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114 posibile care stau la baza lor şi de a recomanda modul de monitorizare şi gestionare a efectelor secundare iatrogene. Metode Am identifi cat publicaţiile relevante, printr-o căutare pe www.sciencedirect.com, între anii 2004- 2012, folosind cuvinte cheie: antipsihotice, antipsihotice atipice, denumirea individuală a antipsiho ticului, diabet zaharat, hiperglicemie, obezitate, sin drom metabolic, şi am rezumat studiile cheie din această literatură. Rezultate Deşi antipsihoticele sunt piatra de temelie a tratamentului pentru mai multe boli psihice, aceste <strong>medica</strong>mente se asociază în mod semnifi cativ cu risc crescut de obezitate şi boli cardiovasculare. Antipsihoticele de generaţia a doua prezintă riscuri diferite de a produce creşterea în greutate şi alte tulburări metabolice: clozapina şi olanzapina au riscul cel mai ridicat, quatiapina şi risperidona un risc moderat, aripiprazolul, amisulprida şi ziprasidona cel mai redus risc. Este difi cil de determinat dacă prevalenţa tulburărilor metabolice este crescută în această populaţie independent de tratamentul antipsihotic, deoarece schizofrenia a fost asociată cu diabet zaharat şi tulburări ale metabolismului glucidic încă înainte de introducerea <strong>medica</strong>ţiei antipsihotice. Un risc crescut de diabet zaharat sau scăderea toleranţei la glucoză la rudele de gradul întâi ale pacienţilor cu schizofrenie sugerează un rol genetic în relaţia dintre schizofrenie şi tulburările metabolice. Unele efecte adverse metabolice au fost corelate cu afi nităţile pentru neurotransmiţători, şi anume pentru receptorii: serotoninergici 5-HT2C şi 5-HT1 A, dopaminergici D2, histaminergici H1,α adrenergici şi muscarinici M<strong>3.</strong> În plus, antipsihoticele pot modifi ca homeostazia glucozei prin creşterea secreţiei de insulină. Caracteristicile individuale ale pacienţilor care pot predispune la tulburări metabolice includ vârsta tânără (copii şi adolescenţi), sexul feminin, prima utilizare a antipsihoticelor, durata lungă a trata mentului, răspuns clinic bun, indicele de masă cor porală parental, indicele de masă corporală mare înainte de primul tratament antipsihotic. Concluzie Multe studii au confi rmat potenţialul <strong>medica</strong>mentelor antipsihotice de a produce sau a declanşa dereglări metabolice, dar mecanismele farmacologice care stau la baza asocierii lor cu anomalii metabolice rămân neclare. REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LIX, NR. 2, An 2012 Ultrastructural aspects for understanding adipogenesis and adipose ti ssue dysfuncti on related to obesity G.-V. Mirancea 1 , B. Smeu 2 , A.-M. Morosanu 3 , C. Copaescu 4 , N. Mirancea 3 , I. Popescu 4 , S. Carniciu 5 , C. Ionescu-Tirgoviste 5 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 “Delta” Hospital, Bucharest, Romania 3 Insti tute of Biology, Bucharest, Romanian Academy 4 Fundeni Clinical Insti tute, Bucharest, Romania 5 Nati onal Insti tute of Diabetes, Nutriti on and Metabolic Diseases “N.C. Paulescu” Bucharest, Romania The major role of the adipose tissue is to store energy. Human body has two distinct types of fatstoring tissues: (1) brown adipose tissue (BAT) represented by adipocytes with multilocular lipid droplets and (2) white adipose tissue (WAT) represented by adipocytes, each with a unilocular huge lipid droplet, functioning as a secretory organ that releases soluble factors, known as adipokines involved in regulation of some physiological processes. Irrespective of body location, adipose tissue consists of (1) mature adipocytes (M A), (2) endothelial cells and associated pericytes, (3) nerves and (4) other stromal cells, which all are surrounded by (5) extracellular matrix, mainly represented by different species of molecules (a) fi brillar organized, (b) as basement membranes components or (c) soluble molecules. Mention must be made that, in some circumstances, inside of stromal spaces mainly located between adipocytes, infl ammatory cells as extravasated cells – for ex. granulocytes, macrophages – can be detected. Perturbations in body energy balance by limitation of the adipose tissue amount or an excess of adipose tissue (obesity) lead to severe dysfunctions and disease. In our days, because of wrong diet rich in glucose and fat, as well as of the adopted abnormal life style, a lot of people are affected by obesity. The obesity and its related diseases, including cancer initiation and progression, are increasing, being one of the major causes of morbidity and mortality in developed countries. That is why there is a great need and interest to study the factors and subtle mechanisms involved in excessive accumulation of adipose tissue in the human body. One major question arises: what is the real explanation for the body mass/weight increasing by adipose tissue accumulation during obese adult life? Does human body need new adipocytes – as
REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LIX, NR. 2, An 2012 115 the already pre-existent ones are exceeded in their capability to store lipids? If so, what the source of new adipocytes would be? The lineage origin of adipocytes is still a mater of debate. Different papers published confl ictual data. Here we report about the possible origin of the M A during achievement of the obese status by the adults. Small fragments of s.c. and visceral adipose tissue were surgically excised as therapeutic option (surgeon got patients’ consent) and processed following routine Transmission Electron Microscopy protocol (Mirancea et al., 2007). Our TEM study suggests the possibility that some stromal cells with a specifi c morphology, which to some extent mimics the telocyte phenotype described into the other tissues as skin, trachea (Rusu et al., 2012) could be at the origin of the new adipocytes and we called them Stromal Telocytelike Cells (S T-l C). We consider that S T-l C will evolve as pre-adipocyte stromal cells, able to synthesise and accumulate lipids, fi rst as small individual vesicles which later will fuse to form an unique huge lipid droplet pushing the rest of cytoplasm, including the mitochondrion, at the periphery of the cell; nucleus will be eccentric located (signet-ring appearance), characteristic to the mature white adipose tissue. Cell traffi king membranous infrastructures (coated pits and coated vesicles) are detectable. A continuous basement membrane can be seen at the periphery. Endoplasmic reticulum (ER) of the M A appears as isolated or grouped short profi les of tubules devoid of ribosomes but with a larger diameter at the middle region compared to the ends (Mirancea & Mirancea, 2010). This aspect is different from the pre-adipocyte case: ER is well visible as relatively large tubules (endogenous cytomembranes) with their long axes randomly oriented. Ribosomes are attached to the external surface of cytomembrane, identifi able as rough endoplasmic reticulum which resembles much that of S T-l C. 1. Mirancea N., et al., 2007, J. Dermatol. Sci., 45: 175-185. 2. Mirancea N., Mirancea D., Ultrastructura celulelor şi ţesuturilor, 2010, 703 pg., Editura Ars Docendi, Universitatea Bucureşti. <strong>3.</strong> Rusu M.C., Jianu M.A., Mirancea N., Didilescu C.A., Mănoiu V.S., Păduraru D., 2012, Traheal Telocytes, J. Cell Mol. Med.,16 (2): 401-405. The prevalence of smoking in pati ents with graves ophthalmopathy Rucsandra Dănciulescu Miulescu, Denisa Margină, Roxana Roşca UMF „Carol Davila“, Bucharest Background and Aims Graves’ ophthalmmopathy is the most frequent extrathyroidal manifestation of Graves’ disease. Ophthalmopathy is more frequent and tends to be more severe in smokers than in non-smokers patients. Smoking may infl uence ophthalmmopathy through direct irritative effects or increased orbital glycosaminoglycans synthesis in response to relative hypoxia. We investigated the prevalence of smoking status in patients with Graves’ ophthalmopathy. Materials and Methods 82 patients (48 women and 34 men) with Graves’ ophthalmopathy were recruited for this study. Graves’ ophthalmopathy is diagnosed clinically by the presenting ocular signs and symptoms. Orbital imaging is useful in monitoring patients for progression of the disease. Patients were screened with a questionnaire detailing their smoking status, <strong>medica</strong>l history, concomitant <strong>medica</strong>tions. Results The median age was 53 years (30-66) in men and 39 years (23-46) in women.The prevalence of smoking in patients with Graves’ ophthalmopathy was 15% (12 patients – 5 women and 7 men). There were statistically signifi cant differences in the recorded parameters in smokers patients and nonsmokers patients. All patients had proptosis (mean 18.24 mm in non-smoker patients and 20.11 mm, in smokers patients). Palpebral edema was present in 9 patients (1 non-smoker and 8 smokers patients) and ophthalmoplegia in 10 patients (2 non-smoker and 8 smokers patients) Conclusion Elimination of controllable risk factors for the progression of the ophthalmopathy – smoking may be very important, even though controlled trials on the effects of smoking withdrawal are lacking. Key words: Graves’ ophthalmopathy, controlable risk factors, smoking status.
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