Contrast enhanced ultrasound of carotid plaque in acute ischemic stroke (CUSCAS study).

INTRODUCTION: Carotid atherosclerosis represents 8 to 15% of ischemic strokes in relation to the concept of "vulnerable" plaque. Contrast enhanced ultrasound (CEUS) can detect moving microbubbles within the plaque corresponding to neovessels that constitute "precursors" of vulnerable plaque and intraplaque hemorrhage. CEUS was not studied specifically in acute ischemic strokes. The aim of this study is to analyse the prevalence of CEUS carotid plaque ipsilateral at the ischemic stroke as well as the main characteristics of contrast-plaques. METHOD: A single-centre prospective pilot study involving 33 consecutive patients with a stroke ≤10 days, diagnosed by an MRI with positive diffusion sequence and having a carotid plaque thickness ≥2.5mm with low or heterogeneous echogenicity, located in the ipsilateral carotid territory at the stroke. Plaque echogenicity was done by visual analysis and by measurement of the gray scale median (GSM). A transcranial Doppler monitoring was carried out in search of HITS. The contrast ultrasound was performed after 2.5 cc IV injection of SonoVue®. A video clip was recorded after injection which was used for interpretation by visual analysis in 3 grades, provided by two independent expert readers. RESULTS: The population consisted of 10 women and 23 men aged 73 on average. The topography of strokes in the carotid territory was located on the right in 11 (33%) cases and on the left in 22 (67%) cases. Seventeen patients had carotid stenosis between 0 and 49% according to the Nascet method and 16 patients had stenosis of 50 to 99%. The visual characterisation of the plaques had echolucent dominance (Type 1-2) in 18 cases and echogenic dominance (Type 3-4a) in 15 cases. Cardiovascular risk factors were common with no difference by sex. The inter-observer agreement of plaque enhancement was moderate in first reading (k=0.48) and excellent at consensus (k=0.91). Only one disagreement was found. Contrast agent enhancement of carotid plaque was observed in 11/32 patients, representing a prevalence of 34.4% - CI95% [17.9-50.9]. Variables associated with contrast plaque included the absence of antiplatelet drug (63.6% vs. 23.8%, P=0.05) and the presence of a regular edge on the plaque (91% vs. 48%, P=0.04). There was no difference in contrast enhancement for stenosis>or<50% in diameter and neither for the type of plaque. CONCLUSION: In a consecutive cohort of 33 patients, the prevalence of CEUS from an ipsilateral carotid plaque to a recent acute ischemic stroke was 34.4%. There was a statistically significant association between the contrast enhancement of the plaque and the absence of antiplatelet drug (P=0.05) and also the presence of a regular edge on the plaque (P=0.04). There was no correlation between plaque contrast and clinical and biological characteristics of patients or the presence of HITS.

Experimental study regarding the changes in the median sagittal suture post disjunction on common rabbit breed.

Widening of the upper jaw by undoing the median suture is a relatively common clinical procedure and the histological studies on sutural tissues, both immediately after disjunction and post disjunction are relatively rare. The present research aims to study cellular changes caused after undoing the median maxillary suture, on a strain of common rabbit breed, in an attempt to prove that the purpose of this therapeutic technique is obtaining neoformed osseous tissue, as a guarantee of the stability of orthodontic treatment results. Of course, changes in rabbit desmale tissues cannot be fully assimilated to the human ones.

The class II/1 anomaly of hereditary etiology vs. thumb-sucking etiology.

RATIONALE: The etiology of class II division 1 Angle anomaly comprises many entities, including heredity and the vicious habit of sucking the finger. A close connection between the etiology and the clinical features needs to be outlined, in order to have a more appropriate treatment approach. AIM: This study aims to find common clinical features for two groups of Class II division 1 etiological factors (heredity and the vicious habit of sucking the finger), outlining a characteristic dento-facial pattern for each etiological factor. MATERIALS AND METHODS: 160 orthodontic cases were studied, taken randomly from the Department of Orthodontics in "Carol Davila" University of Medicine and Pharmacy, between 2005 and 2011. From a total of 46 diagnosed with Class II/1, the following data were noted for each subject in a table: age, sex, etiology, facial symmetry, profile, size of the lower face, stage lip, labiomentonier ditch, menton, form of arches, palate, occlusion in the three plans, Spee curve, other dental anomalies. DISCUSSIONS: The facial asymmetry was found in a greater proportion within the finger-sucking group. Subjects in the finger sucking group have 100% pronounced convex profile, with pronounced lip stage and sharp curve of Spee, being known that the thumb-sucking stops the mandible growth and stimulates the upper jaw protrusion. CONCLUSIONS: The predominant etiological factor is heredity and the clinical features obvious for II/1 Angle anomaly are present in the highest proportion in the thumb-sucking group, but no significant differences were observed between the groups studied according to etiology.

[Targeted therapy and breast cancer: state of the art]. / Thérapie ciblée et cancer du sein: état de l'art.

CONTEXT: Scientific advances in molecular biology and understanding of oncogenesis have lead to anticancer molecular targeted therapies. They encompass monoclonal antibodies binding to active membrane epitopes and small molecules interfering with enzymatic reactions essential to cancer cell survival (oncogene addiction). These pathways may be optimal targets. Clinical benefits achieved using these targeted agents have been outstanding both in localized and metastatic disease. METHOD: We conducted a survey of literature analyzing activity and safety of targeted agents approved by FDA and/or FDA for the treatment of patients with breast cancer: anti-HER2 and antiangiogenic agents. RESULTS: Activity and main toxicities of these targeted agents are described according to signaling pathway targeted as well as stage of breast cancer. CONCLUSIONS: Availability of these targeted therapies has indeed transformed the outcome of subgroups of breast cancer to the expense of acceptable and manageable side effects, as compared to classical cytotoxics to which they are nevertheless combined.

Altered anatomy in a case with a buccally impacted maxillary canine tooth.

Bilateral dissections of maxilla were performed in a human adult cadaver head, male, aged 53 years. After the en block removal of the soft tissues in the oral and infraorbital regions, the antero-lateral surface of maxilla was exposed and also the vestibular aspect of the upper alveolar process. An oblique labially impacted right upper canine was evidenced, completely submucosal: its apex was tangent to the maxillary sinus floor, while the superior side of the apical part of the root was in close relation with the floor of the laterally expanded inferior nasal meatus. Superior and adjacent to the neck of that impacted canine a follicular cyst was evidenced and the antral wall presented distally to the apex of the impacted canine a dehiscent area, where the antral mucosa was only covered by an incomplete thin bony lamella. The incisors on that side were present but no resorption was identified at their level. Within the anterior border of the wall separating the maxillary sinus, small, and the inferior nasal meatus, the nerve for that impacted canine was coursing; the nerves for the upper incisors were initially located within the antero-lateral wall of the inferior nasal meatus. Although small, the maxillary sinus presented a supero-medial recess above the enlarged inferior nasal meatus and lateral to the normally-sized middle nasal meatus.

[Preprosthetic orthodontic treatment--interdisciplinary cooperation in dental medicine]. / Tratamentul ortodontic preprotetic--un model de interdisciplinaritate in medicina dentara.

If, not long time ago, the simple prosthetic rehabilitation of an edentulous patient--with or without additional maxillary teeth abnormalities--was the only therapeutic solution, presently, the pre-prosthetic orthodontic treatment enabling the dental restoration treatment meets the basic requirements of any dental treatment, i.e. the (re)set-up of the morphological and functional integrity and the functions of jaws, with minimum biological sacrifice.

The magnitude of adhesion-related problems.

Adhesions perhaps should be considered to be the most frequent complication of abdominopelvic surgery. The incidence is well documented but the burden to the cost of healthcare is not given the recognition it deserves. For any other disease or operation, with a recognized complication with such a high incidence, a prophylactic therapy or preventative strategy would be recommended if not mandatory. Adhesions occur in over 95% of all abdominal operations and can account for up to 6% of all readmissions. The problem affects all ages and exists for the life of the patient.

[Primary trabeculectomy in the surgery of primary open angle glaucoma]. / Trabeculectomia tratament primar al glaucomului primitiv cu unghi deschis.

OBJECTIVE: Comparative analysis of the results of trabeculectomy in the surgery of primary open angle glaucoma (POAG) as the primary therapeutical approach and after the medical treatment failure. MATERIALS AND METHOD: Retrospective study including two therapeutical groups: A (59 patients) with primary trabeculectomy; and B (60 patients) with trabeculectomy following a medical treatment failure; mean follow-up period was 3 years and 5 months. RESULTS: Postoperative drop in intraocular pressure was similar in the two groups; there is no statistical significant difference between the two groups regarding stationary disease (76.27% in group A, versus 73.33% in group B), regressive disease (6.8% versus 6.7% respectively) and progressive disease (18.6% in group A, versus 21.6% in group B). At an intraocular pressure < or = 21 mmHg 13.6% of glaucoma cases do progress. The rate of peroperative and postoperative complications is similar in the two groups. CONCLUSIONS: The prior medical treatment of glaucoma doesn't affect the evolution of operated POAG. Primary trabeculectomy is indicated for non-compliant patients and for patients in whom administration of combined medical treatment for short time periods doesn't lower the intraocular pressure at safe levels. Surgical treatment has the advantage of an important and constant lowering of the intraocular pressure which is an absolute requirement for an efficient control of advanced glaucoma.

[Corticotherapy in ophthalmology--the theoretical and practical problems]. / Corticoterapia în oftalmologie--probleme teoretice si practice.

The authors review the principal elements linked to the use of cortisone in ophthalmology, emphasizing new facts concerning the action of cortisone and especially the problems connected with this treatment.