Risk stratification and consecutive prognosis progresses in childhood Wilms tumors. Two cases report.

BACKGROUND: Even if Wilms' tumour is the commonest primary malignant neoplasia in children, it maintained a continuous interest due to actual therapeutic successes contrasting with the customary delayed diagnosis, malignancy and specific risk factors. PATIENTS AND METHODS: Two recent illustrative cases from our clinic are presented. The first one - a little girl of 22 months with repeated admissions for habitual constipation and psychomental disturbances revealed at abdominal ultrasonography a hypo-echoic mass at the superior pole of the right kidney. CT confirmed the presence of a solid homogeneous mass of 23/25 mm without node or distant metastases, suggestive for Wilms' tumour. Conforming to SIOP protocol she received chemotherapy and after 4 weeks a superior polar nephrectomy was performed. Pathology confirmed the diagnosis of triphasic nephroblastoma of intermediary risk. Postoperative chemotherapy according to the protocol SIOP assured the cure with a disease free period of 23 months. The second case - also a girl, of 3 years, is admitted for constipation, pain in the left flank and mental retard (QI=40). Ultrasonography determined a huge mass (Ø~6 cm) situated at the superior pole of the left kidney. CT attested a nonhomogeneous, encapsulated tumour image of 6.2/5.4/7.2 cm in large posterolateral contact with the renal parenchyma out of which it appears to be developed. The diagnosis of WT is strongly suggested and after chemotherapy a radical left nephrectomy with initial vessels ligature was performed. Pathology: stage IIb nephroblastoma with focal epithelial anaplasia. After surgery she continued the chemotherapy (HR regime), was cured and excepting a medullar aplasia is in a good health after 24 months. DISCUSSIONS: Our both cases were girls under 3 years, presenting nonspecific features: constipation and psychic troubles, the tumour being incidentally discovered by the abdominal ultrasonography. CT established the diagnosis. Conventional chemotherapy framing adapted to the tumour's stage and surgery conducted to a stable cure of about two years in both cases. CONCLUSIONS: Conforming to the SIOP protocols preoperative chemotherapy was applicable, well-tolerated and efficacious for two recent cases presented in our clinic, determining the shrinkage of tumour volume and stage and consecutive reduction of the surgical risks.

[General and local risk factors in infectious keratitis]. / Factori agravanti locali si generali în cheratitele infectioase.

PURPOSE: The paper presents a study of corneal ulcers at aged persons for the identification of etiologic and aggravates factors that may have a negative influence for the prognostic of the diseases. MATERIAL AND METHOD: We have performed a retrospective study using a lot of aged patients with corneal ulcers, hospitalized in 2002-2003 period. The data were obtained by both clinical examination (anamnesis and ocular examination) and by the laboratory exams (microbiologic exam). RESULTS AND DISCUSSIONS: We have analyzed by the epidemiological point of view, the distribution of cases with the age, sex, provenance area, and profession. We have demonstrated a predominant repartition of cases in the 7-th decade (45%) and for the masculine patients (in 60% of cases). The patients from rural area represented 75% of cases. In relationship with the etiology, the traumatic ulcers represent 25%, microbial keratitis 45% associated with local or general aggravating factors. Microbiological exam has revealed in principal non pathogen or pathogen germs in 10 cases (staphylococcus), moderate virulence germs in 5 cases (streptococcus) or very virulent germs (escherichia colli and pyocyanic bacillus) in 2 cases. CONCLUSIONS: The evolution of corneal ulcers at aged people is determined by etiologic and aggravating factors. The improvement of the evolution and of the prognosis depends on the most precocious application of local and general therapeutic measures.

[Primary juvenile glaucoma--clinical and genetic aspects]. / Glaucomul juvenil primitiv--aspecte clinice si genealogice.

PURPOSE: We have done a retrospective study of juvenile glaucoma cases hospitalized between 1993-2002. MATERIAL AND METHOD: 52 primary juvenile glaucoma patients were available for our clinical and genealogical investigations. RESULTS: In this study we have analyzed the distribution of cases per year, the age of appearance of the diseases, and the distribution in function of the sex and the genealogical factors. Genealogic analyze was performed by statistical methods: Weinberg and penetrance. CONCLUSIONS: Under 16 years, juvenile glaucoma diagnosis was mostly established by examining the children for visual acuity disorders caused by different ametropies, especially progressive rapid myopia. Genealogical exams confirmed an autosomal recessive transmission with incomplete variable penetrance but the possibility of polygenic multifactorial heredity may be also considered.

[Iris-corneal dysgenesis]. / Disgenezie irido--corneana. Consideratii în legatura cu o familie.

This work presents a family, a mother and her 3 daughters, aged: 10 months, 4 years, 5 years with Rieger's anomaly. For children, this anomaly is associated with glaucoma and buphtalmy, this last element is the one that made the family ask for medical assistance and come to the hospital. The study of the disease was done on five generations in the same family, on the mother's line. This revealed that in the mother's family the grand grandmother and her two sisters were blind at an early age (30-40 years old). The presence of the anomaly in many generations proves the genetic transmission of the disease. We have to mention that in the last generation, the most serious appearance was registered at the patient with the earliest age (10 months).

[Diabetes mellitus and glaucoma]. / Diabet zaharat si glaucom.

PURPOSE: The evaluation of the incidence of the open angle glaucoma to the patients with diabetes mellitus compared to the incidence in the general population and the frequency of the neovascular glaucoma. MATERIAL AND METHOD: The work consists in a study of 1700 patients with diabetes mellitus who where examined during 13 years. RESULTS: From 1700 patients with diabetes mellitus, 240 (14.1%) have glaucoma (primary or secondary). Of those 240, 15 (6.2%) have diabetes mellitus type I and 225 (93.7%) have diabetes mellitus type II. Concerning the clinical form of glaucoma, 177 patients (10.4%) have primary glaucoma with open angle, 23 (1.3%) have primary glaucoma with narrow-angle and 40 (2.5%) have secondary glaucoma. CONCLUSIONS: The highly incidence of the primary glaucoma to the patients with diabetes mellitus comparative to the general population can be explained by the vegetative dysfunction in association with diabetes mellitus and the presence of some common immunitary anomalies. The small numbers of cases with neovascular glaucoma means an indicator of the efficiency of the antidiabetic treatment and of the ocular complications of the diabetes mellitus.

[The para-clinic investigation of temporo-mandibular joint changes in patients with acromegaly]. / Investigarea paraclinica a modificarilor articulatiei temporo-mandibulare la bolnavii cu acromegalie.

The Acromegaly is an endocrinological disease determined by the hypersecretion of STH in a certain period of the body evolution and it causes the hypertrophy of bones in general and of mandible and cranio-facial bones, determining a disorder due to this development of bones, associated with troubles in the activity of muscles and of the phospho-calcium metabolism. This study was made on a group of 33 acromegaly patients. Their temporo-mandibular joint was investigated by ortopantomography, tomography, computer tomography and scintigraphy. All of these exams shows the changes in temporo-mandibular joint due to the cells hyperactivity determined by the hypersecretion of STH.

[The terminal occlusal contacts of the edentulous patient with a complete denture]. / Contactele ocluzale terminale la pacientul edentat total protezat.

For the last few decades our knowledge concerning the occlusion have developed a lot, because of the many clinical, morphological and functional implications of the occlusion. In the study of the terminal occlusion, it is considered to be of functional importance the closing trajectory of the mandible in centric relation and the closing trajectory of the mandible in maximal occlusion. The purpose of this research is to analyse the terminal occlusion of the complete denture patients, emphasize the link between occlusion disharmony and instability of the complete denture. Complementary exam used is the computerized T-scan system connected a compatible IBM computer. The study included 17 to subjects (11 males and 6 females), with an age over-age of 63 years. When completing this study the authors were able to classify four types of occlusal contacts.

[The frontal bonding of a microprosthesis with respect to arch physiognomy]. / Agregarea frontala prin microproteze ce respecta fizionomia arcadei.

A series of 4124 patients who presented at the Gnathoprosthetic Clinic of Iasi with dental coronary lesions were investigated. The dental lesions situated at the level of frontal arches, the possibilities of aggregating the microprostheses at this level and the clinical-technical procedure of realizing them were studied. By the joint efforts of the entire dental team, artificial substitutes completing the lack of dental substance were obtained and the physiognomic function, cosmetic harmony and facial esthetics were fully restored.

[Computer-assisted clinical gnathoprosthetic examination]. / Examenul clinic gnatoprotetic asistat de calculator.

Within the informatics strategy of the clinic of dental prosthetics we suggested, among other things, a computer-assisted clinical gnathoprosthetic examination, a careful and complete examination being the first medical act when the patient presents to a physician. The information collected during the patient's examination (essential data on affections of the stomatognathic system) were systematized in a data base. Since this data base is organized according to the methodology of a complete and complex clinical and paraclinical examination, the possibility of involuntarily omitting certain information is excluded.