptides.

A comparative study of the renin-like activity in the heart and vascular system under various experimental conditions.

Renin-like activity in the heart and aorta of rats being slightly modified by binephrectomy, its variations in DOCA hypertension and infarcted ventricular muscle were studied. The daily i.p. administration of DOCA 12 mg/kg body weight for 35 days in male adult rats resulted in a significant decrease of renin activity in plasma and tissues of the heart, aorta, hypothalamus and hypophysis. In contrast to renin-like activity, cathepsin D measured in the same animals increased in all organs, except for the plasma. Similar changes of renin-like activity were observed in salt-loaded animals with 1.7% sodium chloride solution ad libitum for 35 days. In the infarcted myocardial ventricular muscle of the rats and rabbits, the tissue isorenin showed a tendency to decrease, associated with a significant increase in cathepsin D activity. Like in aorta, isorenin seems to be a different enzymatic entity of cathepsin D in the myocardial tissue. The measurement of isorenin content of the vascular endothelium and cardiac muscle fibers seems to reveal much higher amounts in the coronary vascular endothelium than in the myocardial fibres. The activation of the enzymatic angiotensin forming mechanisms in the coronary vascular bed could be one of the risk factors in myocardial infarction.