Maternal hemodynamics at 11-13 weeks of gestation and preterm birth.

OBJECTIVE: Women who experience preterm birth (PTB) are at increased risk of cardiovascular morbidity and mortality in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP(Ao)) and arterial stiffness, assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this screening study was to evaluate SBP(Ao), PWV and AIx at 11-13 weeks' gestation in women who delivered preterm. METHODS: This was a prospective study in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded, and PWV, AIx and SBP(Ao) were measured. We compared these parameters in women who had spontaneous (n = 244) or iatrogenic (n = 110) PTB before 37 weeks' gestation and before 34 weeks with those in women who had term delivery (n = 7489). RESULTS: Compared with women who had term delivery, women who had iatrogenic PTB had significantly higher AIx (1.08 (interquartile range (IQR), 0.91-1.27) multiples of the median (MoM), vs. 1.00 (IQR, 0.86-1.16) MoM) and SBP(Ao) (1.06 (IQR, 0.98-1.15) MoM vs. 1.00 (IQR, 0.93-1.07) MoM). However, there was no significant difference in AIx, PWV or SBP(Ao) between those who had spontaneous PTB and those who had term delivery. These findings were similar for those who had PTB at < 34 and < 37 weeks' gestation. CONCLUSION: Women who had iatrogenic PTB, but not those who had spontaneous PTB, have increased SBP(Ao) and arterial stiffness that is apparent from as early as the first trimester of pregnancy.

Study of the VOC emissions from a municipal solid waste storage pilot-scale cell: comparison with biogases from municipal waste landfill site.

The emission of volatile organic compounds (VOCs) from municipal solid waste stored in a pilot-scale cell containing 6.4 tonnes of waste (storage facility which is left open during the first period (40 days) and then closed with recirculation of leachates during a second period (100 days)) was followed by dynamic sampling on activated carbon and analysed by GC-MS after solvent extraction. This was done in order to know the VOC emissions before the installation of a methanogenesis process for the entire waste mass. The results, expressed in reference to toluene, were exploited during the whole study on all the analyzable VOCs: alcohols, ketones and esters, alkanes, benzenic and cyclic compounds, chlorinated compounds, terpene, and organic sulphides. The results of this study on the pilot-scale cell are then compared with those concerning three biogases from a municipal waste landfill: biogas (1) coming from waste cells being filled or recently closed, biogas (2) from all the waste storage cells on site, and biogas (3) which is a residual gas from old storage cells without aspiration of the gas. The analysis of the results obtained revealed: (i) a high emission of VOCs, principally alcohols, ketones and esters during the acidogenesis; (ii) a decrease in the alkane content and an increase in the terpene content were observed in the VOCs emitted during the production of methane; (iii) the production of heavier alkanes and an increase in the average number of carbon atoms per molecule of alkane with the progression of the stabilisation/maturation process were also observed. Previous studies have concentrated almost on the analysis of biogases from landfills. Our research aimed at gaining a more complete understanding of the decomposition/degradation of municipal solid waste by measuring the VOCs emitted from the very start of the landfill process i.e. during the acidogenesis and acetogenesis phases.

[Pancreaticoduodenectomy in surgical treatment of malignant tumors of Vater's region]. / Duodenopancreatectomia cefalica in tratamentul tumorilor maligne ale regiunii vateriene.

BACKGROUND: The optimal treatment of tumors of Vater's region represents a permanent interest of every physician involved in the treating of malignant diseases with such localization. AIM: This presentation proposes a pancreaticoduodenectomy (DPC) evaluation in the surgical treatment of tumors of Vater's ampulla. MATERIALS AND METHODS: Between 1999 - 2009 our clinic has treated a number of 37 cases with mechanic jaundice by malignant diseases (JMN). Out of these, 5 cases (13.5%) have been hospitalized with JMN (preoperative diagnose) by malignant tumors of Vater' region: 4 men and a woman, aged 46 to 72, from rural medium, who represent the aim of this paper. RESULTS. DISCUSSION: In 4 cases (10,.8%), intra-operatory exploration confirms the existence of tumors of Vater's ampulla or duodenal papilla (diagnosis having been established by preoperatory duodenoscopy) using DPC (Child Procedure). Postoperative evolution, either immediate or distanced, was favorable, implying no deaths. The microscopic exam of the extirpated piece confirms Vater's Ampulloma in two cases (5.4%); in the other two cases, the above mentioned exam reveals the small bowel's carcinoma at duodenal papilla. In the last 2.7% cases intra-operatory lymph node and visceral metastases have been observed, choledochoscopy revealing cholangiocarcinoma (confirmed by microscopic exam), the patient having suffered only a choledochoduodenostomy. CONCLUSIONS: Without being endowed with great experience in the field, the results of DPC treatment in these first cases of malignant tumors of Vater's region allow us to found the reasoning of the righteousness of surgical indication. DPC draws the hope of radical healing intention in the cancer with this localization.

Antibacterial antibodies for some enterobacteria in sera of patients with reactive arthritis and other rheumatoid diseases.

The presence of the specific antibodies for some enterobacteria--Yersinia, Salmonella and Shigella was investigated in patients hospitalized in the period 2000-2007 with reactive arthritis and other rheumatoid diseases. The antibacterial antibodies in the diagnosis titres were found in 172 out of 1102 (15.6%) patients. Increased antibodies levels to Yersinia were detected in the sera from 113 (65.7%) of the 172 patients, for Shigella in 47 (27.3%) and for Salmonella in 12 (7.0%) cases. From all serologically positive patients 126 (73.2 %) had clinical diagnosis of reactive arthritis and 46 (26.7%) other rheumatoid diseases (ankylosing spondilytis, Reiter's syndrome, sacroilitis). The most serologically positive cases (63.9%) were of middle-age (30-50 years). There were no significant differences between sexes among serologically positive cases.

[Bulbantrectomy with truncal vagotomy in the surgical treatment of duodenal ulcer]. / Bulbantrectomia asociata vagotomiei tronculare in tratamentul chirurgical al ulcerului duodenal.

Duodenal ulcer benefits of very efficient medical treatment. In currently medical practice exist many cases with complicated duodenal ulcer (by stenosis or penetration in neighbor organs like pancreas or biliary tract or painful forms etc.) to which surgical treatment is necessary. Based on the retrospective study of 116 patients operated between 1991-2002 years for gastric or duodenal ulcer, this paper demonstrates that bulbantrectomy associated with bilateral truncal vagotomy (63.7% of cases) is the best surgery in the treatment of duodenal complicated ulcer or resistant to the medical procedures. Provided by correct indication, the intervention is the most pathogenic, offering the best immediate and long term postoperative results. If the bulbantrectomy is contraindicated (critical general status, etc.), the alternative is a bilateral truncal vagotomy associated with a drainage procedure: pyloroplasty (6.9% of cases) or gastroenterostomy. When the vagotomy are contraindicated or cannot be correctly performed, a large gastrectomy (29.3% of cases) followed by gastroduodenal (preferable) or gastrojejunal anastomosis are practiced.

[Upper digestive hemorrhage, physiopathologic and therapeutical considerations]. / Hemoragia digestiva superioara. Consideratii fiziopatologice si implicatii terapeutice.

The study is based on the analysis of 158 patients admitted in the "Fourth Clinic of Surgery" with diagnosis of "Upper Digestive Haemorrhage" (U.D.H.) between 1998-2002, emphasising the importance of the physiopathological chains induced by the ulcer bleeding; 119 cases (76%) were diagnosed with gastro-duodenal ulcer, 20 with portal hypertension (20%), 14 subjects were with gastric carcinoma (8.8%) and 5 with miscellaneous etiologies so called "rare circumstances" of U.D.H. (two patients with Idiopathic Thrombocytopenia, one case with Dieulafoy gastric ulceration and two subjects with Haemorrhagic Gastritis). All the patients were admitted in the first moment in the Intensive Care Unit where haemostasis were successfully obtained with drug therapy adapted to the physiopathological changes induced by bleeding, in the majority of cases with light bleeding (8 cases, 5.4%) or medium bleeding (139 patients, 87.4%); only in 9 subjects (6%) with severe haemorrhage surgery was indicated (posterior bulbar ulcer in which the surgical haemostasis was necessary). In 88 patients (55%) surgery was performed as an elective procedure--74 from them had haemorrhagic gastric or duodenal ulcers with a medium amount of bleeding and 14 observations for gastric carcinoma with a chronic bleeding. In most all the cases the postoperative evolution was in good terms. Two observations with severe U.D.H. due to rupture of esophageal varices occurred on hepatic cirrhosis were out of therapeutical proof (1.2% deaths from all the admitted patients with U.D.H.).

[Antibiotic prophylaxis in surgery for colorectal cancer]. / Antibioticoprofilaxia în chirurgia cancerului colorectal.

The prophylactic use of antibiotics in the purpose of decreasing the frequency and severity of surgical infections is still controversial. The practical need of defining the concept of antibiotic prophylaxis gave rise to numerous polemics in the literature. This paper presents a retrospective study on 103 cases whom diagnostics were colon and rectum cancer, that were operated in the IV-th Surgical Clinic in 1993-2002 period; at these patients was done antibiotic prophylaxis local and systemic before, during and after operating. This method made possible the registration of a minimum number of cases with surgical infection (7 cases, representing only 7% of the operated patients): a case (1%) with peritoneal collection (needing the surgical evacuation of this collection) and in 6 cases, parietal superficial infections, which imposed the prolong of drainage for almost 7 days. Starting from the basic principles of antibiotic therapy, this paper aims at outlining practical guidelines for a judicious antibiotic prophylaxis.

[The antioxidant systems in rheumatoid polyarthritis]. / Sistemele antioxidante în poliartrita reumatoida.

The inflammatory process from rheumatoid arthritis (RA) is marked by complexity, maintenance and destruction. The inflammatory lesions are induced by oxygen free radicals, that have a great capacity of destruction. We studied 52 patients with RA (defined by ARA criteria--1987). We have observed the inflammatory rheumatic syndrome, humoral and cellular immune syndrome and the antioxidant systems, i.e.: superoxidedismutaze, glutathione and its fractions, glutathione peroxidase, the total SH groups. We have observed the decrease of the glutathione in 40% of patients and the decrease of the total SH groups in 65% of patients. The total SH groups are correlated with the severe forms of the disease. Superoxide dismutase had decrease values in 85% of cases. We have remarked that the treatment with corticosteroids and D-penicillamina improved the serum levels of the glutathione and total SH groups.

Serological diagnosis in human Yersinia infections.

Serological examinations revealed Y. enterocolitica 0:3 specific antibodies in 34% of 80 children affected by a yersiniosis epidemic at titres of 1/40-1/640 and in all sporadic Yersinia enteritis cases. Similarly, agglutinins were identified for Y. enterocolitica 0:3 and 0:9 in 3.4% of 430 appendectomized children hospitalized with painful syndrome in the right iliac fossa. In 10% of 101 patients hospitalized with arthritis and Reiter's syndrome antibodies to Y. enterocolitica 0:3 (8 cases) and Y. pseudotuberculosis (3 cases) were detected at titres of 1/80-1/640. Our results stress the importance of serological examinations in diagnosing human infections with Yersinia.

[Reflex sympathetic algodystrophy--the therapeutic options]. / Algodistrofia simpatica reflexa--optiuni terapeutice.

The patients entering this study were divided into 3 series according to the administered drug treatment, being then followed up for at least 28 days for the main symptoms (pain, tumefaction, vasomotor disturbances, limited movements). The more satisfactory results were obtained in the patients receiving prednisone, indomethacin, propranolol, sympatholytics, vasodilators, calcium anabolisants, tranquilizers to which, at the right time, massage and kinesitherapy were associated.

Presence of Yersinia specific antibodies in hospitalized patients with arthritis and Reiter syndrome.

A number of 50 patients admitted with arthritis and Reiter syndrome were investigated to detect the presence of Yersinia specific antibodies. The specific antibodies were evidenced in 5 patients (10%)--3 with antibodies to Y. enterocolitica and 2 with antibodies to Y. pseudotuberculosis, in titers greater than or equal to 1/160. The patients were followed in dynamics up to 3-4 months. The antibodies to Y. enterocolitica persisted in time longer than those to Y. pseudotuberculosis. For a better knowledge concerning the germs responsible for sero-negative arthritis, serological investigations for Yersinia, in the patients with arthritis, appeared as necessary.

[Functional recuperation after femoral osteotomies]. / Recuperarea functionala dupa osteotomiile femurale.

The varus femoral osteotomy type Pauwels I is indicated in early arthrosis (stages I-III) on a hip dysplasia or in stages I and II of femoral neck aseptic necrosis. After 6 weeks - 4 months postoperative immobilization the rehabilitation is initiated. Its main purposes are to obtain and to maintain a good joint mobility, a muscular balance and gait rehabilitation. This program was applied to 12 patients with good evolution, the followed up parameters being pain, hip mobility and stability. The benefits of sending these patients in time to orthopedic units and the need of their subsequent professional reorientation are underlined.