Qualitative strain elastography - strain ratio evaluation - an important tool in breast cancer diagnostic.

AIMS: To assess the quality of real time elastography as a differential diagnosis tool for breast nodules and to compare it with standard ultrasonography. MATERIAL AND METHODS: In this prospective study we enrolled 174 patients in which 174 dominant breast nodules were considered for the final diagnosis. The results of ultrasonography and real time elastography, both qualitative and quantitative, were compared with pathology findings from the biopsy specimens. RESULTS: Pathology examinations determined 102 nodules were benign and 72 malignant. Qualitative elastography had a better diagnostic performance (82.4% sensitivity and 81.9% specificity) than ultrasonography plus Doppler evaluation (70.3% sensitivity and 73.5% specificity). Quantitative elastography, assessed using the fat-to-lesion ratio, was a good discriminant for malignancy (AUROC = 0.93, p < 0.001). Our results pointed to an optimal threshold for malignancy of > 4.88; by using this threshold, the diagnostic reliability of the fat-to-lesion ratio was better than both ultrasonography and qualitative elastography (86.5% sensitivity and 90.4% specificity). CONCLUSION: Real time elastography is superior to ultrasonography in diagnosing malignant breast nodules. The evaluation of nodules using a fat-to-lesion ratio was a better discriminant for malignancy than qualitative elastography.

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease.

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 µg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.

Thyroid Imaging Reporting and Data System (TI-RADS): the impact of Quantitative Strain Elastography for better stratification of cancer risks.

AIMS: Due to the elevated prevalence of the solid thyroid nodules in a general population, an appropriate selection of cases referred to surgery is of paramount importance. The main aim of our study was to evaluate the performance of the Thyroid Imaging Reporting and Data System (TI-RADS) as a differential diagnosis tool for thyroid nodules. MATERIAL AND METHODS: We evaluated 174 nodules using TI-RADS risk stratification model, using conventional ultrasound and real time elastography parameters and linear multifrequency probe (Hitachi Preirus Machine, Hitachi Inc., Japan). All the nodules were classified using the TI-RADS system according to echogenicity, margins, shapes, calcification, lymph nodes, and increased strain ration. The results were compared with the pathology exam, which was considered the golden standard diagnosis. RESULTS: The prevalence of malignant nodules was 16.7% (29 cases). The differential diagnosis performance regarding the malignant tumor for TI-RADS is appropriate for clinical use, obtaining an area under ROC curve of 0.95761 [0.8424-0.989] 95% confidence interval. Combining TI-RADS 2, 3 and 4A as probably benign and TI-RADS 4B and 5 as probably malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 97.93%, 86.20%, 97.26% and 89.28% respectively. The overall accuracy of the method was 95.97%.According to the American Association of Clinical Endocrinologists Guidelines, 169 cases required FNAB examination; by applying the TI-RADS scoring system, the necessity for FNAB would decrease to 74 cases. CONCLUSION: Quantitative strain elastography, as the 6th parameter of TI-RADS system, adds diagnostic power to the risk stratification model.

Metabolic syndrome: its features in overweight women with polycystic ovary syndrome as compared with obese women without ovarian dysfunction?

UNLABELLED: OVARIAN DYSFUNCTIOBJECTIVE: The study assesses the frequency of metabolic changes in overweight patients with or without polycystic ovary syndrome. MATERIAL AND METHODS: The study group was made up by 148 patients of whom 99 patients without polycystic ovary syndrome (group A, control group) and 49 with polycystic ovary syndrome (group B), that came in our endocrine unit for a weight loss program, in the September 2008 March 2009 period. Morphometric parameters (height, weight, body mass index), biological parameters (cholesterol, triglycerides, blood glucose, glycated hemoglobin) and body composition analysis by measuring the electrical bioimpedance, were evaluated. RESULTS: Patients with polycystic ovary syndrome have a higher percentage of total fat (38.22+/-7.2) than patients without polycystic ovary syndrome (36.316+/-5.65) (p<0.05), for the same characteristics. Glycated hemoglobin, blood glucose and triglycerides were found higher in group B patients. Furthermore, the amount of free testosterone is higher in group B patients compared to those in group A. The prevalence of metabolic syndrome was higher in polycystic ovary syndrome cases (26.13%) comparative with overweight cases (16.16%, p<0.01). CONCLUSIONS: In the group of overweight patients, the group of patients with polycystic ovary syndrome is a particular group showing more severe metabolic changes.

[Aminoglycoside resistance of enterobacteria isolated from urinary infections in surgical departments]. / Rezistenta la aminoglicozide a enterobacteriilor izolate din infectii urinare în sectii cu profil chirurgical.

The aim of the study was to determine the aminoglycosides resistance of Enterobacteriaceae strains isolated from urocultures. Identification of the germs was performed by the API system (BioMerieux) and susceptibility tests was performed by disk-diffusion test (CLSI standards) and with API strips. For detecting the resistance to aminoglycosides we used gentamicin, tobramycin, netilmicin and amikacin. From 2500 urine samples we isolated 673 microbial strains, from which 531 were Enterobacteriaceae, especially E. coli, 57.62% and Klebsiella pneumoniae pneumoniae, 27.68% strains. We observed natural maintained sensibility to aminoglycosides at 55.17% from all the strains we have studied The high prevalence of aminoglycosides resistance of Enterobacteriaceae strains is explained by prolonged antibiotic therapy of patients with invasive diagnostic and therapeutic procedures. A rational policy in prescribing antibiotics in this department is therefore mandatory.

[Antibiotic resistance patterns in Acinetobacter spp. strains isolated from hospital environment]. / Pattern-uri de rezistenta la antibiotice ale unor tulpini de Acinetobacter spp. izolate din mediul spitalicesc.

INTRODUCTION: The Acinetobacter species are ubiquitary germs isolated more and more frequently, Acinetobacter baumannii being currently considered the second strictly aerobic microorganism involved in the ethiology of severe nosocomial infections. Acinetobacter baumannii is usually encountered in surgery and intensive care units, especially in patients with depressed immunity, in which various locations are possible, the most frequvent being the respiratory tract infections, urinary tract infections and bacteriemia. MATERIAL AND METHOD: The study used 52 strains of Acinetobacter spp. isolated from 1131 biological samples (bronchial aspirat, urine, wound secretion, blood, pus, CFS) obtained from the patients of the Timisoara Country Hospital. Identification of germs was performed using the API (BioMerieux) system, and the antibiotics sensitivity testing was made by disk diffusion testing (Kirby-Bauer), with automatic reading and phenotyping through the Osiris Evolution (BioRad) system. RESULTS: The study of resistance to beta-lactamines has pointed out the predominance of penicillinase and cephalosporinase producing strains, 55.77% of the tested ones being part of this phenotype. 90.38% of the strains were resistant to one or more aminoglycosides. Of the tested strains 76.93% were resistant to fluoroquinolones, 86.54% to trimethoprim-sulphamethoxazole, and only 21.15% to tethracycline. CONCLUSIONS: Among the emerging pathogens involved in the nosocomial infections, Acinetobacter baumannii strains have become, in the past decades, a real health issue, due to the variety and seriousness of clinical symptoms. Through the constant increase of the cases number, and the difficulty of applying an effective treatment, the above-mentioned strains showed a multiple resistance to antibiotics.

[Phenotypic characterization of Streptococcus agalactiae strains isolated from urocultures]. / Caracterizarea fenotipica a unor tulpini de Streptococcus agalactiae izolate din uroculturi.

UNLABELLED: The aim of this study was to determine the antibiotic resistance of Streptococcus agalactiae strains isolated from urocultures in order to obtain new data regarding circulating phenotypes in Urology Department. METHODS: For identifications of Streptococcus agalactiae strains we used Pastorex Strep (BioRad). The sensitivity of isolated germs to antimicrobials was tested using standardised Kirby-Bauer technique. RESULTS: We isolated 21 Streptococcus agalactiae strains from 1871 urocultures. Analyzing the extended antibiograms we categorized these germs according with their resistance phenotypes and we remarked a high percentage of wild type phenotype Streptococcus agalactiae strains (80.95%). CONCLUSIONS: Streptococcus agalactiae strains are more rarely isolated from hospital acquired urinary tract infections, that's way we can explain the low resistance of these strains.

[Considerations regarding the nosocomial potential of surgical wards]. / Consideratii referitoare la potentialul nosocomial al sectiilor de chirurgie.

PURPOSES: The aim of our study was to determine the prevalence of multiresistant germs with nosocomial potential and their main resistance phenotype and genotype patterns in surgical departments. METHODS: Identification of germs was performed by the API system (BioMerieux France) and susceptibility tests by disk-diffusion tests, (CLSI standards) with automatic reading methods (Osiris-Bio Rad Laboratories). ESBL producing E. coli and Klebsiella pneumoniae strains have been also genotyped. RESULTS: From 190 samples (urines, wound secretions, blood, etc.); we isolated 106 microbial strains with nosocomial potential. 56 (52.83%) from these strains were represented by enterobacteria, 26 (24.52%) by Gram negative non-fermentative rods, and 24 (22.64%) by Gram positive cocci. CONCLUSIONS: We noticed a high prevalence of multidrug resistant germs (ESBL, MRSA, etc). The majority of them were involved in nosocomial surgical site and urinary tract infections.

[The sensitivity of some strains of Klebsiella spp. collected in a neonatal department]. / Sensibilitatea unor tulpini de Klebsiella izolate într-o sectie de nou-nascuti.

In order to analyse the evolution of the sensitivity to antibiotics of same strains with nosocomial potential such as Klebsiella isolated in a hospital, we took into study a number of 976 samples, collected in a new-born care department of the "Dr. D. Popescu" hospital Timisoara. The study took place between November-December 2002. The collected samples were pharyngeal swabs, nasal swabs, gastric aspirates, ocular and umbilical secretions, vernix, urines, faeces and blood. From all these samples 803 strains with nosocomial potential were isolated, 84 strains being Klebsiella spp. Most of the isolated strains presented multiple phenotypes of resistance to antibiotics.

[Incidence and sensitivity to antibiotics of germs isolated from surgical wound infections]. / Studiu privind incidenta si sensibilitatea la antibiotice a germenilor izolati din infectii postoperatorii de plaga chirurgicala.

We studied 119 bacterial strains isolated from postoperative infected wounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections.

[Evaluation of the sensitivity to meropenem of some bacterial strains with nosocomial potential]. / Evaluarea sensibilitatii la meropenem a unor tulpini bacteriene cu potential nosocomial.

This study analyzes the sensitivity to meropenem of 880 bacterial strains isolated from hospitalized patients in various medical units of County Hospital No. 1 Timisoara. As a result, a high sensitivity of gram-negative pathogens to meropenem (82.01%) has been noticed. Among Enterobacteriaceae, 93.17% of Escherichia coli and 71% of Klebsiella sp. were susceptible to meropenem. For Pseudomonas aeruginosa strains, a high susceptibility was noticed to meropenem (91%), more than 70% to imipenem, but piperacillin + tazobactam had 42% resistance rates.

[Bacterial strains isolated in high nosocomial risk departments]. / Tulpini microbiene izolate din sectii cu risc nosocomial crescut.

We collected 312 samples from hospitalized patients in two hospitals in Timisoara between September-December 2003. We isolated 83 strains with nosocomial potential. Identification of the germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and we remarked a high percentage of E. coli, Klebsiella pneumoniae pneumoniae and S. aureus with multiple resistance to antibiotics.

[Resistance phenotypes circulating in nosocomial high risk departments]. / Fenotipuri de rezistenta circulante în sectii cu risc nosocomial crescut.

OBJECTIVES: Between November 2001-January 2002 we collected 406 samples from patients hospitalized in Intensive Care adults and new-borns Unit (ICU). The aim was to observe the colonization and infection status with bacteria that may have nosocomial potential and to establish circulating phenotypes in ICUs. METHODS: The identification was performed by API (bioMerieux) method, and we have performed the antimicrobial susceptibility tests by both: API method and by Kirby-Bauer disc-diffusion test. RESULTS: We isolated 295 strains with nosocomial potential: 34 MRSA strains, 23 MRCNS strains, 29 ESBL producing gram negative rods, etc. CONCLUSIONS: We observed the presence of multiple drug resistant bacteria which play an important roll in both: massive colonization of patients and in the etiology of nosocomial infections. This leads us to the conclusion that antibiotic resistance pattern should be interpreted by the bacteriologist and a consistent policy concerning the use of antimicrobial drugs in hospital settings should be instituted.

[A comparative study of resistance phenotypes in E. coli strains isolated in urine from hospitalized and ambulatory patients]. / Studiu comparativ al fenotipurilor de rezistenta a tulpinilor de E. coli izolate din uroculturi provenite de la pacienti internati si din ambulator.

112 strains of E coli from 620 urocultures of hospitalized and ambulatory patients where isolated between March-June 2002. Our purpose was to make a comparative study of the susceptibility to antibiotics of 31 strains of E coli isolated in hospital (County Clinical Hospital Nr. 1 Timisoara--Urology Clinic and Intensive Care Unit) and 81 strains collected from ambulatory patients. Identification of germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and remarked a high percentage of E coli strains from hospitalized showing multiple resistance to antibiotics.