Clinical, Histological and Prognosis Correlations in Diagnosis and Treatment of Gastric Cancer.

Purpose The study authors have proposed to highlight the main epidemiologic and prognostic aspects of digestive malignancies in the Dolj county population, justifying the need for permanent and detailed estimate of this phenomenon. Methods The authors of the study have proposed to outline a descriptive epidemiological panel, characteristic for the population groups at risk of developing gastric cancers and establishing clinical factors (tumor location, disease stage, type of surgery) and histological factors (histopathological type, degree of tumor differentiation) with prognostic significance having as landmark, survival rate at 5 years or disease-free survival of 5 years. Results The study was conducted on a sample of 458 patients with gastric tumors endoscopically detected, histologically confirmed and treated between 2000-2010. The epidemiological study allowed us to outline the descriptive epidemiological panel characteristic for the group of patients at risk of developing gastric cancer. Analysis of correlation between clinical parameters and histopathological parameters reached statistical threshold in multivariate statistical analysis of the localization of tumor, disease stage and histological type (p <0.0001) and the degree of differentiation of gastric carcinomas (p <0.005). Multivariate statistical analysis has detected statistically significant differences in terms of survival rate at 5 years (p> 0.001) and free interval of disease at 5 years (p> 0.001), depending on the location of the tumor, correlated with other clinical factors (disease stage, type of surgery) and histological factors (histopathological type, tumor differentiation grade), which allowed us to outline clinical, histological and prognostic groups. Conclusions Defining the clinical, histological and prognostic groups, allows an accurate assessment of patient prognosis from the time of randomization and initiation of treatment, type of surgery in advanced loco-regional, reconverted to operability, after neoadjuvant polychemotherapy being dictated by the location of the tumor (1/3 superior vs. 1 / 3 medium vs. 1/3 lower stomach).

[Neurological damage in pelvic injuries: a continuous prospective series of 50 pelvic injuries treated with an iliosacral lag screw]. / Lésions neurologiques des fractures de l'anneau pelvien. A propos d'une série prospective continue de 50 lésions pelviennes postérieures opérées par vissage ilio-sacré.

PURPOSE OF THE STUDY: The purpose of this study was to analyze lesions to the lumbosacral plexus related to pelvic injury and its treatment. MATERIAL AND METHODS: Forty-four patients presented 50 posterior osteoligamentary lesions of the pelvic girdle. All patients except eight had other injuries. Mean ISS was 27/75. Posterior lesions were: iliosacral disjunction (n=23), extra-foraminal fracture of the sacrum (n=4), transforaminal fracture (n=22), intra-foraminal fracture (n=1). Vertical posterior displacement was > 1 cm for 24 posterior lesions. Orthopedic reduction was performed at admission for all patients. Fluoroscopy-guided percutaneous lag screw fixation was performed in all cases, on the average eight days after the accident. Neurological involvement was evaluated at admission, after surgery, and at last follow-up. Data were recorded for skeletal muscles, lower limb dermatomes, tendon reflexes, and anal tone. Screw emplacement was checked on the CT-scan. Outcome was assessed subjectively with the Majeed score, a self-administered visual analog scale, and use of antalgesic drugs according to the WHO classification. RESULTS: The neurological examination could not be performed for ten patients at admission. Postoperatively, there was a neurological deficit associated with 26 osteoligamentary lesions (23 lesions of the lumbosacral trunk, 14 lesions of the S1 spinal nerve, 3 lesions of the pudendal nerve, 12 lesions of the superior gluteal nerve, and 10 lesions of the femoral nerve). Patients with neurological involvement had experienced more severe trauma. The iliosacral screw was partially extra-osseous in thirteen cases, with an associated iatrogenic neurological deficit in seven. At mean follow-up of 20 Months (range 4-50) there persisted ten major sequelae including eight cases of hallux extensor deficit. DISCUSSION: Neurological involvement is underestimated during the acute phase of trauma. After recovery, only the manifestations of major injuries persist. The prognosis is poor in the event of a stretched lumbosacral trunk or gluteal nerve due to iliosacral disjunction. Prognosis is good for nerve contusion due to sacral fracture because of early reduction. The femoral nerve is generally injured by compression due to a peri-fracture hematoma; recovery is the rule. Iliosacral screwing requires rigorous technique by a skilled and experienced surgeon. CONCLUSION: About 52% of posterior osteoligamentary injuries are associated with neurological symptoms. After recovery, permanent deficit persists in 21.7%. The most common sequelae are hallux extensor and gluteus medius palsy due to stretching of the lumbosacral trunk.

Immunological approach in the diagnosis, therapy and prognosis of the exocrine pancreatic cancer.

The aim of the paper is to outline the most important up-to-date methods regarding the immunological approach in the diagnosis, treatment and prognosis of the exocrine pancreatic cancer, keeping in mind that this localisation of neoplastic disease represents the 5th cause of cancer-related death and especially, an important cause of morbidity. This disease, diagnosed in the past in later stages, being therefore associated with poor results, has turned to be characterized by increasing survival rates due to the improvements in diagnostic and therapeutic methods. Regarding the diagnosis strategy, progress was made in imagistic sphera, aiming: 1. an early diagnosis of pancreatic cancer and, implicitly, a high resectability rate of tumor, and 2. an evaluation of the timing for palliative therapeutic methods. So that, if in the past the diagnostic algorithm meant endoscopic retrograde-cholangio-pancreatography, computed tomography and angiography, at present it means nuclear magnetic resonance and helicoidal tomography. Concerning the treatment, it has to be multidisciplinary (surgery, radiotherapy, chemotherapy, immunotherapy), complex, because, after a resection for cure (R0), the main stay of the treatment, the mean survival at 5 years is 3%-28% and the rate of recurrences is 33%-80%. Biological therapy (sometimes called immunotherapy, biotherapy or biological response modifier therapy) is a relatively new addition to the family of cancer treatments that also includes surgery, chemotherapy and radiation therapy. Biological therapies are designed to repair, stimulate or enhance the immune system responses. We shall try to point out how the exocrine pancreatic cancers, the same stages and undergoing the same approaches, have had different responses due to a different biological behavior and how the biological response modifiers (interferons, interleukins, colony-stimulating factors, monoclonal antibodies and vaccines) can improve the results in pancreatic cancer.

[Comparative biomechanical study of 3 types of osteosynthesis of the Duparc grade IV fractures of the calcaneus: value of triangular internal fixation]. / Etude biomécanique comparée de 3 ostéosynthèses des fractures enfoncements du calcaneum stade IV de Duparc. Intérêt du montage en triangulation.

PURPOSE OF THE STUDY: We present an in vitro biomechanical study performed to evaluate and compare, for an experimentally produced fracture of the calcaneum (Duparc grade IV), the reaction of 3 standard models of internal fixation commonly used in these fractures and which occupy different volumes. MATERIALS AND METHODS: We compared different methods of fixation using fresh human calcanei. In two experimental series, we compared triangular internal fixation (3 1/4 tube AO plates Saragaglia), Y internal fixation (2 1/3 tube AO plates Bezes), isolated screw technique (three 3.5 diameter screws, two 4.5 diameter screws). The plates and screws were made of identical material (316L). Both series used 8 pairs of bone (talo-calcaneum system) with the same fracture submitted to a 200N to 1000N load. Stiffness and movement were analyzed using 8 references on the calcaneum. RESULTS: The stiffness and movement analysis with 8 references points demonstrated the superior resistance to bending with the triangular internal fixation. Fixation stability was significantly better than with the Y or screw technique. DISCUSSION: This study underlined the importance of triangular trabecular organization of cancellous bone on calcaneum biomechanics. We showed that the 3 (anterior, posterior and inferior) trabeculae must be repaired in calcaneum fractures to achieve horizontal and vertical stability of the talar joint. CONCLUSION: In our hands, restoration of the triangular architecture of calcaneum fractures, to resemble a roof truss, where the talus is fixed to the triangle vertex, is fundamental to obtain a rigid and stable internal fixation.

Leptospirotic etiology in pulmonary and upper respiratory tract pathology.

A number of 3,200 febrile patients who presented upon admission to hospital primary pulmonary or upper respiratory tract impairment either as single forms of manifestation or associated to other syndromes were tested. The cases were screened by the rapid slide agglutination reaction with heat inactivated Patoc antigen and leptospirotic etiology was confirmed by the ultramicroscopic agglutination reaction with 18 live circulating pathogenic antigens. 64 leptospirosis cases with pulmonary impairment were confirmed and in 52 cases the upper respiratory tract was involved. Particular aspects of leptospirosis with pulmonary impairment: 71.8% of cases had a clinical diagnosis of interstitial pneumonia; 89% of cases presented important chest x-ray modifications; in an approximately equal number of cases the pulmonary involvement was the single manifestation or was associated with other syndromes; icterohaemorrhagiae, wolffi and pomona were the frequently encountered infecting serotypes. Particular aspects for leptospirosis involving the upper respiratory tract: 84.6% of cases had a clinical diagnosis of acute rhino-pharyngotracheitis; in 86.5% of cases the upper respiratory tract impairment was the single feature; the infecting serotypes were in decreasing order of frequency as follows: icterohaemorrhagiae, pomona, wolffi, canicola, grippotyphosa.

Study of the leptospirotic etiology in the digestive pathology, particularly in acute abdomen.

The paper approaches the possible leptospirotic etiology of non-icteric or late icteric digestive manifestations: digestive hemorrhage, particularly epigastric, acute cholecystitis (non-lithiasic), acute appendicitis, acute gastroenterocolitis, etc., which can be indicative of an acute or latent (from 14 days to several months) leptospirosis. A number of 300 patients with high fever, epidemiological data relevant for leptospirosis and diagnosis upon admission to hospital were investigated using the work method presented in the paper. The synoptical table presents in detail 30 serologically confirmed leptospirosis cases; this reveals the fact that any serotype can be determining and the severe evolution may occur when the etiological diagnosis and treatment are delayed. The 1.67% incidence for the cases clinically expressed by the studied pathology points to the need to consider this pathology as a possible expression form of leptospirosis against the specific epidemiological context.