Context. Oxytocin has been investigated as a potential medication for psychiatric disorders. Objective and design. This study prospectively investigates correlations between oxytocin and other neuropeptides plasma levels in patients with autism spectrum disorders (ASD) according to severity and treatment, as compared to controls. Subjects and methods. Thirty-one children (6 neurotypical as control) participated in this study. The patients were classified into mildly and severely-affected, according to Autism Diagnostic Observation Schedule (ADOS) scores. Oxytocin, orexin A and B, α-MSH, β-endorphins, neurotensin and substance P were investigated using a quantitative multiplex assay or a competitive-ELISA method. Results. Plasma oxytocin levels differed between the groups (F (2, 24) =6.48, p=0.006, η2=0.35, observed power=86%): patients with the mild ASD had higher values of plasma oxytocin than those with the severe form (average difference=74.56±20.74pg/mL, p=0.004). Conclusions. These results show a negative correlation between plasma levels of oxytocin and the severity of ASD and support the involvement of oxytocinergic mechanisms in ASD.

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible. Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

RezumatVã prezentãm cazul unui pacient în vârstã de 93 de ani cu ocluzie intestinalã datorate unei tumori de colon descendent, cu ascitã carcinomatoasã şi determinãri secundare hepatice şi pulmonare. Având în vedere riscurile asociate unui act chirurgical la un astfel de bolnav cât şi imposibilitatea efectuãrii unei intervenţii curative, a fost montat un stent colonic metalic auto-expandabil. Evoluţia post-intervenţie a fost favorabilã, pacientul fiind externat 48 de ore mai târziu. Cancerul de colon stâng se diagnosticheazã în fazã ocluzivã în 8 pânã la 26 % din cazuri (1). Acesta, necesitã de cele mai multe ori o rezolvare imediatã chirurgicalã datoritã potenţialului risc de deces. Procedurile chirurgicale efectuate în regim de urgenţã asociazã rate crescute de morbiditate şi mortalitate (2). Astfel au fost dezvoltate alte modalitãţi de rezolvare ale acestor urgenţe chirurgicale. Stenturile colonice au fost raportate prima datã în literaturã de cãtre Dohmoto (3). Iniţial, folosirea stenturilor a fost gandita ca şi metoda finala de paleaţie (4). Ulterior sau folosit ca punte catre chirurgia programata minim invaziva (5).Cuvinte cheie: tumora de colon descendent, ocluzie intestinalã, stent colonic metalic auto-expandabil AbstractWe present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).

Introduction: Self expandable metal stents (SEMS) are developed lately, as an effective and safe, less invasive alternative of surgery for the treatment of malignant intestinal/biliary obstruction. Recently, SEMS are also introduced in benign pathology. Aim: The aim of this presentation is to report a retrospective analysis of the total number of SEMS placed for esophageal, enteral, colorectal and biliary obstruction during the last 3 years in Clinical Emergency Hospital Bucharest, as well to review the literature published on this issue. Methods: Between 2013-2015 in Clinical Emergency Hospital Bucharest, we have placed: 232 esophageal stents, 23 enteral stents, 5 colonic stents and 75 biliary stents under radiologic guidance. The main parameters followed were represented by: sex, age, grades of obstruction, stent diameter and type, immediate and late complications and survival rate. Results: Regarding the esophageal stenting, most of the indications were malignant obstruction (155 cases of esophageal cancer and 30 cases of extrinsic compression), but also for esophageal fistula, peptic stenosis and even traumatic esophageal rupture. The majority of the enteral and colonic stents were inserted for malignant obstructions, having only 2 cases with benign obstructions. This is also the case for biliary stenting, were most of the indications were represented by pancreatic cancer. Technical and clinical success rates were approximately 92% and 80%, respectively. There were no major complications of perforation, bleeding, or death. Conclusions: SEMS insertion can be performed safely, with minimal complications and hospitalization allowing the restart of oral feeding and improvement of nutritional status for the digestive obstruction or jaundice disappearance in case of biliary obstruction. It represents the first option for unresectable digestive/biliary malignant obstruction.

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