[An unusual case of multiple endocrine neoplasia]. / Un caz atipic de neoplazie endocrina multipla.

The patient A.M., woman, presented Multiple Endocrine Neoplasia, associating hyperparathyroidism, an adrenal tumor and pancreatic tumor; one can observe that the disease had features of Multiple Endocrine Neoplasia type-1 (pancreatic tumor), as well as Multiple Endocrine Neoplasia type-2 (MEN-2, pheochromocytoma), while the hyperparathyroidism is common for both two types of the syndrome. The development of the disease is extended over approximate forty years of life and finally led to death. The first symptoms appeared during pregnancy, at age 26, when the severe hyperparathyroidism determined bone mass acute loose, with decrease in height by affecting columnary vertebrae, severe bone pain due to bone resorption and soon after symptoms of renal stone disease. The patient suffered two surgical interventions for renal lithiasis. The biliary symptoms required also the surgical removal of the gall bladder, putting the diagnosis of active metabolic stone disease. At age 56, was established the diagnosis of carcinoma of the adrenal cortex, which was solved with surgical therapy. At age 66, digestive symptoms suggested the presence of a carcinoid tumor. Abdominal ultrasonography revealed a well-lined pancreatic tumor of 2-3 centimeters in diameter, probably adenoma. The malignant evolution of this tumor was rapid, leading to death in less than two years. The constant refuse of other investigations, by the patient, made us incapable to determine the type of secretion of the pancreatic tumor; we rather suspected a VIPoma, because of the watery diarrhea and severe weight loss. The most difficult to treat was anyway the hyperparathyroidism and its complications.

Peri-implant tissue and the longevity of restoration.

The clinical success was analysed several times, based upon the good results obtained and unfortunately not on a basis of correct scientific researches, as the cellular and ultrastructural investigations. In the randomized study a more numerous failures are seen in the first, respectively second year, after the application of the implant. The failures were predominantly observed in case of mandible implants. The quality of the bone is an essential factor for the success of the implant without correlation with the age of the patient. The most objective choice of the patients as well as a correct conceived and executed therapeutical plan, the follow-up cooperation with the patient, in what concerns the strict oral hygiene, would had to an increasing number of successfully solved cases. The success of the implant may be ensured when besides the content of the patient, the long-term stability of the soft and bone peri-implant tissues is achieved. By this is also obtained by morphological stability, which may be evaluated following clinical X-ray parameters. This stability is under dependence of the biological status. Conclusively this means an established biomechanical balance and stable relationships between the immune defense system of the least and the pathogenic potential of the microorganisms.

Peri-implantitis.

Peri-implant lesions are directly linked to the relationship between the implant and the soft tissue. These lesions are rare in the case of pure Ti smooth implants, but appear frequently around the rough-surfaced implants. A marginal inflammation may result in a rapid peri-implant bone loss, since the peri-implant connective tissue constitutes in a less effective barrier than the same tissue surrounding the tooth. The morphopathological examination of the peri-implant tissues revealed after their removal that the gum's mucous membrane is not inflamed, but degenerative lesions were observed both on the epithelium and chorion. The papillary lamina propria contains few cells, but it is rich in collagen fibers; vasodilatation and edema were also present. Multiple areas of lysis of the intercellular junctions were also observed at the intermediary level of the gum peri-implant epithelium (the epithelial cells undergo a process of involution at the intermediary level of the epithelium). Important changes can be seen both at the level of intercellular junction systems and at the junction between the basal extremity of the epithelial cells and the basal membrane.

Fine-needle biopsy cytology in autoimmune thyroiditis.

Fine-needle biopsy is used in the thyroid pathology especially for the differential diagnosis concerning malignant lesions. From a total of 59 cases of thyroiditis, in 12 was possible to proceed to fine-needle biopsy, in large goiters and nodules larger than 1 cm in diameter; in these cases were obtained smears, stained in May-Grünwald-Giemsa technique. In 9 cases of the 12 investigated, in the smears appeared lymphocytes and macrophages, cells commonly found in the infiltrates of the thyroid gland, in autoimmune thyroiditis, and sometimes also few normal thyrocytes. Fine-needle biopsy is important in the diagnosis algorithm of the thyroid nodules, involving 4, up to 7% of the general population. It has also the advantage of reducing the number of cases solved by surgical therapy, as it is the case with the diagnosis of Hashimoto's thyroiditis.

Endocrine diffuse system--histological and functional aspects interrelated with the tumoral pathology.

It was first believed that all these endocrine cells are deriving from the neural crests; in time were discovered more than 40 different types of such cells with different origins and only 6 or 7 are deriving from the neural crests. Serotonin-secreting cells show yellow fluorescence, while those secreting cathecolamines show a green fluorescence, with formaldehyde. The most usual method for the stain of the cells of the endocrine diffuse system is the silver salts impregnation. In the electron microscopy the cells show dense granules, which are modified in appearance in the malignancies developed from such cells. Most of the hormones secreted in the intestine were found also to be hormones secreted in the central nervous system. The border between benign proliferation and malignant tumors arising from these endocrine cells is not well defined. DNES--diffuse neuroendocrine system.

Endocrine diffuse system. Histological and functional aspects interrelated with tumoral pathology.

It was first believed that all these endocrine cells are deriving from the neural crests; in time were discovered more than 40 different types of such cells with different origins and only 6 or 7 are deriving from the neural crests. Serotonin-secreting cells show yellow fluorescence, while those secreting cathecolamines show a green fluorescence, with formaldehyde. The most usual method for the stain of the cells of the endocrine diffuse system is the silver salts impregnation. In the electron microscopy the cells show dense granules, which are modified in appearance in the malignancies developed from such cells. Most of the hormones secreted in the intestine were found also to be hormones secreted in the central nervous system. The border between benign proliferation and malignant tumors arising from these endocrine cells is not well defined. DNES--diffuse neuroendocrine system.

Indirect immunofluorescence--a method for diagnosis of autoimmune endocrine diseases, by putting in evidence serum auto-antibodies.

Used indirect immunofluorescence to put in evidence different types of auto-antibodies, involved in the etiopathogenesis of endocrine autoimmune diseases--thyroid auto-antibodies, anti-sperm antibodies, determined in the serum of both partners of the infertile couples, with infertility of unknown cause, ovary auto-antibodies, in early menopause cases. Besides the establish of a precise etiological diagnosis, this method offers the possibility to localize the auto-antibodies in the tissue and/or in the cells and also the chance to identify some types of auto-antibodies. In the case of thyroid auto-antibodies--antithyroglobulin and antimicrosomal antibodies, in the case of anti-sperm antibodies--anti-head, anti-intermediary piece, anti-acrosomal or anti-tail and anti-ovary antibodies--anti-oocyte, anti tecca granulosa or anti internal tecca.

Prolactin secretion and the immune system.

Prolactin receptors were identified on the membranes of lymphocytes have been demonstrated to secrete prolactin. The decrease, as well as the increase of the prolactin level in the plasma are responsible for immune disorders. Prolactin dysfunction has been described in some autoimmune diseases, such as systemic lupus erythematosus, immune arthritis, uveitis, experimental allergic encephalomyelitis and thyroid disease. The normal prolactin secretion is trophic for the lymphocytes, while the high and also the low levels of prolactin may play an immunosuppressive role.

Complex investigation of Graves'-Basedow disease: case report.

This paper relate a patient case, age 42, female sex, which was complex immuno-morphologically investigated, on thyroid fragments, surgically obtained. The patient was previously diagnosed with Graves'-Basedow disease; the relapses after conventional therapy, orientated the case for surgical treatment--subtotal thyroidal resection. Using polyclonal and monoclonal antibodies, we may confirm that the disease is fully active. Graves'-Basedow disease is the most common form of autoimmune thyroiditis, responsible for the majority of the cases of hyperthyroidism, affecting young women. It was suspected, many years ago and recently demonstrated that the hyperthyroidism is involved in the development of the autoimmune response, by increasing the immune reaction of the organism. Some effects of the antithyroid drugs are mediated by the decrease of the specific stimulator antibodies (long-acting thyroid stimulator), commonly found in Graves'-Basedow disease.

[Adenocarcinoma of an eccrine sweat gland--the diagnostic problems]. / Adenocarcinom de glanda sudoripara ecrina--probleme de dignostic.

Eccrine adenocarcinomas rarely present a clinical aspect that suggests a malignancy. We present a case of an adenocarcinoma of an eccrine sweat gland with a moderate degree of differentiation associated with a verruca vulgaris (papilloma). The verrucous tissue contained a large number of melanocytes giving the macroscopical aspect of a malignant melanoma. The light microscopy elucidated the problems of diagnosis. The immunological status may be responsible for this association between a benign tumour of the epidermis with a viral histogenesis and the carcinoma of an eccrine sweat gland.