The basic phenomenon in myocardial ischemia is represented by an imbalance occurred between the coronary blood flow and the myocardium requirements, followed by metabolic changes (oxygen deprivation, glycolysis, reduced washout of metabolites, tissue acidosis and ionic redistribution – calcium overload, potassium loss) and changes in the energy producing system (excessive consumption of reserves – high-energy phosphate compounds).
Depending on the length of ischemia, different impairments of myocardial contractility and tension may appear (reduced ventricular end-diastolic pressure and volume, clinically manifested by congestive heart failure to cardiac arrest), followed by electrocardiographic signs: morphological changes of the ending phase and of the QRS complex (ischemia – T wave changes, lesion – ST segment changes, necrosis – pathologic Q wave) and favouring arrhythmias.
Electrocardiographic ischemia resulting from the alteration of the normal myocardial repolarization process is illustrated by changes in both aspect and polarity of T wave, which becomes ample, pointed, symmetrical, negative in subepicardial ischemia and positive in subendocardial ischemia.
The restoration of coronary blood flow may come at a cost due to the reperfusion injury in four distinct types: stunned myocardium, microvascular stunning, reperfusion arrhythmias and lethal reperfusion injury; its scope may be reduced by the coexistence of the belated ischemic preconditioning phenomenon.

M. Drăgan

Epithelial ovarian carcinoma is one of the most frecquent gynecologic cancer and represent the fifth cause of cancer death in women.
Because ovarian cancer has no specific symptomas in early stage, many patients are diagnosticated in advanced stage disease.
Numerous clinical trials are in progress to refine existing therapy and test the value of different approaches to postoperative drug and radioactive therapy.
Patients with any stage of ovarian cancer are appropriate candidates for clinical trials.
S. Andrei, B. Szabo, C. Enciulescu, L. Seres – Sturm

The renal artery stenosis, the main cause for the renovascular hypertension, is relatively frequent (up to 10% of the etiology of the systemic hypertension), but due to the high evolutivity and “malign” potential over the renal function, it needs a quick diagnostic, because it has a relatively good response to treatment (medical and/or surgical). This diagnosis needs the follow of an algorithm, in which besides the suggestive clinical data, the investigation specific data (urography, renal nefroscintigraphy, renal Doppler ultrasonography, computed tomography, MRI angiography and digital substraction renal arteriography) have a primordial role.

R. Motoc, Crina Motoc, L. Cozlea
2006, nr.2

Postdural puncture headache has become a clinical problem since the clinical instrumetation of the epidural space. The reported incidences are variable: 1-40%. There are known risk groups, the diagnostic is quite simple. The mechanism attributed to PDPH is the spinal fluid depletion. The treatment is conservative for the first 2-3 days, then an EBP is advised. The conservative treatment consists of positioning, anlgesia, sedation, oral and/or parenteral hidration, caffeine. EBP is performed using autologous blood injected either in the same intervertebral space or one space beneath the dural puncture site. The amount of injected blood varies between 10 and 20ml. Contraindications include: patient refusal, lack of experience, disorders of blood coagulation, local or systemic infections, fever, anatomical anomalies preventing localisation of the targeted space. Reasons of concern are: risk of seeding (bacterial, viral, oncological), HIV. The complications are predominantly neurological: dural sinus thrombosis post delivery, extensive neuraxial block when the blood was injected in the presence of a residual block, back pain. To explain the mechanisms of efficiency, two theories were advanced: the plug theory and the pression patch hypothesis. Epidural blood diffusion can remarkably be visualised by MRI. EBP is also practiced for PDPH prophylaxy. The alternatives to EBP are the use of: cristalloids, coloids and fibrin glue.

The actual trend is not to delay EBP, the prophylactic use of EBP to risk groups, restriction of needles to pencil-point ones to perforate the dura.

Efficiency of EBP is immediately 91%. In less then 40% of the cases, EBP needs to ne repeated.

Sanda-Maria Copotoiu, Klara Brânzaniuc, Ioana Ghiţescu, L. Azamfirei, I. Nemeş, Ruxandra Copotoiu

2006, no.2

Dyspharingy is generally accepted as a difficulty in deglutition appearing as a result of the pharynx-oesophageal pathology. Regarding the described acquisitions of the last 20 years, there are a wider range of maladies, regarding neurology and internal diseases, as basis for dyspharingy release. In order to establish the etiology of dyspharingy apart from clinical aspects some paraclinical examinations should be performed.

Cross-nose pharynx-oesophageal fibro-endoscope exam, oesophagiscope exam, indirect laryngeal-scope exam, laryngeal-scope in suspension, thyroid scinthygraphy and sound-graphy are methods used in currently practice, lately some other kinds of exams, like manometry are performed too. In the manometric exam, the catheter has to be introduced through the nose to reach the pharynx and oesophagus.

Other methods such as electromyography together with manometry, angyodynography, video-radiography are not currently used in practice, only in research laboratories equipped for this reason. Video-radiography and high frequency radio-cinematography and multiocular electromyography explorations are useful especially in deglutition dysfunctions having a cortical cause. By performing electromyographical analysis each muscle activity, and also the muscle co-ordination can be assessed.

As patients suffering from dyspharingy call on to the ENT specialist in an early stage, he has the duty of establishing the etiology of diagnosing dyspharingy. This can not be made without an interdisciplinary collaboration with neurology, internal medicine, medical imagistic, functional laboratory exploring etc.

Simona Cibu

2006, no.1