[Evaluation of umbilical artery resistance index and plasma angiotensin II in pregnancy induced hypertension]. / Evaluarea indicelui de rezistenta al arterei ombilicale si nivelului plasmatic de angiotensina II in hipertensiunea indusa de sarcina.

UNLABELLED: It has already been proven that the renin-angiotensin system has deep implications during the normal pregnancy and along with pregnancy induced hypertension. MATERIAL AND METHOD: We evaluated 14 third trimester pregnancies (8 normotensive and 6 hypertensive women) for body mass index, parity, age, blood pressure (BP), resistance index of the umbilical artery (RIUA), plasma angiotensin II (AngII) level. RESULTS: We identified statistical significant correlations for BP with RIUA, AngII. The covariance analysis showed that the correlation was not influenced by the gestational age. CONCLUSION: AngII and RIUA have statistical significant correlations with BP but no interdependence between them was identified.

Contractile effects of angiotensinogen and its multiple metabolization pathways on vessel walls.

The contractile effects of angiotensinogen (Aogen) and its metabolization pathways were studied on rat renal vein (RRV), rat pulmonary artery (RPA) and human umbilical vein (HUV) rings. Experiments were made in the presence or in the absence of pepstatin A (a renin inhibitor, 10 microM), captopril (an ACE inhibitor, 10 microM), chymostatin (a chymase inhibitor, 10 microM), amastatin (an aminopeptidase-A and -M inhibitor) or losartan (a specific AT1 blocker, 10 microM). On all rings, Aogen-induced contractions were reduced by pepstatin A or captopril, amplified by amastatin and blocked by losartan. Chymostatin had a stronger inhibitory effect than captopril on HUV and simultaneous administering of chymostatin and captopril prevented Aogen contractile effects on HUV. It is suggested that all studied vessels possess a local renin-angiotensin system and possibility of angiotensin II production within the vessel walls using various and species-dependent enzymatic pathways.

[Cytologic examination of the axillary lavage fluid obtained during modified radical mastectomy]. / Citologia lavajului axilar practicat în cursul mastectomiei radicale.

The axillary dissection is part of the breast cancer surgical protocol. We have cytologically analyzed the axillary lavage fluid obtained during 67 modified radical mastectomy. Our results showed good correlation between the node status, histological grading and the cytological diagnosis of the axillary lavage fluid. As some other dissemination assessment techniques showed important prognostic value, the cytologic analysis of the axillary lavage fluid also seems to be a prognostic parameter.

[Assessment of prognostic factors in breast cancer]. / Evaluarea factorilor de prognostic in cancerul mamar.

Prognostic factors predict the long term outcome of treatment, recurrence rate and overall survival. Treatment decision is based on assessment of prognostic factors. They are classified as clinical (age, menopausal status, tumoral growth rate, inflammatory signs), histological (tumoral stage, pathological type, grading, tumoral necrosis, lymph nodes status, margins status) and biological factors (steroidal receptors pattern, ploidy etc). There are tumor markers currently evaluated, being considered conventional and new markers that are not usually evaluated. Patients with negative lymph node will show no recurrences after surgery and/or radiotherapy in 70% of the cases. Factors with specific prognostic value are used for deciding on the therapeutic strategy in negative axillary node cases.

[Breast conservative surgery]. / Tratamentul chirurgical conservator al cancerului mamar.

Breast conservative therapy is considered an adequate therapeutical method for early stage breast cancer. Breast conservative treatment consists of partial mastectomy, axillary dissection and radiotherapy. Patient selection is based on clinical, histological and individual factors. The frozen sections examination provides prompt differentiation between benign/malign lesions and precise assessment of the oncologic margins of the specimen. Preoperative marking of nonpalpable breast lesion with hook wire represents a progress for breast conservative treatment. Sentinel lymph node biopsy represents an alternative to axillary dissection, in order to reduce subsequent morbidity.

[Pregnancy induced hypertension and renin-angiotensin system: how far is the truth?]. / Hipertensiunea indusa de sarcina si sistemul renina- angiotensina: cât de aproape suntem de adevar?

This review aims to describe the new trends in designing the model research for the study of pregnancy induced hypertension, with a special focus on the renin-angiotensin system. There are also discussed some clinical implications.

[Malignancy risk in some benign mammary lesions]. / Riscul malignizarii unor leziuni mamare benigne.

We analyzed retrospectively 821 patients operated on in our clinic for benign mammary lesions and for breast cancer. Histopathology identified in some cases associated benign and malign lesions. Atypical hyperplasia is considered significant risk factor for malignancy. Women in this category need close surveillance.

[Practical aspects in diagnosis and treatment of benign breast lesions]. / Elemente practice privind diagnosticul si tratamentul leziunilor mamare benigne.

We analyzed 444 patients operated on in our clinic. Triple test diagnosis is the modern trend. Surgical treatment is not justified in all cases. When needed, partial mastectomy is commonly used. Surgical principles must be respected for good cosmetic results. Histopathology only certifies the diagnostic.

[Reasons for conservative treatment in breast cancer]. / Argumentarea aplicarii tratamentului conservator în cancerul mamar.

We analyze 112 patients with breast conservative treatment operated in our clinic in the last 5 years. Breast preservation surgery represented 30.35% of all cases treated for breast cancer in this interval of time. In other 63 situations conservative treatment was attempted but finally given up due to justified motivations and decision for mastectomy was adopted as optimal. Rigorous selection of patients for conservative surgery was our care. Tumor size, excisional margins, nodal status were the main criteria. Correlation with breast volume, age, patient's opinion were also important. Preservation of breast in women interested and cosmetic results were the purposes of our attitude. Breast conserving therapy may be indicated only respecting the oncological principles and close surveillance of patients is obligatory.

[Phyllodes tumor. The experience of the 4th Obstetrics-Gynecology Department]. / Tumora filoda. Experienta clinicii a IV-a obstetrica ginecologie.

The experience of the IVth Obstretrics Gynecology Department. Between the 1st of January 1994 and the 1st of November 2001 587 operations have been performed as treatment of breast tumors in the IVth Obstetrics and Gynecology Department. The phyllodes tumor has been diagnosed in 11 cases (1.8% of the benign breast masses). The genesis is unknown. Local trauma, pregnancy, lactation, high estrogenic levels have been suggested to have an influence upon the tumoral development. The most common aspect is a round, hard, unpainful breast mass. The diameter is variable (1 to 45 cm). The mammogram shows a well defined, high density, smooth contour opacity. A four degree classification has been described. Specific evolution features may involve local recurrences and metastasis. The surgical treatment is mandatory but radiotherapy, chemotherapy and endocrine treatment protocols have been brought up.

[NK cells in the physiology of the fetomaternal relationships]. / Celulele NK în fiziologia relatiilor materno-fetale.

The NK cells are large granular lymphocytes that are found as approximately 2-15% of the global peripheral lymphocytes. As endometrial granulocytes, they represent 70% of the decidual leukocytes during the first trimester of pregnancy, with a progressive decreasing until term. The complex actions of these numerous and active cells, consist in: 1) placental regulation and control, based on the receptors for the HLA--G and HL--C antigens, that are trophoblast specific and act as universal inhibitors of the NK cells; 2) secretion of a large range of cytokines as IL-1, TNF alpha, IL-8, TGF, IFN gamma, GM-CSF, CSF1 which regulate the trophoblastic proliferation, differentiation and invasion; 3) removal of abnormal trophoblastic cells, which may appear in such a proliferating cell population; 4) infectious protection of the placental unit, due to their unspecific cytotoxic effect. In conclusion, the NK lymphocytes have important implications in the formation of the decidua, as the maternal side of the fetomaternal interface and they are deeply involved in the evolution of normal pregnancy concerning the nutritional, hormonal and immunologic aspects.

Contractile effects of intracellularly administered angiotensin II are partially dependent on membrane receptors internalization in isolated rat aorta.

In the present study we used the isolated rat aorta as a model to characterize the modulation of contractile effects of extra- and intracellularly administered angiotensin II by dithiothreitol (DTT) and hyperosmotic sucrose. DTT inactivation of AT1 receptor as well as disruption of the clathrin-coated pits by hyperosmotic sucrose significantly inhibited the contraction induced by intracellularly administered AII. We suggest that these intracellular effects of angiotensin peptides are associated with AT1 receptor activation/internalization and may thus be part of the mechanism of angiotensin peptides direct contractile effects in the vascular smooth muscle.

Contractile effects of angiotensin peptides in rat aorta are differentially dependent on tyrosine kinase activity.

It has been suggested that tyrosine kinase activity participates in the regulation of signal transduction associated with angiotensin II (Ang II)-induced pharmaco-mechanical coupling in rat aortic smooth muscle. We further tested the effects of genistein, a tyrosine-kinase inhibitor, and its inactive analogue, daidzein, on angiotensin I (Ang I), angiotensin III (Ang III) and angiotensin IV (Ang IV) contractions, as compared with those on Ang II. Genistein partially inhibited Ang II- and Ang I-induced contractions. The genistein-induced inhibition was more evident on Ang III and especially important on Ang IV contractile effects. Thus, Ang IV- and Ang III-induced contractions seem to be more dependent on tyrosine kinase activity than those evoked by Ang II or Ang I. Daidzein did not significantly affect the contractile effects of any of angiotensin peptides tested. These results clearly suggest that the inhibition of the action of angiotensin peptides actions by genistein is mediated by inhibition of endogenous tyrosine kinase activity. Furthermore, our data show that the type and/or intensity of tyrosine kinase activity is differentially associated with the contractile effects of different angiotensin peptides in rat aorta. Nifedipine, a blocker of membrane L-type Ca2+ channels, strongly inhibited Ang IV-induced contractions. At the same time, it significantly inhibited Ang III contractile effects as compared with Ang II and Ang I contractions. Meanwhile, we observed a close relationship between calcium influx and tyrosine kinase phosphorylation activity under the stimulatory effects of angiotensin peptides. Furthermore, genistein did not significantly influence the phasic contractions induced by angiotensin peptides in Ca2+-free Krebs-Henseleit solution. Thus, it appears that Ca2+ influx, rather than the release of Ca2+ from IP3-sensitive stores, may play a major role in the contractile effects of angiotensin peptides in rat aorta via tyrosine kinase activation. One argument against a direct action of genistein on the Ca2+ channel itself is that it did not markedly affect the K+-induced contraction (depolarisation) in rat aorta. At the same time, a potential role for tyrosine kinase activity in the process of calcium entry is suggested. An elevation of intracellular calcium via tyrosine kinase-mediated processes may mediate the actions of G-protein coupled receptor agonists in smooth muscle, including angiotensin peptides.

Implications of imidazolines and imidazoline receptors role at the vascular level.

There are both post- and pre-synaptic vascular imidazoline (IM) binding sites. The importance of direct IM actions and that of peripheral imidazoline receptors (IRs) are shadowed by the central effects of IMs and by their interaction with alpha 2 adrenoceptors. Since the discovery of clonidine the many studies on IMs have been focused on their hypotensive effect, with rilmenidine and moxonidine as representative drugs. Formerly called IM preferring alpha 2 or IM/guanidium sites, the IRs (idazoxan-sensitive) are the plasmalemmal I1 (clonidine-sensitive) and the various I2 (one structure identified as MAO). I1 signaling includes activation of phosphatidylcholine-selective phospholipase C and inhibition of some ligand-gated channels. Inhibitory IRs on postganglionic sympathetic terminals, are not alpha 2, H3, I1 or I2. Some IMs directly affect CaL, while others inhibit K+ efflux. Clonidine-displacing substances including agmatine are endogenous ligands at IRs and alpha 2 and may participate in arterial pressure control. Beside few speculations, the roles of vascular IRs are largely unknown.

[The evolution of the natural-killer-dependent cytotoxic activity during normal pregnancy]. / Dinamica citotoxicitatii natural--killer (NK) dependente în evolutia sarcinii fiziologice.

The fetus was compared to an allograft because paternal antigens are also expressed. Even the analogy is not a real one, the main steps of the rejection phenomenon are relevant for the understanding of the complex materno-fetal interactions as the large granular lymphocytes are the first immune cells which invade the graft. Due to the important role of NK cells in the cell mediated immune response, the purpose of this paper was to assess the NK cell dependent cytotoxicity during normal pregnancy. The study was performed on a test group of 52 normal gravidas, in the Ist, IInd and IIIrd trimester and a control group of 20 healthy nonpregnant women with similar age and parity averages. The cytotoxic activity of the NK cells was measured in a 51Cr release assay against K 562 cell line. The results were expressed as the cytotoxicity index (%) and showed a statistically significant decrease for all gravidas compared to controls, mostly for the IInd trimester. The trend of the NK cytotoxic activity during normal pregnancy suggests the deep involvement of the NK cells in the mechanisms acting at the fetomaternal interface.

Abdominal pregnancy. Case report, review of the literature.

Abdominal pregnancy (AP) is a rare form of ectopic pregnancy (EP). It is a medical emergency because of high maternal and fetal morbidity and mortality. Early diagnosis is essential. Surgery is indicated as soon as the diagnosis is made. We present a case with AP in the third trimester with malformed fetus and left ovarian tumour. The fetus has been extracted at 33 weeks gestational age; the placenta and the ovarian tumour have been removed five weeks later. Pathology showed corpus luteum with hemorrhage, serous cystadenoma, follicular cyst. The fetus died, the woman successfully recovered.

Present data concerning the renin-angiotensin system of extrarenal origin.

After a brief historical incursion regarding RAS of renal origin, we present the main extrarenal angiotensin-forming enzymes, starting with isorenin, tonin, D and G cathepsin and ending with the conversion enzyme and chymase. This is followed by a short presentation of data concerning tissue RAS in the heart and vessels, brain and neurocranial accessory glands, cortico-suprarenal and gonadal glandular territory. In the end we refer to the relations between circulating RAS of renal origin and the extrarenal RAS specific to tissue underlying the fact that the two RAS components cooperate and constitute a unitary hormonal system, regulating the major functions of the organism and maintaining the main homeostatic equilibria. While the circulating RAS of renal origin is acutely activated to contribute to the accomplishment of short term homeostatic reactions, tissue RAS, in paracrine or autocrine ways, exerts local-regional adaptive actions of long duration.

[Dipsogenic behavior]. / Comportamentul dipsogen.

Hydroelectrolytic homeostasis assumes balance between the intake and elimination of water and electrolyte, according to the necessities of the organism. The water intake is made mainly by fluid ingestion. The necessity to drink is a subjective sensation which is the expression of an objective situation, because it translates the homeostatic deviations. The ingestion of water is motivated (reparatory thirst), when it appears after hydric and electrolytic imbalances (ex. a decrease of the fluid volume, increase in the plasmatic osmolarity) or is manifested without an objective reason (unreparatory thirst).