[Early diagnosis in hypertrophic cardiomyopathy--case report]. / Importanta diagnosticului precoce în cardiomiopatia hipertrofica.

Disproportionate heart muscle enlargement compared with little or no chamber enlargement are characteristic for hypertrophic cardiomyopathy (HCM). The clinical course of HCM is highly variable. Many patients are asymptomatic or mildly symptomatic and may be relatives of patients with known disease. Unfortunately, the first clinical manifestation of the disease may be sudden death, frequently occurring in children and young adults, often during or after physical exertion. We present 2 cases of HCM who emphasize the variability of clinical and ECG modifications and underline the importance of routine echocardiography in patients with atypical cardiac symptoms in order to identify the disease and prevent high risk for sudden death.

[When is it a diagnosis of overlap syndrome?]. / Când punem diagnosticul de sindrom overlap?

The connective tissue diseases comprise a group of syndromes of unknown etiology affecting as many as 1 person in 40, often with a predilection for the female sex. Included are: systemic lupus erytematosus (SLE), polymyositis and dermatomyositis, Sjögren syndrome, scleroderma and the vasculitis (polyarteritis nodosa, Wegener's, giant cell arteritis). There are patients who are not easily defined; having features overlapping with those of other connective tissue diseases. A variety of terms such as mixed connective tissue disease, undifferentiated connective tissue syndrome and overlap syndrome have emerged to describe such patients. Although many of these overlap syndromes are unlikely to have life-threatening consequences, they may be extremely debilitating and distressing, significantly reducing quality of life for the patient and his or her family. We present the case of a patient initially diagnosed with dermatomyositis and who eventually evolved to overlap syndrome by developing SLE.

[Oxidative stress in atherosclerosis]. / Stresul oxidativ în ateroscleroza.

Oxidative stress is the result of the imbalance between pro-oxidant and antioxidant factors. The participation of oxidative stress in atherosclerosis (ATS) is reflected by lipid peroxidation which is a process initiated and maintained by oxygen reactive species generated by the aterogenic cells themselves. The endothelial aggression in ATS is accompanied by endothelial dysfunction, which is due to the neutralization of nitric oxide by superoxid anion. The key role in the onset and the development of the ATS lesions belongs to oxidated LDL-cholesterol that influence at different levels and by several mechanisms the ATS process. The neutralization of the toxic effects of free radicals is due to the endo and exogen antioxidant systems. It appears that the individual antioxidant status is influenced by environmental factors as well as by a genetic determinant. The antioxidant therapy, which is controversial at the moment, represents an associated therapy in endothelial dysfunction from ATS.

[Chronic lead poisoning-- a" forgotten" cause of anemia]. / Intoxicatia cronica cu plumb--o cauza "uitata" a sindromului anemic.

We present the case of a female patient with a chronic hypersideremic anemia associated with digestive and neurological symptoms, with a long time ignored toxic history. The diagnose was based on very high levels of lead in serum and urine, very high levels of D-aminolaevulinic acid in the urine, and the presence of basophilic stippling of erythrocytes in the smear of the patient. Lead intoxication was due to ingestion of home-made alcohol (domestic devices made from lead mixtures) and of yogurt preserved in lead-glazed mugs.