Immunohistochemical analysis of bone metabolism in osteonecrosis of the femoral head.

Osteonecrosis of the femoral head occurs because of the suppression of blood circulation. At the level of the area affected by the ischemic phenomenon, there are two types of events, in the first stage there is necrosis of the cellular elements, followed by a reparatory phase of the spongy bone tissue. The objective of the study was the histological and immunohistochemical (IHC) analysis of bone metabolism in the repair phase. We observed the action of the main cells involved in the remodeling, the osteoblasts and the osteoclasts, following the reaction of the markers of their activity: osteoprotegerin, osteonectin, osteopontin. We included 23 patients diagnosed with femoral head osteonecrosis, stage II, Ficat and Arlet classification, biological material required for histological and IHC analysis being obtained during hip arthroplasty. Regardless of the age or presence of risk factors, the reaction to osteoprotegerin was mildly positive, being only highlighted at the level of the reactive dividing line, being absent in the other areas, indicating a reduced activity of inhibiting differentiation and activation of osteoclasts, also highlighted with classical histology methods, the affected area being well-defined and we could observe the necrotic tissue resorption by osteoclasts. The intense positive reaction of osteopontin and osteonectin, especially at the line of demarcation, is due to the increase in the number of osteoblasts required for the synthesis of neoformation bone tissue. We believe that the aspects revealed by our study can be a track in finding new-targeted therapies useful in stopping the development of the disease.

Muscle metastases from cervical carcinoma - case report.

Muscular metastases are rarely found in medical practice, and the reported cases in literature are not numerous. The diagnosis of these lesions involves an interdisciplinary collaboration. We present a case of secondary determination in the psoas muscle, with a starting point of cervical squamous carcinoma. In establishing the diagnosis, there contributed the clinical, imagistic and magnetic resonance evaluation and computed tomography (CT), the histopathological diagnosis being determined after the CT-guided biopsy puncture.

The metabolic syndrome--a multifaced disease.

The metabolic syndrome (MetS) is a huge public health problem worldwide, being one of the major causes of cardiovascular disease, responsible for a growing number of premature deaths throughout the world. MetS includes a cluster of anomalies, such as: abdominal obesity, insulin resistance, hyperinsulinemia, hypertension, type 2 diabetes mellitus or glucose intolerance, hypertriglyceridemia etc. The number of people with MetS increases with age, affecting more than 40% of people in their 60s and 70s. About 30% of European people over 50 have MetS. Some experts estimate that as many as two thirds of Americans may be suffering from MetS. The exact cause of MetS is not known: genetics play a minor role, acquired in-utero factors also play a role (prenatal malnutrition, toxin exposure, exposure to high levels of maternal cortisol). For most people, the MetS results primarily from lifestyle factors, such as: chronic stress, inadequate exercise. The MetS can be avoided and reversed in most cases. Weight loss is both a treatment and goal for MetS patients. Moderate weight loss, in the range of 5-10% of body weight, can help restore body's ability to recognize insulin and greatly reduce the chance that the syndrome will evolve into a more serious illness. In most people weight loss will lower blood pressure and improve triglyceride levels. Increased activity alone can improve insulin levels. Physical activity result in a weight loss, improved blood pressure, improved cholesterol and triglyceride level and reduced risk of developing diabetes. It is also important to treat: hyperlipidemia, hypertension, prothrombotic state.

The quantification of cardiovascular risk factors in subjects with/without diabetes mellitus.

Data from the literature showed an increased cardiovascular risk in patients with type 2 DM comparatively to subjects without DM, sustaining that diabetes mellitus is a cardiovascular disorder. In this context, we aimed to study the prevalence of modifiable cardiovascular risk factors in patients with type 2 DM comparatively to a control group without DM. The results are alarming, despite the great efforts of the members of the caring team. Smoking and alcohol consumption exceeding 30g/day are more frequent habits in patients with diabetes comparatively to controls, especially in men. Hypertension was present in 70.17% of diabetic patients, comparatively to 40.47% in controls; though already diagnosed, in the majority of diabetic patients, the therapeutic goal was achieved in only 25.45% subjects at the time we performed the study. Obesity including abdominal obesity is present from the moment diabetes is diagnosed and it is maintained further, indifferent of the duration of diabetes. Lipid parameters are very increased. So, it is imperative to intensify the therapeutic medical education, regarding each risk factor.

Metabolic changes in Klinefelter syndrome.

Klinefelter syndrome is a hypergonadotropic hypogonadism determined by the presence of one or more extra X chromosomes and has an incidence of 1:800 males. It was shown that in Klinefelter syndrome mortality is increased due to diabetes, cardiovascular, respiratory and digestive diseases. Our goal was to assess the presence of metabolic changes which can increase cardiovascular risk. We compared 31 untreated Klinefelter patients aged 19-54 years (mean age 33.84 years, SD 11.79 years) with 31 age matched controls. Hypercholesterolemia was present in 56.67% of Klinefelter patients and correlated with age and the magnitude of androgenic deficit. None of the patients had diabetes mellitus but glycemic values above 100 mg% were present in 16.13% of cases (vs 3.2% in controls). 35.5% of Klinefelter patients and controls were overweight and 16.1% of Klinefelter patients were obese vs 9.7% of controls.

Erectile dysfunction in diabetes mellitus.

Erectile dysfunction (ED) is 2-3 times more frequent in men with diabetes mellitus than in men without such a history and might be an early marker of endothelial dysfunction. We studied a group of 310 unselected male patients within the Clinical Center of Diabetes and Metabolic Diseases of Dolj County, with ages ranging between 20-78 years (57.43 + 0.835) and a positive history of diabetes mellitus for 1-47 years (10.09 +/- 8.715). Erectile dysfunction, quantified using SHIM (Sexual Health Inventory for Men), was present in 196 patients (63.2%); severe in 52 patients (16.8%), moderate in 42 patients (13.5%) and mild in 102 patients (32.9%). Erectile dysfunction showed a positive correlation with age after 65 years, history of diabetes of more than 10 years, obesity, stroke, arteriopathy, retinopathy, neuropathy and the smoking habit and was not correlated to the type of diabetes mellitus, history of diabetes less than 10 years, diabetes therapy, hypertension, ischemic heart disease, nephropathy, dyslipidemia and alcohol consumption. Our results plead for a holistic approach of the diabetic patient, irrespective of age, in order to detect and to treat all the risk factors, keeping in mind that the appearance of erectile dysfunction might indicate the presence of occult chronic diabetes complications.

The endothelial dysfunction in diabetes mellitus.

The vascular chronic complications are the main cause of morbidity and mortality in patients with diabetes mellitus. Nowadays it is well known the fact that the arteriosclerosis is initiated by the injury of the vascular endothelium and that the normal endothelial cells are producing a number of vasoactive factors. Thus, the vascular endothelium was considered an inert "lining" layer, but today is seen as a complex organ, with paracrin and autocrin function, which provides a "first line" physiological defence against atherosclerosis. Impaired endothelial function occurs in people with diabetes as a result of associated conditions (e.g. hyperglycemia, hypertension, dyslipidemia), or as an effect of hyperglycemia itself (e.g. cytokines, free fatty acids, AGES). The presence of endothelial dysfunction in non diabetic insulin resistant subjects suggests that metabolic and vascular abnormalities are tightly related at a fundamental level. Recent evidence suggests that insulin signalling for glucose transport in classical target tissues (muscle and adipose tissue) and upregulation of NO production in the endothelium utilises the same postreceptor pathway. This pathway involves the enzyme P13 kinase. Knowledge of the molecular mechanisms involved in the pathogenesis of endothelial dysfunction may ultimately result in novel approaches to the treatment and prevention of cardiovascular disease in people with diabetes mellitus.

Evaluation of the metabolic balance in type 2 diabetes by assay of the hair glucose.

The authors used a relative new method of long term retrospective evaluation of metabolic balance in type 2 diabetes. This method was based on the variations of the glucose in the hair with the variations of HbA1c (r=+0.96; p<0.001). In this way the authors could follow up the diabetic's metabolic balance on longer time periods than by determination of the HbA1 values.

The analysis of structural lipid of the hair of patients with angina pectoris.

A study of 48 patients with angina pectoris carried out, in which the structural lipids of the hair were analyzed and correlated with the manifestations of angina and the potential incidence of dyslipidemia. It was noted that the excesses of hair lipids associated with deficiencies of some unsaturated fatty acids raised the frequency of angina attacks in the group studied by 2.7 times. The normalization of the lipid levels diminished the levels of angina. Data were obtained on the influence over a long time (weeks, months) of the hypolipidemic treatment. The analysis of the hair has been shown to be also useful in detecting latent dyslipidemia associated with angina pectoris. Also, through the analysis of hair, large scale epidemiologic studies can be carried out on the association between dyslipidemia and angina pectoris.