Biliary cystadenocarcinoma with two types of tumour cells.

We report a rare case of biliary cystadenocarcinoma that occurred in the left hepatic lobe of a 62-year-old man and measured 20 cm in its greatest dimension. The neoplastic epithelium consisted of two types of cells: (1) cells with clear cytoplasm containing abundant mucin, and (2) cells with eosinophilic cytoplasm, which in some areas formed nodules with hepatocytoid features (polygonal cell shape, large nuclei with prominent nucleoli, and pseudoglandular structures). Histochemical stains revealed the presence of cytoplasmic mucin in the hepatocytoid areas, whereas immunohistochemical stains clearly showed a biliary phenotype (diffuse positive staining for "biliary type" cytokeratins, rare foci of positive staining with antibody to human hepatocytes (HEP-PAR1), absence of staining for alpha-fetoprotein, and no evidence of canalicular pattern of staining with polyclonal antibody to carcinoembryonic antigen). These findings indicate that areas reminiscent of hepatocellular carcinoma may occur in biliary cystadenocarcinomas. Histochemical and immunohistochemical stains are useful in reaching a definitive diagnosis in such cases.

Esophageal tumor with an unusual histological appearance: a case report.

An unusual esophageal tumor in a 58-year-old man complaining of dysphagia and weight loss is herein described. Esophageal radioscopy and endoscopy visualized a huge polypoid tumor which was occluding the esophagus. After esophageal resection, the histological examination revealed miscellaneous benign cells (squamous, columnar fat cells, cartilaginous cells, and glandular structures) and two different malignant areas (spindler sarcomatous cells and squamous cells). There was no malignant invasion in the stalk, in the adjacent esophageal wall, or in the periesophageal tissue, and there were no malignant adenopathies. The postoperative course was favorable for one year, until the patient developed pain in the right superior back. A sarcomatous relapse was diagnosed by fine-needle biopsy under CT guidance, and the patient subsequently received radiation therapy.

[Remodelling of the crown for occlusal equilibration in partially edentulous patients]. / Remodelarea coronara în cadrul echilibrarii ocluzale în edentatia partiala.

Two clinical cases of partial edentulous patients with irregular occlusal plane and their treatment are presented. The authors emphasize the role of occlusal rehabilitation before any prosthetic treatment. Gingivectomy, osteoplastic surgery and crown reshaping are used. Occlusal relationships before fixed or removable prosthodontics is applied, are essential to insure correct mandibular movements and the dento-maxillary system homeostasis. Two clinical cases of patients with irregular occlusal plane because of teeth migrations (horizontal or vertical) after long-term edentation are presented. Both cases were by crown reshaping after pulpectomy and gingivectomy to obtain a regular occlusal plane. Prosthetic treatment was applied only after these preparations. We achieved good results concerning the dento-maxillary functions.

The influence of "selenium organicum" upon the hepatic function of carbon tetrachloride poisoned rats.

The hepatoprotective action of the Romanian preparation Orgasel containing selenium (Se) 5.01 mg/100 g autolysated yeast powder, was tested on adult Wistar rats poisoned with carbon tetrachloride (CCl4). The hepatotoxic agent (a 20% CCl4 solution in oil) was administered i.p. in a single dose of 0.3 ml CCl4 solution/100 g body weight, and the preparation tested (autolysate of seleniated yeast) was administered by gavage in 4 doses (of 100 mg Se powder/100 g animal each) along 2 days. After 48 hrs the animals were sacrificed, then their blood and liver were collected. The treatment with Orgasel significantly reduced the organs, morphological changes (fat liver degeneration, splenomegaly, testicle degeneration) induced by CCl4 poisoning in the rat, an effect found also at the biological parameters levels studied in plasma and liver. In the plasma, the high lipid peroxide concentrations, the increased activity of alkaline phosphatases, and the reduced antioxidative activity generated by CCl4 have been statistically significant brought to the normal range after Orgasel administration. At the liver this treatment significantly decreased the lipid peroxides production, the total lipids and cholesterol concentrations, and statistically significant increased the enzymes activity (alkaline phosphatases, GPT). The results obtained after Orgasel administration proved that this preparation has a global beneficial action upon the organism in the poisoned rat, as well as a strong antioxidative effect, confirming once again the essential role of Se in maintaining cells' integrity.

The antioxidative action of fibrinogen and the implications of this effect on platelet aggregation.

Purified fibrinogen strongly acts as an antioxidant by inhibiting the chemiluminescent emission developed in vitro, in a cell-free system composed of luminol and hydrogen peroxide. The antioxidative action of fibrinogen depends directly on its concentration, even in the presence of human serum. On the other hand, the platelet aggregation is an important source of oxygen free radicals. These radicals can also be measured by chemiluminescence, when the platelet aggregation is triggered by arachidonic acid. In a platelet suspension, fibrinogen inhibits both aggregation and the associated chemiluminescent emission. A possible correlation between the plasma level of lipid peroxides and fibrinogen was studied in different groups of patients, mostly with cardiovascular diseases and neoplasms. A weak correlation was found only in cardiovascular diseases, in which the tendency of fibrinogen increase could also be interpreted as an antioxidative action of peroxidation restriction, especially in ischemic conditions. In neoplasms, this correlation could not be found, in spite of the high level of fibrinogen associated with a decrease of peroxide formation, a characteristic feature of tumoral growth due to the change of fatty acids nature in the cellular membranes.

Estimation of oxidative stress in cardiovascular diseases.

Patients with mild and severe cardiovascular diseases showed a significant disturbance of the redox equilibrium, manifested by increases of lipid peroxides and decreases of plasma total antioxidants. When the resulting oxidative stress is associated with ECG changes characteristic of "coronary disease" it indicates an acceleration of atherosclerosis, in the initial phase (cellular involvement, migration, proliferation) and an additional thrombogenic risk in the "ischemic phase". When oxidative stress is associated with chronic heart failure, it indicates a progressive form with replacement fibrosis. These data suggest the necessity of adding to the usual therapy antioxidants, that reduce the oxidative stress, may slow down the pathologic changes and improve the patient's homeostatic systems.

Wilms' tumor in the adult patient.

One documented case of Wilms' tumor in an adult patient is presented. The patient is diagnosed clinically with renal tumor, probably renal carcinoma. Wilms' tumor is extremely difficult to diagnose preoperatively in an adult patient. The pathologic hallmarks of this neoplasm are distinctive and it is histologically similar to the childhood tumor. The therapeutic guidelines and surgical principles governing childhood Wilms' tumor should be applied to adult Wilms' tumor. This patient is still alive after 15 months.

Effects of radioiodine therapy in hyperthyroidism (thyroid function, thyroid volume, Graves' ophtalmopathy, thyrotoxic heart disease).

The study group consisted of 135 hyperthyroid patients--128 with Graves' disease and 7 with toxic multinodular goiter. A single dose of radioiodine was given in 110 cases (81.48%), two doses in 22 patients (16.3%) and three doses in 3 patients (2.22%); mean total dose was 6.8 mCi (range = 3-24 mCi). The main goal of radio iodine therapy is to achieve euthyroidism; after radioiodine treatment, 61 patients (45.2%) were euthyroid, 60 patients (44.4%) with permanent hypothyroidism and 14 (10.36%) with PERSISTING HYPERTHYROIDISM--the mean duration of follow-up being 4.2 years. After radioiodine therapy, goiter became absent in 30 patients (28%); in those patients, goiter was moderately enlarged or large before therapy. Around 63% (12 cases) of the patients with thyrotoxic atrial fibrillation reverted to sinus rhythm. During the last four years (1990-1994) the patients with Graves' ophthalmopathy from the study group were treated with Prednisone after radioiodine therapy; this corticotherapy contributes to the lower percentage (1.5%) of worsening Graves' ophthalmopathy after radioiodine therapy.

The negative impact of oxidative stress in chronic cardiac failure and coronary heart disease calls for a new pathophysiologic and therapeutic approach.

Oxidative stress, when associated with ECG aspects of "coronary disease", indicates an accelerated course of atherosclerosis in the onset phase (by cellular involvement, migration, proliferation, etc.) and an additional thrombogenic risk in the "ischemic disease" phase, when associated with chronic cardiac failure, it indicates a progressive form with "replacement fibrosis". The therapy that reduces the oxidative stress can slow down the physiopathologic process, and clinically improves the patients' condition and prognosis.

Cardiothyreosis.

In the present study: (a) physiopathology, (b) clinics, and (c) therapy of cardiothyreosis are discussed. (a) The hyperkinetic syndrome, the earliest clinical sign in thyrotoxicosis (vasodilatation, increase in inotropism, automatism, etc.), is mediated by a two-fold increase in the number of beta-receptors, and supported by an adequate synthesis of ATP and creatinphosphate (CP) in the young and, to a lesser extent, in the elderly. Genetical heart reserves are mobilized, thus significantly increasing the number and the size of mitochondria and also the enzymatic equipment (such as: the alpha-glycerophosphate-dehydrogenase, malic, pentosic cycles, etc.), a.s.o. Due to an excessive adrenergic action (glycogenolysis, an excessive oxygen consumption, up to necrosis, the ATP and CP syntheses dramatically drop; the phosphorus/oxygen ratio decreases to 2 (normal = 4). In this condition, the high functional cardiovascular performances are also impaired (the submaximal effort capacity is attained at a smaller and smaller oxygen consumption; Propranolol 2 mg i.v. decreased the cardiac output by above 30% (vs 10%--normal); electrocardiogram presents aspects of "coronary disease", tachycardia, etc.). An ultrastructural damage occurs: from "mitochondrial disease", partial lysis of myofibrils, to myofibrosis (revealed postmortem), in spite of a reduced degree of coronary atherosclerosis. Ultrastructural and biochemical experimental data support this point of view. (b) The incidence, precocity and severity of the thyrotoxic heart increase with age and the existence of a previous cardiovascular pathology. Cardiothyreosis is not present under 27 years; in 4,353 patients its incidence is of 25% (arrhythmia--21%, heart failure--12%, coronary insufficiency--1-3%). Of a major interest are tachyarrhythmias which may lead to a high mortality by hypodiastolic congestive heart failure, heart failure with secondary hyperaldosteronism, thromboembolic episodes and ventricular fibrillation. Thyrotoxicosis favours the disease of papillary muscles--mitral prolapse and insufficiency, reversible especially in children. (c) The treatment of thyrotoxic heart is an etiologic one (medical, surgical, radioactive--the last two being preferable after the adequate medical therapy). In particular, cardiothyreosis requires a reinforced irradiation (10,000 rads instead of 7,000 rads) in smaller 131I doses. The protection against the increased nocivity of catechols in thyrotoxicosis is very important (which explains the high mortality in the thyrotoxic "storm") and requires propranolol; doses above 2 mg/kilo body/day are recommended. In the elderly, the sensitivity to propranolol decreases: verapamil i.v. is more efficient in paroxysmal tachyarrhythmias (flutter, atrial fibrillation) and in those occurring intra-operatively during halothane narcosis. The anticoagulant therapy is administered in tachyarrhythmias with high ventricular rate, especially in the elderly, to avoid the embolic risk, higher in defibrillation condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical interpretations of some bony structures in the skull.

For the causal understanding of some evolutive morphological particularities at the level of the lateral wall of orbits (in mammals and in man), the authors have resorted to biomechanical interpretations of bony structures at the cranium level. To this effect some stress factors as well as the modeling effect on the local bone morphogenesis have been analysed.

Clinical and biological correlations related to zinc depletion and lipid peroxide generation in some metabolic and endocrine diseases.

A great many apparently unrelated disorders present similar clinical features. Among pathogenetic mechanisms which could explain this phenomenon we studied, in some metabolic and endocrine diseases, the possible role of zinc (Zn) in correlation with lipid peroxidation (oxygen radicals). In the patients with Zn depletion (14 cases) the production of malondialdehyde (MDA) (marker for lipid peroxidation) was higher than in controls (10 subjects). Zincemia 57.62 vs 100 micrograms/dl, p less than 0.001, MDA 1.24 vs 0.7 nM/l, p less than 0.01. The clinical tests used were the gustative test for ZnSO4 1% and a clinical severity score. Between Zn and MDA levels a strong correlation was found in hypercortisolism cases, "r" = -0.82, p less than 0.01. After Zn therapy the MDA levels lowered by 23.55%, and the clinical score and gustative test improved significantly: chi 2 = 16.98, p less than 0.01 (for gustative test), chi 2 = 31.84, p less than 0.001 (for clinical score). These results suggest that the clinical features could be attributed both to Zn depletion and to oxygen radicals excess. However, only in the cases with hypercortisolemia (endogenous and exogenous) does the Zn-peroxide relationship seem significant. This fact suggests that in the course of corticosteroid therapy, Cushing's syndrome and reactive hypercortisolism Zn supplementation should be beneficial.

Recurrent Adams-Stokes attacks treated by intravenous corticosteroids in a 48 year old thyroidectomized female.

A 48-year old female patient, thyroidectomized 4 weeks previously, returns as an emergency with arterial hypertension (AH), atrial fibrillation, cardio congestive failure; after a common therapy which included cardiotonics and diuretics, the patient's condition was improved, but quite unexpectedly she developed 5 cardiac syncopes within 3 hours (pulse and arterial pressure fall, electric asystole) with a dramatic Adams-Stokes syndrome requiring external resuscitation maneuvers. High speed infusion with glucose and ascorbic acid 2,500 mg given intravenously appeared to have stopped the imminence of an attack, but only after corticosteroids both in bolus and infused a stable sinusal rhythm was obtained. Intensive corticotherapy was preferred to sympathicomimetic drugs which are at risk for ventricular arrhythmia. Corticosteroids are the therapy of choice because they prevented the production of oxygen derived free radicals whose accumulation causes bradycardia and finally heart arrest.