IMPLICATIONS OF GHRELIN AXIS IN BREAST CANCER--REVIEW.

Breast cancer is, by far, the most frequent cancer among women and many factors influence the physiological and pathological growth and development of the mammary gland. There is developing evidence that the hormone ghrelin, known for the growth hormone releasing effect and food intake modulator, could also play a role in the pathogenesis of breast cancer and may represent a new diagnostic marker and a potential therapeutic target. We performed a PubMed Database search of relevant studies and ten papers were included in our systematic review. Ghrelin axis seems to be definitely involved in the pathogenesis of breast cancer, although a precise role has not been yet established. In order to verify the precise role of ghrelin axis in breast cancer further studies with larger populations are necessary that should include the analysis of metabolic, genetic and environmental factors which are expected to influence the results.

[Early results of the surgical management of gastrointestinal stromal tumors (gist)--the experience of the 3rd surgical unit]. / Rezultate imediate in managementul chirurgical al tumorilor stromale gastrointestinale primare (gist)-- experienta clinicii a III-A chirurgicale.

UNLABELLED: This study provides a clinical and paraclinical algorithm of assessment of gastrointestinal stromal tumors (GIST), with the possibilities and limits of their current management. It is focused on defining an optimal imaging and anatomoclinic diagnosis protocol. In the absence of specific algorithm of surgical management, the study proposes an evaluation of possible histologic diagnosis and the indication for surgery, and the assessing the immediate results of thesurgical treatment. MATERIALS AND METHODS: A retrospective analysis was carried out over a period of 8 years (2004-2011), including patients with pathologic results of resection specimens revealing the stromal nature. There were analyzed the tumor characteri stics, the association with other digestive tumors, the biologic behavior, clinical manifestations and the comorbidities of the patient, the indication for surgery, and also, the surgical morbidity and mortality. From 2004 to 2011 there have been operated 24 cases of GIST diagnosed histologically by common stains. Among them, a total of 16 patients (beginning with 2007) were confirmed immunohistochemicaly. RESULTS: During the study, each clinical suspicion of GIST was an opportunity for thorough assessment of the clinical picture, imaging studies or anatomoclinical aspects (intraoperative macroscopical aspects, pathological and immunhistochemical examination). We have tried a standardization of diagnostic and therapeutic algorithm. Positive diagnosis of GIST was clinicaly suspected in patients with digestive tract tumors (22 cases out of 24) without mucosal involvement, or based on intraoperative macroscopic appearance. The lesions were confirmed by the pathologist. The surgical morbidity (4 cases--16.6%), was to the surgery (a single case of anastomotic leakage) or due to patient's comorbidities (diabetus, chronic renal failure, etc), and has been framed to acceptable extent. No deaths occurred in relation to the surgery. CONCLUSIONS: The diagnostic difficulties are overcome in terms of a positive laboratory features revealed by immunhistochemical examination. The surgical approach of GIST is different from that of a carcinoma. The postoperative immunhistochemical confirmation of GIST, leads the patient to a specific adjuvant treatment.

[Assessment of the quality of life of women with breast cancer in adjuvant treatment with tamoxifen or aromatase inhibitors--a randomized trial]. / Evaluarea calitatii vietii in cursul tratamentului adjuvant cu tamoxifen versus inhibitori de aromataza la paciente cu cancer mamar--un trial randomizat.

PURPOSE: To evaluate and compare the impact on quality of life of tamoxifen and aromatase inhibitors (AIN's) in adjuvant settings, at women with breast cancer. METHODS: From a total of 441 patients with breast cancer with hormonal treatment, were selected 177 of patients with adjuvant hormonal treatment (95 with tamoxifen treatment and 82 with AIN's treatment). These patients have completed the EORTC QLQ C-30 and EORTC QLQ BR23 questionnaires after 1 month of treatment (baseline), at 2 year of treatment with tamoxifen versus aromatase inhibitors (exemestane, anastrazole, letrozole). Mean change score from baseline and 2 years of treatment were compared in the both arms (tamoxifen vs. AIN's). RESULTS: In both arms, after two years, a decreased QOL was observed as compared with the baseline. In the tamoxifen arm, global health status (GHS) and breast symptoms score (BRBS) were similar comparative with AIN's arm at baseline, with a similar status at 2 years measurement. CONCLUSIONS: The global health status (GHS) and breast symptoms score (BRBS) shows that there is no difference in the QOL at the women with breast cancer treated with tamoxifen, comparative with the women treated with AIN's. We conclude that AIN's did not have an adverse impact on overall QOL, comparative with tamoxifen, in adjuvant settings.

Features of pathological assessment in rectal cancer.

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

[Prognosis and treatment of membranous glomerulonephritis-a 5-year prospective study]. / Prognosticul si tratamentul glomerulonefritei membranoase: studiu prospectiv pe 5 ani.

UNLABELLED: The aims of the study were to describe the clinical, pathological and biological features of membranous GN and to prospectively evaluate the relationships between individual negative prognostic factors--type of therapy and outcome. Between 1993-1998, 13/150 (8.7%) consecutive patients with renal biopsy had membranous GN (M = 62%, age = 42.5 +/- 14.5 years). Main (major) findings in these patients were: asymptomatic proteinuria--23.1%, heavy proteinuria (> 10 g/day)--33.3%, microscopic hematuria--53.8%, increased plasma creatinine levels--33.3%, hypertension--23.1% cases. 60% of the patients with nephrotic proteinuria had an underlying cause (infection, malignancy, immune-mediated systemic diseases). 40% of the patients with nephrotic proteinuria had 0 or less than 2 negative prognostic factors (without any of the recognized severe morphological changes). The following differentiated treatment protocols were applied: no treatment for asymptomatic proteinuria (group A), i.v. methyl-prednisolone boluses + prednisone 1 mg/kgc/day 3 months for those patients with few negative prognostic factors (group B), and steroids (as above) + cyclophosphamide (2 mg/kgc/day 3 months) or the Ponticelli regime in patients with important risk factors (group C). Outcome after a median follow-up period of 24 months was: complete remission in all cases from groups A + B (with only one exception were the underlying cause was breast malignancy); in group C in 75% of the subjects a complete or partial remission (proteinuria < 1 g/day) was obtained. Only one case progressed to chronic renal failure. There were no secondary effects from corticoids or immunosuppressive therapy. CONCLUSIONS: In membranous GN treatment should be tailored to the presence and type of negative prognostic factors. Even in high-risk patients combined steroids and immunosuppressive therapy determines a favorable outcome in 75% of the cases, without severe adverse effects.

Hepatitis virus infection in haemodialysis patients from Moldavia.

BACKGROUND: Although the epidemiology of hepatitis B (HBV) and C (HCV) now seems well established for Western European countries, in Central and Eastern Europe < 50% of all dialysis centres routinely test for hepatitis C antibodies since testing is not available or is not applied to all patients. This study describes the prevalence, risk factors and clinical significance of HBV and HCV infection for the haemodialysis population of the North Eastern region of Romania, Moldavia. METHODS: The presence of HBV antigens was determined with an ELISA kit (Wellcome, Abbot) and HCV antibodies with the ELISA-3 Ortho-HCV, third generation test. The following individual data were collected: gender, age, duration of dialysis, rural/urban domicile, actual and previous HBV status, actual HCV status, known acute, clinically evident hepatitis episodes in the last 3 years, monthly alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) levels, complete biochemical hepatic assessment at the time of the study, transfusions for the past 3 years and family history. RESULTS: HBV and HCV prevalences were 17% (stable over the last 3 years) and 75%, respectively; co-infection was seen in 10% of the subjects. Hospitalization (nosocomial infection) for HBV, blood transfusions and duration on dialysis for HCV, emerged as the main risk factors for hepatitis infection. Socio-economic conditions appear to be equally important for HCV infection, since the prevalence was significantly higher among patients from rural, underdeveloped areas than urban areas (80.8 vs 60.3%), and infection was already present in a large proportion of patients (47%) before starting dialysis, without being related to previous disease duration or blood transfusions. HBV and/or HCV was not associated with a worse clinical or biochemical profile at the time of the study. However, infected patients had significantly more previous cytolytic episodes, with higher, transient increases in ALAT and ASAT levels. CONCLUSIONS: HCV infection is endemic among dialysis centres in Moldavia. Apart from previously well-known risk factors for hepatitis infection, our study demonstrates the negative impact of socio-economic underdevelopment. Simple measures such as enforced general asepsia rules, careful disinfection and equipment sterilization, routine testing of patients from economically disadvantaged areas and monthly, serial determination of hepatic enzymes should be the common practice in dialysis centres in Romania.

[Klatskin's tumor]. / Tumora Klatskin.

During the period 1989-1998, 27 patients with primary proximal bile duct cancer were treated (17 females and 10 males with a mean age of 61 years). The main presenting symptoms were: jaundice (96.2%), itching (92.5%), weight loss (74%) and atypical pain (33.3%). All the patients underwent ultrasound (US) examination, 7 patients endoscopic retrograde cholangiopancreatography (ERCP) and 4 patients computed tomography (CT) examination. US examination revealed the tumor in 51% cases; most frequently a dilatation of the intrahepatic bile ducts was diagnosed with all methods. 8 patients underwent resection of the tumor and one a biliary-enteric anastomosis, in 15 cases a stent was inserted. In 3 cases the extension of the malignancy did not allowed any procedure. Three patients died during immediate postoperative period (mortality 11.2%). The mean survival was 13 months after stenting and 22 months after resection of the tumor. The authors recommended an aggressive surgical therapy for Klatskin tumors.

Rifampicin-induced acute renal failure: a series of 60 patients.

BACKGROUND: Since 1971, 55 case-reports of rifampicin-induced ARF have been published, but systematic data on this condition are not available, in view of the disparate nature of the observations. METHODS: We retrospectively assessed prevalence, clinical and biochemical features, and prognostic factors of 60 consecutive cases (41 males/19 females, age 22-68 years), who were admitted to the Iasi Dialysis Centre from 1987 to 1995 for acute renal failure (ARF) following re-treatment with rifampicin. RESULTS: The clinical appearance consisted mainly of gastrointestinal and 'flu-like' symptoms and clinical signs of intravascular haemolysis (the latter in 17% of cases). Frequent laboratory findings were anaemia (96% of cases), leukocytosis (63%), and thrombocytopenia (50%). Severe anaemia was associated with marked haemolysis (25% cases), thrombocytopenia, longer anuria, and slower rate of renal function recovery. Signs of hepatic injury were found in 25% of patients, but it did not seem to affect the outcome of renal function. Prognostic factors in post-rifampicin ARF proved to be the following: the duration of the anuric phase (correlated with the number of dialysis sessions and with the rate of decrease of azotaemia) and the severity of the immunological abnormalities and inflammatory syndrome (haemolysis, leukocytosis, hypergammaglobulinaemia). Post-rifampicin ARF accounted for 16.6% of all ARF cases hospitalized in our Centre during the studied period. Its clinical course was favourable; the mortality rate was only 1.6% (1 case), compared to a 20% general mortality rate among all ARF patients. Full recovery of renal function was achieved in 40% and 96% of patients, 30 and 90 days respectively from onset. CONCLUSIONS: ARF after treatment with rifampicin is not an uncommon condition, especially when tuberculosis prevalence is high, but renal prognosis is usually favourable. Thrombocytopenia, immune haemolytic anaemia, and intravascular haemolysis are frequent complications which are associated with a more severe renal injury.

[The determination of the prevalence of antibodies to the hepatitis C virus (anti-HCV) and of the serum levels of C-reactive protein in chronic dialysis patients]. / Determinarea prevalentei anticorpilor fata de virusul hepatitei C (anti-VHC) si a nivelelor serice ale proteinei C reactive la pacienti dializati cronic.

UNLABELLED: The chronic dialysis patients are subject at risk for the hepatitis C virus (HCV) infection. Among these subjects, the hemodialysis-induced and increased synthesis of IL6 which suggest an acute phase response. 58 chronic dialysis patients were tested for presence of anti-HCV antibodies; 45 (77.58%) presented this serological marker. None of the 15 nursing subjects tested presented anti-HCV. C reactive protein (CRP) levels were measured in 41 patients. Elevated levels were detected in 5 (12.19%) patients. Such a high prevalence of anti-HCV reveals the hemodialysis to be a risk factor for the HCV infection. CRP levels measured by Mancini method lack the sensitivity for a more accurate interpretation. CONCLUSION: 1. the high anti-HCV prevalence among hemodialysis patients emphasize the opportunity of blood testing also for serological markers in ante-transfusional screening. 2. the immunoturbidimetry method for CRP testing may be a better assay in order to establish significant correlations.