[PSA as a marker for prostate cancer progression]. / PSA CA marker in evolutia cancerului de prostata.

Monitoring the evolution of prostate cancer has crucial importance since this tip of neoplasia has a variable biology, ranging from latent cancers to extremely aggressive tumors. At the moment, PSA (prostate specific antigen) values point out to either successful or unsuccessful prostate cancer therapy. Depending on therapeutic strategies, biochemical recurrence (BCR) is differently defined. After radical prostatectomy, the PSA declines to undetectable levels in 3-4 weeks; BCR: PSA = 0.2-0.5 ng/mL for a single measurement or two consecutive values which surpass 0,2-0,4 ng/mL. PSADT < 10 months is a predictor for the progression of the disease. After external beam therapy, PSA is slowly decreasing reaching up the nadir of 0.2-0.5 ng/mL in months or years; BCR: PSA = nadir + 2 ng/mL. In the case of brachytherapy, the nadir is reached in 2-4 years; BCR: nadir + 2 ng/mL. After hormonal therapy, PSA declines in 3-6 months, maintains low values for 18-24 months, then increases, settling for hormone independency. After chemotherapy, PSA is considered normal at values < 2 ng/mL; the response of PSA represents a confirmed decreasing from the second test at 4 or more weeks after the initial decline; the length of the response is the period between first decline with 50 % of PSA to 50 % increase from nadir; the progression of PSA is shown in the increase with 25 % in comparison to the basic level. In the case of active monitoring, a PSADT < 2 years is an indication for radical prostatectomy, but there are cancers which can evoluate despite a stable PSA. The "PSA bounce" phenomenon and the "PSA surge postchimiotherapie" syndrome can complicate the assessment of biochemical recurrence.

[Parathyroid glands involvement in multiple endocrine neoplasia]. / Interesarea paratiroidelor in neoplaziile endocrine multiple.

UNLABELLED: Multiple endocrine neoplasias are syndromes characterized by the involvement of at least two endocrine glands. Parathyroid gland involvement is usually noted in Multiple Endocrine Neoplasia (MEN) type I and type II. Parathyroid glands tumor associated with endocrine pancreatic tumor, as well as pituitary tumors is the typical pattern of MEN I. The parathyroid gland is the most frequent abnormality in MEN I. CASES REPORTS: We presented five cases with MEN I and parathyroid glands involvement. In three cases with young ages (28-33 years old) and familial setting, the MEN I syndrome was "complete" (parathyroid adenoma, gastrinoma or insulinoma and pituitary adenoma--prolactinoma or GH-secreting tumors), and, in the other two cases, with 57 and 68 years old respectively, the MEN I syndrome was "incomplete" with parathyroid glands and pituitary gland involvement. The cases with gastrinomas were operated in emergency for complication of peptic ulcer (perforation associated with peritonitis and gastro-intestinal bleeding); then the pancreatic tumors were diagnosed and left pancreatectomy with spleen preservation and respectively, tumor resection have been performed. Hyperparathyrodism was then diagnosed and subtotal parathyroidectomy has been performed in both cases. Unfortunately one patients died due to severe endocrine disorder. During the necropsy, the pituitary adenoma has been diagnosed. The third case with "complete" MEN was a women of 33 years old, admitted for severe hypoglycemia. The imagistic and laboratory test diagnosed a tumor situated into the pancreatic body, and an parathyroid adenoma. The resection of pancreatic tumor associated with resection of the parathyroid adenoma, in the same time, were performed. The other two cases with "incomplete" MEN were older then the first patients, and were diagnosed with hyperparathyrodism and pituitary gland tumor. The resection of parathyroid gland adenoma has been performed in both cases, with uneventful postoperative course. The literature data was also discussed. CONCLUSIONS: The parathyroid glands involvement in MEN is common. There are two kinds of MEN associated with parathyroid gland involvement: the "complete" form, especially in young patients, with diffuse involvement of the parathyroid glands, and the subtotal parathyroidy is the best choice, and the "incomplete" form, especially in elderly, with the involvement of a single parathyroid gland; in this way, the resection of the adenoma associated with biopsy from the other parathyroid gland is the best approach. The presence of gastrinomas, complicate the disease prognosis and the surgical approach. The treatment of these patients is challenging and has to be done in multidisciplinary team.

[Unusual forms of liver abscesses]. / Forme particulare de abces hepatic.

UNLABELLED: Liver abscess is a rare disease. In this paper we present five unusual cases of liver absceses. These cases represents 5.68% from all patients with liver abscesses treated in the First Surgical Clinic Iasi, from 1977 to 2007. The ethiology of the abscesses was different: intrahepatic biliary duct migration of Ascaris lumbricoides, migration of a foreign body (toothpick) from stomach into the liver, infected hydatid cyst with a large biliary leak and cholangitis and, residual cavities after surgical treatment of hepatic hydatid cyst associated with foreign bodies. Another case was a patient with a very large, multilocular liver abscess (2000 mL) with biliary ethiology. In all cases a surgical drainage was performed. In the cases with hydatid cysts and biliary leakage, ERCP procedures were performed. The postoperative course was uneventful. CONCLUSIONS: Surgical treatment remains a valuable option in the treatment of pyogenic hepatic abscesses especially in unusual form.

[Scintigraphic visualization of Pgp protein: a non-invasive method to evaluate the MDR cellular character]. / Vizualizarea prin scintigrafie a proteinei Pgp--metoda neinvaziva de evaluare a caracterului MDR tumoral.

The MDR character is a major factor that influence the effectiveness of cancer chemotherapy. This feature can be noninvasively evaluated through 99mTc isonitrils (MIBI, Tetrofosmin) scintigraphy, because these radiotracers cellular efflux is mediated by the Pgp membranar active transport system, the same that mediate chemotherapy drugs cellular efflux. The Pgp glycoprotein overexpression in the case of the MDR positive tumoral cells will determine both the chemotherapic drug and the isonitrile radiotracer quickly efflux from the cell. This paper present, based both on the literature and personal authors research work, the principle of the method, radiotracers structural characteristics and cellular uptake mechanism, practical protocol details from the acquisition untill the qualitative and quantitative image processing and results interpretation. Quantification indexes are proposed for the radiotracer cellular uptake quantitative evaluation on the scintigraphic image. The results could bring the possibility to make MDR positive patient diagnosis and further selection for the MDR modulators drug therapy.

[The role of fine needle aspiration biopsy in differentiated thyroid carcinoma]. / Utilitatea punctiei cu ac fin in carcinoamele tiroidiene bine diferentiate.

UNLABELLED: Fine needle aspiration biopsy (FNAB) in evaluation of nodular goiter generated a true revolution. It is generally assumed that the use of FNAB reduces the number of surgical procedures by 50%, while doubles the proportion of carcinoma in surgically treated patients. The aim of the study was to demonstrate the utility of FNAB in preoperative diagnosis of thyroid carcinoma. MATERIAL AND METHOD: We have investigated 3240 patients with nodular goiter by FNAB (MGG stain and morphometrical analysis), followed by morphological examination in those who underwent surgery. RESULTS: Globally, FNAB had a good sensitivity (77%) and specificity (95%), which made an accuracy of 92%, proving its diagnostic value. In follicular carcinoma (FC), where the cytological diagnostic cannot be certain, morphometry helped the diagnostic: mean cells diameter was significantly higher (p < 0.001) in FC (9.5 mm) vs. thyroid adenoma (8.6 mm). CONCLUSION: With good statistical value, FNAB remain a useful preoperative diagnostic method.

An image pre-processing automatic system for bone scan metastasis evaluation.

Scintigraphic images provide morphologic and functional information referring to pointed human body tissues and organs. Depending on the ability and experience of the nuclear medicine physician and the degree of scintigram complexity, the diagnosis process becomes very difficult sometimes. Image processing might decrease subjectivity and help physicians in decision making in complex cases as bone metastasis diagnosis based on scintigraphic explorations. The aim of this paper is to describe the compulsory steps of a pre-processing method in order to build a database for an automatic final appreciation of pathologic bone scan areas as a percentage of the total bone scintigraphic surface. This may include the scintigraphic result in some metastasis probability category with more accuracy than a simple, subjective appreciation of the scintigram, especially in doubtful cases. This paper points to the steps of the processing method of the database used in the rule-based nuclear medicine aide-decision expert system (NMADES). The objective evaluation of the pathological sites requires image preprocessing operations in a number of steps: histogram transforms, correlated superposition of direct and reversed incidences to reinforce the uptake sites, smoothing by pseudo-cepstrum methods, symmetry axes extraction by robust linear regression and symmetric areas search with fuzzy methods. Some for and against's are underlined in the last section, devoted to conclusions and future work.

[PET-CT scan: a major progress toward fused, metabolic and functional images]. / PET-CT: un progres major în fuziunea imaginilor metabolice si anatomice.

Positron emission tomography (PET) is an imaging method that allows metabolic mapping of disease processes after a specific radiotracer administration. One of the major disadvantages of using radioactive glucose is the fact that this radiotracer is not entirely specific for tumor tissue. Also, the physiological distribution of 18F FDG makes difficult the anatomical localization. Computed tomography (CT) provides en excellent anatomic resolution but the functional information is reduced. In this circumstances PET and CT gives complementary information, and together increase the lesions localization and reduce the artifacts of interpretation. That was exactly the purpose for building the new hybrid gamma camera PET-CT. The new concept of hardware fusion between PET and CT is now commercially available from five years. By the meaning of fused anatomic and functional imaging PET-CT has already found a number of clinical applications in oncology. The new imaging technology reduces image acquisition time, improves tumor localization which is difficult if not impossible with PET alone, and calculate more accurate the target tumor volume for radiotherapy planning. This article is a review from literature data, concerning the mean indications, weaknesses, current evidence and future directions of PET-CT. In Romania, there are not available either PET or PET-CT. We believe that the aspiration at the European standards will remedy it as soon as possible.

Cancer evolution assessment using artificial neural networks.

Artificial Neural Networks have demonstrated good utility to establish disease prognostic, if there are correctly trained. Our aim was to realize Artificial Neural Networks in different cancer types, to evaluate time survival. For the beginning this was applied for breast cancer. The conclusion is that the homogeneity of data entrance sets, the number, and their coding in relation with their importance for cancer prognostic are decisive for the results of the trained ANN. These results can be useful in the physician clinical decision.

[A retrospective study of bone metastases distribution on 420 whole body scans]. / Studiu retrospectiv al distributiei metastazelor osoase pe 420 de scintigrame "corp intreg".

UNLABELLED: 420 patients with cancer of breast, prostate, lung and colon were investigated through 99mTc Methylene-diphosphonate whole body scintigraphy. The presence of pathologic radiotracer uptake was qualitatively and quantitatively analyzed in order to establish the metastases distribution. Patient selection was realized over 2455 whole body scintigraphies effectuated between 1998 and 2001 in our Nuclear Medicine Service. All selected cases were metastases with known origin primary cancer. RESULTS: Using the Qui-square Test we have compared the frequency of nine well delimited skeleton regions involved like metastatic site in the different cancer types. We have found a significant statistic difference of the range of frequency only between breast and prostate cancers as well as between pulmonary and prostate cancers. The mean number of the metastatic involved skeletal regions was significantly greater in breast and prostate cancers in comparison with lung and colon cancers (p < 0.0001). The higher metastases site frequency was the rachis, than the pelvis, the ribs and the sternum. The skull metastases localization is more frequent in breast cancer in comparison with all other cancers (7.67% versus less than 4% in other cancer types). The pelvis was more involved for the metastatic process in prostate neoplasm. On the other hand, the highest mean anatomic sites number per patient was found in breast cancer (5.7) and prostate cancer (4.8) related to colon (3.3) and lung (3.0) cancers. CONCLUSIONS: Even some particularities were evident, in our study, between the metastases distribution in these four cancer types, the data are not sufficient to sustain the existence of a characteristic pattern related to the primary cancer origin. Metastases localization could be, however, related to the metastazation mechanism.

[Correlation in imaging techniques for the early detection of bone metastases in a case of breast cancer]. / Corelatia tehnicilor imagistice pentru depistarea precoce a metastazelor osoase într-un caz de cancer mamar.

The presented case is part of a pilot study performed in the Biophysics and Nuclear Medicine Service from the Tenon Hospital (Paris), chief Department Prof. J.N. Talbot. A 46 years patient, with mastectomy for a left breast cancer in 1999, followed by radiotherapy, is detected, in January 2004, through CT scan, with a tumoral mass at the left thoracic base. To confirm the rib osteolysis hypothesis a standard Rx was done; the result was the detection of a pathologic IX left rib fracture and a lacuna site on the L1 vertebra. The following bone scintigraphy make evidence of two hot spots (rib and vertebra) and also of a new pathologic site on the sternum. An 18FFDG PET image detects, despite the three known sites, another one on the left iliac bone crest. In conclusion, an extensive scintigraphic examination, including PET, is necessary to optimize the osteofil cancer metastases detection.

[Role of radioisotopic investigations in breast cancer diagnosis and follow-up]. / Rolul investigatiilor radioizotopice în diagnosticul si urmarirea evolutiei neoplasmului mamar.

Breast cancer represents the disease with the highest incidence in the female population. In the last years there was observed, in western countries, an increase of morbidity by breast tumors and in the same time, a decrease of mortality in direct relation with an earlier diagnosis. Until the spread at distance, breast cancer it's a loco-regional disease that can be curable by surgical treatment and adjuvant therapy, like chemotherapy or radiotherapy. The principal goal is to diagnose it before distal metastases appear, most frequently bone metastasis. Certain role has nuclear medicine in the diagnosis and prognosis of breast cancer because it's more sensitive and gives functional imaging. The aim of this study is to answer the question: what technique, in what indication. The detection of sentinel lymph node has now a clear place in the algorithm, the scintimammography test is important, especially for prediction of tumor resistance to chemotherapy. The bone scintigraphy (which explores the entire body in one time)is generally used in the detection of bony metastases and FDG tomoscintigraphy for the evaluation of local and distal recurrences, or response to chemotherapy. The measure of the isotopic ejection fraction, actually considered the gold standard, is very useful and also very easy to perform, in patients who will receive chemotherapy.

[18F FDG PET-Applications in Oncology]. / 18F FDG PET--aplicatii în oncologie (II).

In the first part our intention was, essentially, to present the particularities of glucose tumoral cells metabolism, PET components, the synthesis of 18F FDG and the detection of unknown cancers. This second part makes reference about mainly types of tumors who benefit by FDG-PET indications. Clinical PET has a rapid growth because of its use in cancer diagnosis and management. According with published studies all over the world, the sensibility and specificity of FDG-PET, noninvasive method, is higher than that of the conventional methods like CT, IRM, ultrasonography. PET is en excellent detection method of most of common cancer types and depends not on the histological neoplasm type; the more aggressive is the tumor, more it will uptake the radiotracer. The cost is significant, so the indications must be very precise: evaluating the malignity of solitary pulmonary nodules, evaluating the recurrences of melanoma, colon cancer diagnosis, differentiation between recurrent brain tumor and radiation injury, differential diagnosis of the benign lymph and malign lymph nodes, staging of Hodgkin's and non-Hodgkin's lymphoma, evaluation the response to therapy. Because the PET images are difficult to interpret, appears the necessity of correlation with anatomic images: this was the fusion images beginnings (the PET and CT images combination); now the physiologic information has precise anatomic localization. The growing of this method is very probably, both using 18F FDG -thanks to its highly favorable physical characteristics- and other new radiopharmaceuticals. The clinical cases that illustrate the applications are investigated at CERMEP, Lyon, France.

[Moiré effect. Application in medicine and dental technology]. / Fenomenul moiré. Aplicatii în medicina si în tehnologia protezelor dentare.

Moiré effect is an optical phenomenon that occurs when two similar arrays of alternately opaque and transparent lines or dots are superimposed upon each other. Superimposition of two such similar, but slightly different, line arrays causes interference between the arrays; the interference results in the formation of moiré fringes. There is a definite relationship between the pitches of the two arrays and the spacing of the fringes. Therefore, given the pitch of one of the arrays and the distance between the moiré fringes, the pitch of the other array can be calculated. The moiré effect can be used to determine the development of cutaneous tumors in a very short time-frame and to assess the measurement of dental eruption within 20 minutes. The 3-D facial, palatal and dental morphology can thus be evaluated very accurately. The CAD/CAM dental technology is actually possible due to the moiré effect.

[18F FDG PET- applications in oncology]. / 18F FDG PET--aplicatii în oncologie (I).

The greatest branch of evolution in Nuclear Medicine that appear in the last period of time, also in medical practice, is scintigraphy with 18F FDG-PET. At the beginning, the images with 18F FDG were used especially in the study of functional cerebral metabolism. Now, new data show that the method presents en major role in cancer diagnosis, localize the tumour and metastasis, and monitoring the treatment in oncology because of the peculiars changes in glucose metabolism of the cancer cells. In this two parts of reference synthesis our goal was to present the following subjects: I) first part include the particularities of glucose metabolism of tumour cells, functionality and components of PET, radiopharmaceutical used in PET, the synthesis of 18F FDG, the clinical procedure and the detection of unknown cancers; II) the second part is about the mains types of tumours identified with 18F FDG-PET (lung, breast, lymphoma, melanoma, colorectal cancer and others). The clinical cases that illustrate the applications are investigated at CERMEP, Lyon, France.

[Preoperative and intraoperative scintigraphic detection of sentinel node]. / Detectia scintigrafica preoperatorie si intraoperatorie a nodulului sentinela.

It is known that the malignant primary tumor site has a specific lymphatic drainage, all the time intermediate, however, by a first lymph node named sentinel node. This can be situated in some typical or atypical topographic area and can be or not clinically evident. If the sentinel node is not invaded by the metastatic cells there is no metastatic risk for other lymphatic nodes, so the surgical treatment is not necessary to involve the corresponding lymphatic area dissection. An imagine, noninvasive detection of the involvement of the sentinel node in the spread of cancer could be related with the surgical decision to perform (or not) fully regional lymphadenectomy (based on biopsy result of such positive detected nodes) allowing only a tumorectomy in the first stages of neoplasia. For the case of scintigraphic method to detect the sentinel node, the performance depend on the development of radiotracers, the modification of the lymphoscintigraphic mapping techniques protocols, and the development and improvement of detectors.

[Whole-body bone scintigraphy in the diagnosis and follow-up of the evolution of breast cancer]. / Scintigrafia osoasa corp întreg în diagnosticul si în urmarirea evolutiei cancerului mamar.

UNLABELLED: We have studied 75 patients, diagnosed with breast cancer, (39 on the right, 36 on the left and 4 on the two breasts), the TNM classification being: stage I--13.3%, stage II--36%, stage III--40% and stage IV--10.6%. Each patient has undergone a whole body scan, 2 hours after a 20-25 mCi 99mTc MDP i.v. dose, using a Siemens Diacam gamma camera. Three parameters where assessed: 1) the distribution of multiple metastasis bone sites; 2) an index, the counts/pixel ratio between the metastatic site interest region and a homologous normal bone interest region (IMDP); 3) a graphic representation of the metastasis heterogeneity radiotracer uptake. RESULTS: Bone metastasis have been found in 23 patients (30.6%), 16 cases having multiple sites; the rate between right and left breast cancer, for these metastases, was 13:10, according with the previous mentioned breast frequency. From all the 23 cases, the most involved site was the ribs (18 cases), followed by the spine (in 17 cases), the iliac bone (9 cases), the femur (7 cases), the skull (3 cases). On the spine, the more frequent involved was the dorsal spine (49.23%), than the lumbosacral (26.13%) and last the cervical spine (12.3%). On the dorsal vertebrae, in 91% the metastasis were localized between D8 and D12. The highest values of I-MDP characterize the femoral metastasis. The heterogeneity was high only for the vertebrae multiple sites. In conclusion, our study show pattern characteristics on the distribution and also on the uptake radiotracer bone metastasis quantification in breast cancer, in respect with others neoplasm's bone metastasis.

[Recurrent unilateral inflammatory exophthalmos]. / Exoftalmie unilaterala inflamatorie recurenta.

The issue discusses the diagnosis difficulties concerning the case of 58-years-old woman who was watched for a recurrent exophthalmos after a mild conjunctival trauma. The debut was orbital cellulite appearance, complicated by a nonaxial exophthalmos due to a dacryoadenitis. The exophthalmos is axial in the other two recurrences. All exophthalmic episodes progressed with inflammatory features associated with optic neuritis and oculomotor nerves implication without any neurological signs. The paraclinical tests (ECHO, orbital radiography, CAT) find inflammation of orbital elements: extrinsic muscles and lacrimal gland. Biochemical tests showed minimal inflammatory changes without be able to provide the positive diagnosis. Initial combined therapy (antibiotics and steroids), then steroid monotherapy had favorable response.

[The Wermer syndrome]. / Sindromul Wermer.

The difficult diagnostic and therapeutic management of patients having gastrinoma with multiple endocrine neoplasia type I (MEN I) has been discussed by reference to the literature and a personal experience of 2 patients with Wermer syndrome. The syndrome is often familial and might be inherited as an autosomal dominant trait with a high but variable degree of penetrance. Pancreatic islets, parathyroid glands and adenohypophyseal [correction of antehypophyseal] cells are the three localization main for endocrine involvement in MEN I syndrome.

[Intra- and postoperative use of 5-fluorouracil in the surgical treatment of refractory glaucoma]. / Utilizarea intra si postoperatorie a 5-fluorouracilului în chirurgia glaucoamelor refractare.

OBJECTIVE: Analysis of the safety and efficiency of various modalities of 5-FU administration in the surgery of refractory glaucoma. MATERIALS AND METHOD: A prospective, randomized study including 36 patients with refractory glaucoma who received 5-FU in the following protocols: group A (10 patients)--intraoperative application of 50 mg 5-FU, group B (12 patients)--postoperative subconjunctival injections of 5 mg 5-FU, group C (14 patients)--intra and postoperative administration of 5-FU. Mean follow-up interval is 6 months. RESULTS: Last controlled intraocular pressure is lower in C group patients (13.92 mmHg) versus group A and group B patients (< or = 15.7 mmHg). The real therapeutic success rate (intraocular pressure < or = 15 mmHg) and the qualified success rate (intraocular pressure < or = 21 mmHg) are higher in group C (85.7% and 92.8% respectively) as compared with group A and group B (50% and 82% respectively). The rate of side-effects in highest in group B and lowest in group C. CONCLUSIONS: Association of intra and postoperative use of 5-FU in refractory glaucoma increases the rate of therapeutic success and a lower incidence of side-effects.

[Complementary scintigraphic examinations (99mTc-MDP, 99mTc-MIBI and Octreoscan) in breast neoplasm assessment]. / Explorari scintigrafice complementare (99mTc-MDP, 99mTc-MIBI si Octreoscan) în evaluarea neoplasmului mamar.

Scintigraphic imagery was used in breast carcinoma mostly for the bone metastases screening, using 99mTc-MDP. Others radiopharmaceuticals can be used to visualize either the primary tumour or the soft tissues metastases. It's mainly the case of 99mTc-MIBI, and also of some somatostatin analogues, like Octreoscan. This case report of a patient with a T3N1M+ breast adenocarcinoma having different secondary sites represent also a prove of the complementarity of these explorations, which give the possibility of diagnostic and therapeutic evaluation and, in the same time, the possibility of a better understood of the metastasizing mechanism.