The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period.

INTRODUCTION: Previous series during the dissemination era of minimally invasive techniques for treatment of prostate cancer (PCa) showed a declining use of pelvic lymph node dissection (PLND). The aim of our study was to re-assess the impact of robot-assisted radical prostatectomy (RARP) on the utilization rate of PLND and its extent in the post-dissemination period. METHODS: Relying on the Surveillance Epidemiology and End Results (SEER) Medicare-linked database, 5804 patients with non-metastatic PCa undergoing open radical prostatectomy (ORP) or RARP between years 2008 and 2009 were identified. Uni- and multivariable logistic regression analyses tested the relationship between surgical approach (RARP vs. ORP) and: 1 - the rate of PLND (pNx vs. pN0-1); and 2 - the extent of PLND (limited vs. extended). RESULTS: Overall, 3357 (57.8%) patients underwent a PLND. The proportion of patients treated with PLND was significantly higher among ORP vs. RARP patients: 71.2 vs. 48.6%, respectively (P < 0.001). In addition, the median number of lymph nodes removed was significantly higher for patients treated with ORP vs. RARP: 5 vs. 4, respectively (P < 0.001). In multivariable analyses, ORP was associated with 2.7- and 1.3-fold higher odds of undergoing PLND and of receiving an extended PLND compared to RARP, respectively (both P ≤ 0.001). Stratified analyses according to disease risk classifications revealed similar trends. CONCLUSIONS: In the post-dissemination era, RARP remains associated with a decreased use of PLND and suboptimum extent. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumor aggressiveness, despite surgical approach.

Morphological and immunohistochemical criteria of tissue response to radiotherapy in rectal cancer.

AIM: Given the context that rectal tumours respond to a certain degree to radiotherapy, a necessity arises for estimating a tumour's capacity to react to radiation from the very moment of diagnostic biopsy. MATERIAL AND METHODS: We have histologically and immunohistochemically analysed tissues coming from 52 patients with rectal adenocarcinomas. RESULTS: Of the studied parameters, the ones presenting significant variation under radiotherapy in terms of statistics(p 0.05) were: colloid type (p=0.001), EGFR in the tumour(p=0.00045), EGFR in the normal epithelium (p=0.0017),VEGF in the tumour (p=0.0132) and VEGF in the tumour stroma (p=0.030). CONCLUSIONS: Our study follows the same trends as the medical literature we have consulted regarding the variation of EGFR and VEGF with radiotherapy, and the distinct note of our study relies in the observation that normal stroma in case of rectal tumors also reacts to radiotherapy, sometimes more aggressively than the tumor itself, especially in which concerns the nerve and muscle fibers.

Analysis of several BRCA1 and BRCA2 mutations in a hospital-based series of unselected breast cancer cases.

BACKGROUND: The distribution of BRCA mutations varies significantly between populations. The spectrum of BRCA1 and BRCA2 mutations in breast cancers in the Romanian population is incompletely known. The aim of the present study is to investigate the presence of nine BRCA mutations in patients with breast cancer identified in a surgical clinic from Bucharest. METHODS: Unrelated women diagnosed with breast cancer from Coltea Hospital (n=114) and healthy controls (n = 150) were selected for this study. Seven mutations in BRCA1 (185delAG, 5382insC, 943ins10, E1250X, 1294del40, E1373X, R1443X) and two in BRCA2 (IVS16-2A4G and 6174delT) were tested using PCR based protocols. In addition, the presence of BRCA1 185delAG, BRCA1 5382insC, BRCA2 6174delT mutations were tested with a post amplification mutation detection system, based on the ELISA method. RESULTS: Two patients with sporadic breast cancer (2%) and one patient with family history of the disease (7.14%) have the BRCA1 5382insC mutation. No other mutation was detected in patient and control groups. The mutations were not present in the control lot. CONCLUSIONS: Our results indicate that BRCA1 5382insC is a common mutation in Romanian women with breast cancer (3 114).

[Synchronous gastrointestinal stromal tumor (GIST) and multiple digestive neoplasms, benign and malignant]. / Tumora gastro-intestinala stromala (GIST) asociata sincron cu multiple neoplazii digestive benigne, precursoare si maligne.

Gastrointestinal stromal tumors (GIST) are a broad category of mesenchymal, non-epithelial primary tumors of the digestive tract, located in the wall of hollow viscera, from the esophagus to the anus and often in adjacent mesentery and omentum. They are clinically unpredictable (may be discovered incidentally during an imagistic investigation or during surgery for other pathological entity, or at necropsy) and also have an unpredictable behavior (GISTs with very low risk, with low or moderate malignancy, which have benign histopathologic features but can recurr or can metastasize). The case we present here represents a rare association between a synchronous gastrointestinal stromal tumor (GIST) and multiple gastric benign and malignant tumors.

MTRR polymorphism and the risk for colorectal and breast cancer in Romanian patients--a preliminary study.

BACKGROUND: The risk of colorectal cancer (CRC) and breast cancer (BC) is influenced by polymorphisms located in the genes encoding enzymes of the folate pathway. The aim of this study was to evaluate if A66G MTRR (rs1801394) polymorphism is involved in predisposition for colorectal and breast carcinogenesis in Romanian patients. MATERIALS AND METHODS: In the present case-control study, 300 individuals divide in four groups: sporadic CRC patients (n = 120), control CRC (n = 60), BC patients (n = 60) and control BC (n = 60), were genotyped by PCR-RFLP method. RESULTS: Frequency of genotype AA was 11.7% in CRC control and 5% respectively in BC control. For cancer groups the frequency of genotype AA was 9.2% in CRC and 0% in BC. CONCLUSIONS: Study results do not demonstrate an association between A66G MTRR polymorphism and CRC or BC in Romanian patients.

The weak rate of sphingolipid biosynthesis shown by basal keratinocytes isolated from aged vs. young donors is fully rejuvenated after treatment with peptides of a potato hydrolysate.

A new study was carried out to bring more information on the effect of the potato proteins ferment. Basal keratinocytes obtained from freshly excised skin samples of two groups of five donors, a young one (25-36-year-old) and an aged one (59-70-year-old) were established in culture. The results showed a downward trend in the content of all lipid fractions in untreated keratinocytes of aged donors when compared with young ones. We found major differences in the response of keratinocytes to potato proteins ferment treatment between young and old donors. Whereas the lipid content of cells from young donors increased either moderately or actually decreased in some cases in comparison with the untreated controls, the lipid biosynthesis was strongly stimulated in aged donors' keratinocytes whose lipid contents globally became close to those found in young donors. However, the changes elicited by potato proteins ferment treatment were not seen at the same extent for all lipid classes. Cholesterol content increased up to three-fold and alpha-hydroxy fatty acids were augmented up to seven-fold, whereas the increase in normal fatty acids was quite moderate. In sphingolipids labelled by incubation of keratinocytes in culture medium containing [(14)C]-serine, ceramides and glucosylceramides in cells from aged donors showed the highest uptake of radioactivity, with somewhat less incorporation in sphingomyelin and gangliosides. Therefore, it seems that potato proteins ferment has a much more potent stimulatory activity on the lipid biosynthesis of basal keratinocytes of aged donors, thereby normalizing the cellular lipid content that obviously decreases along with ageing. Although our results were obtained only with basal keratinocytes in this study, potato proteins ferment could be beneficial to maintain an efficient skin barrier in ageing people, provided that the peptides can get through to the basal membrane upon topical application.

[Adenoid cystic carcinoma of the breast--two case reports]. / Carcinom adenoid chistic mamar--prezentare a doua cazuri.

Adenoid cystic carcinoma is a rare type of breast carcinoma with a good prognosis. It represents less than 0,1% of breast carcinomas. We present two cases of adenoid cystic carcinoma diagnosed in the Surgical Department of Coltea Hospital in the last 3 years. The first case is a 66 years old patient with a breast tumor that has clinical and imagistic features compatible with a benign diagnosis. The frozen sections established the diagnosis of adenoid cystic carcinoma, confirmed by histopathologic examination of paraffin embedded tissue and immunohistochemistry. The second case is a 68 years old patient with a breast tumor located in the central quadrant of the left breast, with skin infiltration. Preoperatory fine needle aspiration is sugestive of a papillary tumor, so the cytologic exam cannot establish malignancy. The frozen sections established the diagnosis of ductal invasive carcinoma and histopathologic examination of paraffin embedded tissue and immunohistochemistry established the diagnosis of adenoid cystic carcinoma associated with ductal invasive carcinoma grade I and adenomyoepitelioma. The cytology had a false papillary aspect, in fact there was amorphous material contained in pseudoluminal spaces. In both cases the treatment was surgical resection with tumor excision and free resection margins. In the second case lymphadenectomy was also performed.

[Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem]. / Tumora stromala de diverticul Meckel--cauza rara de hemoragie digestiva si problema de diagnostic.

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.

A set of glycoproteins recognized by A2B5 antibody with major bands at 55 and 76 kDa is overexpressed in human head and neck squamous cell carcinomas.

A2B5 antibody was found to strongly label frozen sections of human head and neck squamous cell carcinomas. The low amount of glycolipids (c-series gangliosides and sulfatides) purified from the same tumors and reactive with A2B5 by immunostaining on thin-layer plates could not account for the high level of tissue labeling. Proteins were extracted from both normal tissues and squamous cell carcinomas and analyzed by Western blot with A2B5 antibody on PVDF membranes. The antibody was found to stain a set of glycoproteins with two major bands at 55 and 76 kDa present in normal tissues and overexpressed in carcinomas. Staining was abolished by prior treatment of the PVDF membranes either with Arthrobacter ureafaciens neuraminidase or with a solution of 10 mM periodate that is known to destroy carbohydrates. Our results show that the carbohydrate epitope recognized by A2B5 antibody can be displayed by both glycolipids and glycoproteins.

[Mental and behavior disorders in children placed in long term care institutions in Hunedoara, Cluj and Timis, Romania]. / Les troubles mentaux et les troubles du comportement des enfants placés en établissement de long séjour dans les judets de Hunedoara, Cluj et Timis, Roumanie.

This article originated from a descriptive study done in 1992-1993 in Romania. The study was initiated and coordinated by the French NGO "Médecins du Monde", was directed by three health organizations (the "Observatoire régional de la santé de Languedoc-Roussillon", the "Unité 265 INSERM", the Romanian League for Mental Health) and was granted by the Romanian government and the European Community Commission. There are many publications about children's mental and behavioural disorders. But there are few epidemiological studies concerning the prevalence of these disorders among children suffering from social difficulties. This article explores the prevalence of mental and behavioral disorders among Romanian children institutionalized and examines specifically the prevalence among children in homes for children ("Casa de Copii") to compare it with similar data published in other countries. First, this article explores the prevalence of mental and behavioral disorders among a population of 4.692 children institutionalized in three Romanian districts in 1992. Second, this article examines the prevalence of these disorders among a population of 1.610 children institutionalized in homes for children ("Casa de Copii"), i.e. 1,610 children ages ranging from 4 to 18 years and suffering from social difficulties. Homes for children are out of home care institutions which are specialised neither in physical deficiencies nor in mental disorders. From this population, a randomized sample of 508 children has been screened by physicians and psychologists based on an evaluation protocol. Then each disorder has been coded as a diagnosis, according to the Tenth International Disease Classification (WHO). Fifty-four percent (54%) of the children institutionalized in homes for children in three Romanian districts in 1992 had a main diagnosis of mental or behavioural disorder. Third, this article compares our results to the prevalence found in other studies. Only three studies could be selected for comparison because they were the only ones with the three following criteria: 1) a focus on a population of children or a randomized sample of children ages ranging from 4 to 18 years, 2) a focus on children suffering from social difficulties and living in out of home care, 3) disorders evaluated by health professionals or a validated methodology. Our results lies within the range of prevalence found in the literature (41-70%). A discussion follows regarding methodological matters and critiques that may be launched from such a comparative designs. Finally, the high frequency of institutionalization in Romania in 1992 illustrates how few solutions there were to social difficulties and how exaggerated institutionalization was. This was a very different situation compared to Western Europe and Northern America. This should not hide, however, the actual modifications that took place in Romania. This article concludes with a brief description of the modifications which have been generated by the evaluation protocol used here.

Cystic fibrosis mutations in Romania.

UNLABELLED: We have investigated the genotype in 32 children with cystic fibrosis from Romania. The diagnosis of cystic fibrosis was made on the basis of typical clinical findings and sweat electrolyte levels using the pilocarpine iontophoresis method. CONCLUSION: Genetic analysis of 32 children with cystic fibrosis from Romania showed a 25% incidence of DeltaF508 mutation and a 64.5% incidence of unknown mutations, 5 other known mutations and 1 new mutation 1,717-2(A > G).

[Esophageal stenosis and esophagotracheal fistula with concomitant gastric ulcer in "caustic soda" ingestion]. / Stenoza de esofag si fistula esotraheala însotite de ulcer gastric, în ingestia de "soda caustica".

The article deals with a special case through it's gravity and lesional complexity. A forty years old ill person with esophagus stenosis and postcaustic esophagotracheal fistula, having both a gastric ulcer on the date of surgery is operated in three stages: 1. Vagotomy, pyloroplasty and gastrotomy. 2. Esophagectomy with Kirschner-Nakayama gastric grafting. Posterior tracheorraphy with esophageal muscular patch. 3. Anastomotic cervical stenosis--plastic replacement (grafting) with a fat-less skin.

Biological activity of maleic anhydride copolymers. I. Biocompatibility and antitumoural effects of maleic anhydride-vinyl acetate, maleic anhydride-methyl methacrylate and maleic anhydride-styrene copolymers.

A series of maleic anhydride (MA)-vinyl acetate (VA), MA-methyl methacrylate (MM), and MA-styrene (S) copolymers were prepared and characterized. On employing various amounts of initiator, maleic anhydride-vinyl acetate, methyl methacrylate, and styrene copolymers with molecular weights ranging between 18,000 and 200,000 have been obtained. The in vivo and in vitro tests performed on K562 cellular cultures (human chronic myeloid leukemia) have shown that, as a function of the molecular weight, the synthesized copolymers demonstrate a 50% in vitro cytotoxicity and an average tumour regression of maximum 68%.

Ultrastructure of the adipose tissue matrix in children with malnutrition.

Bioptic fragments of adipose white tissue taken from trochanterian area from children of 2-22 months old were ultrastructurally investigated. Children were of both sexes, 5 normal and 22 with clinical diagnosis of malnutrition. There were studied many interadipocyte spaces signalling out in cases with malnutrition modifications of different components, some of them related with the degree of malnutrition. There were noted: disorganisation and disappearance of basal membranes of capillaries and glycolema; modifications of endothelial cells with lesions of the capillary wall and free degraded red blood cells; disorganization of the ground substance in small areas or sometimes extended to all matrix of the space; collagen fibres reduced in number and size, and in two cases the presence of collagen fibrils with severe lesions, realeasing an electrondense material, fibrinoid-like; matrix infiltration, in some cases with lipids. In only one interadipocyte space a synaptic button was noted in contact with capillary. In malnutrition lesions of cellular elements of the white adipose tissue the following were observed: adipocytes, fibroblasts, fibrocytes, endothelial cells, mast cells--which in their turn are responsible for modifications of macromolecular structures of the extracellular matrix--glycosaminoglycans, proteoglycans, components of which biosyntheses are cell-dependent.

[The clinico-echocardiographic aspects in acute pericarditis in a small child]. / Aspecte clinico-ecocardiografice în pericardita acuta la copilul mic.

The authors present a case of pericarditis in a 12-months-old child. They underlined the peculiarities of the onset and of the evolution.

Clinical results of the Pop De Popa xenobioprosthesis in patients with advanced heart failure: long-term follow-up of 562 patients.

From January of 1984 through December of 1990, we implanted 739 Pop De Popa wild boar aortic valves in 626 patients, in all cardiac valvular positions. Of these patients, 562 received only the Pop De Popa xenobioprostheses, which numbered 620 valves. Only patients with contraindications for bioprosthetic valves (such as children under the age of 15) were excluded. At surgery, the 562 patients ranged in age from 17 to 66 years (mean, 41.7 yrs). Five hundred thirty-one (94.48%) were in NYHA functional class III or IV before valve replacement. Of the 620 valves implanted, 20 were replacements for Pop de Popa prostheses and the other 600 were replacements for native valves. Survivors were followed-up for a mean period of 31.6(+/-22) months (range, 3 months to 7 years), and for a cumulative period of 2,432 patient-years. Over the 7-year period of study, there were 78 late deaths, and 32 other patients were lost to follow-up. The analysis demonstrated good cardiac and general improvement. At the conclusion of the 7-year study, 94.83% of the survivors subject to follow-up were in NYHA functional class I or II. The early mortality rate was 12% (68 patients), and the following incidence of early valve-related complications was noted: thromboembolism, 3% to 4%; endocarditis, 1% to 2%; paravalvular leak, 1% to 2%; primary tissue failure, 1%; and anticoagulant-related hemorrhaging, 1%. At 7 years, 90% of survivors subject to follow-up were still free of valve failure. The probability of complications was as follows: thromboembolism, 16.1%; endocarditis, 8.8%; paravalvular leak, 4.4%; anticoagulant-related hemorrhaging, 1.2%; and valvular degeneration and reoperation, 12.5%. The probability of survival at 7 years was 86.12%. While this study does not yet demonstrate the superiority of the wild boar valve over other bioprosthetic valves, it does reaffirm the worth of implanting biologic valves in adult patients when not contraindicated. Perhaps as we continue follow-up beyond 7 years, the apparent durability of the wild boar cusps will manifest itself in a statistically significant manner.