Optimizing the indication for breast-conservative surgery (BCS) in patients with locally-advanced breast cancer.

BACKGROUND: The main benefit of neoadjuvant chemotherapy is a reduction in tumor size, which allows breast-conserving surgery (BCS) in patients who otherwise would have required a mastectomy. Breast magnetic resonance (MRI) has been proposed to evaluate tumor extent after neoadjuvant chemotherapy, to determine which patients have become eligible for BCS. AIM: The aim of our study was to determine how the association of breast MRI to routine clinical and radiologic assessment of the tumor at initial presentation, and after chemotherapy, affects the overall surgical decision process. MATERIAL AND METHODS: 54 women with stage IIB-IIIB breast cancer were prospectively enrolled in a study investigating the effects of MRI on the surgical decision. RESULTS: Surgical plan was changed from BCS to radical mastectomy in 6 cases (13.04%). As a result of using MRI in evaluating disease extent, 21.73% of valuable data were added by MRI (pectoralis major muscle and skin invasion, multifocal multicentric disease). Due to MRI examination 28 (60.86%) of the patients with operable breast cancer after neoadjuvant chemotherapy, were eligible for BCS. CONCLUSIONS: Our study demonstrates that MRI is the most accurate in determination of tumor size and extent, and in establishing eligibility for BCS.

Classical testicular seminoma in young man.

A 29 year old man was admitted in Urology Department of County Hospital of Constanta for left testicular increased size in last six months, without other symptoms. Testicular tumor was palpated and visualized by ultrasound. Computed tomography did not revealed metastatic lymph nodes. Beta-human chorionic gonadotropin and alpha-fetoprotein were within the normal range. We diagnosed the case as a left testicular tumor and performed high orchiectomy. Histological examination revealed typical seminoma. Subsequently, the patient was given two courses of systemic chemotherapy (bleomycin, etoposide, cisplatin) as an adjuvant therapy. The patient has remained free of disease six months after discharge.

[The main aspects of vesical risk in intraperitoneal surgery]. / Consideratii generale asupra riscului vezical în chirurgia intraperitoneala.

They are described the main aspects of vezical risk in intraperitoneal surgery: subembilical celiostomy, haernios surgery, rectal surgery, gynecological surgery. It is shown few aspects of our experience in the treatment of haernias, vesicovaginal fistules secondary to total hysterectomy.

[The experience of our clinic in the treatment of vesicovaginal fistulas]. / Experienta noastra în rezolvarea fistulelor vezico-vaginale.

In this work paper we have presented the experience of our clinic in the treatment of vasicovaginal fistulas (17 cases), secondary surgical procedures. The frequency of vesicovaginal fistulas is very high after gynecological surgery (14 after total hysterectomy for uterine cancer, uterine fibroma or uterine necrosis secondary to septic abortion). In all cases authors used Diettel-Forgue-Legueu procedure, with good results in 88.30% of cases.

[Clinical outcome of lupus nephritis in Constanta County]. / Studiu epidemiologic descriptiv al insuficientei renale cronice în Judetul Constanta.

UNLABELLED: The epidemiology of chronic renal failure (CRF) and renal replacement therapy (RRT) is under continuous surveillance all over the world. In Constanja county, as well as in other Romanian regions, an increase in the prevalence of patients on RRT (dialysis or transplantation) has been observed during the recent years. AIM: To determine the prevalence of chronic renal failure in Constanta county, in variable stages of evolution, as well as monitoring of renal replacement therapy in our region. METHODS: This epidemiological study is based on data collected from patients hospitalized in the 1st Clinical Department of Internal Medicine, or from other Department of the Emergency Hospital, regular periodic visits of predialytic patients in the Ambulatory Nephrology Cabinet and from the Hemodialysis Center of Constanta, in the interval of time 1st January 2003-30 June 2005. A total group of 585 patients were evaluated till the end of our study. The study was based upon the available clinical and biochemical data, obtained during routine clinical care. RESULTS: The disease affects more frequently the male gender and the young to middle-aged population. Because 56.88% of renal patients are in a predialytic phase, it is obvious that a large population group will need in the proximate future places for renal replacement therapy. CONCLUSION: CRF has a high incidence in Constanta county; the rate detected during our study was 82.1 cases per 100,000 population. Chronic glomerulonephritis and pyelonephritis, followed by diabetic nephropathy were the most frequently reported causes of renal failure. The most frequent comorbid associated conditions were cardiovascular diseases, followed by infections and bone diseases, in both predialytic and dialytic/transplanted population. Almost 10% of our patients died during the study. The most frequent causes of death were: cardiogenic shock, arrhythmias, cerebral strokes and sepsis.

Fabry's disease.

Fabry's disease is a rare X-linked, recessive, glycolipid storage disorder. It is caused by the deficient activity of a lysosomal enzyme, alpha-galactosidase A. Deficiency of alpha-GAL causes an inability to catabolize the lipids with cellular accumulation of its most abundant substrate, globotriaosylceramide (GL-3), and other neutral glycosphingolipids in the vascular endothelium and numerous tissues throughout the body. This progressive glycosphingolipid accumulation leads to life-threatening clinical sequelae in renal, cardiac and cerebrovascular systems. Heterozygous Fabry's disease is less studied. We present a patient, 43 years old, with cardiac (hypertrophic cardiomyopathy), neurological (sensitive-motive polyneuropathy), digestive (chronic diarrheea), renal and cutaneous involvements.

Effect of short-term lithium carbonate administration in hyperthyroidism, with or without associated ophthalmopathy.

The study was carried out on 21 female hyperthyroid patients aged 22-53 years, with or without associated ophthalmopathy, admitted to the Endocrinology ward of the 1st Medical Clinic of the Craiova County Hospital, Romania, between 1983 and 1985. Administration of lithium carbonate was proceeded and followed by radioimmunoassay (RIA) determinations of T3 and T4 and measurement of Achilles' reflex (AR). Two regimens were employed. The first comprised ten patients receiving doses of 500 mg/day lithium carbonate and the second 11 patients who had an associated ophthalmopathy and who received 250 mg/day lithium carbonate and 30 mg/day carbimazole. Lithium administration was discontinued after 4 weeks. The results of the therapy suggest a possible intervention of lithium carbonate in the process of blocking the biosynthesis of thyroid hormones and/or its regulating processes, with concomitant improvement of the clinical status, much more in the patients without ophthalmopathy.

Investigation of thermic transition and renaturation of high polymerized DNA extracted from thyroid nodule.

The study was carried out on 16 cases of mixed thyroid hypertrophy in which total or partial thyroidectomy was performed. Fragments collected intraoperatively from the thyroid nodule were used for extraction of high polymerized DNA. At the same time with quantitative evaluation of DNA, RNA and proteins were also assayed. The thermic transition mean temperature of the DNA extracted from the thyroid nodule is compared to other standards (DNA-HP-standard, calf thymus DNA, normal leukocytic DNA) and the thermic transition curves are presented. Hyperchromicity after thermic denaturation and renaturation is analysed and expressed in per cent values.

[IgA changes in chronic alcoholic hepatopathy]. / Modificari ale IgA în hepatopatia cronica alcoolica.

Chronic alcoholic hepatitis (CAH) has been included, in the last 10 years, among the disease accompanied by particular changes of IgA (primary glomerulonephritis with mesangial deposits of IgA, Berger; Henoch-Schonlein's purpura with IgA deposits in dermatic capillaries and herpetiform dermatitis, with deposits of IgA in dermatic papillae). The characteristics of IgA involvement in CAH are: The whole IgA system is changed, at its 3 levels: circulatory, tissular, formative. at the circulatory level, the IgA2 monomeric fraction increases characteristically; in hepatic parenchyma, perisinusoidal linear deposits of IgA are formed; they have a great significance for the alcoholic etiology, the length of time and seriousness of alcoholism.