Takayasu's Arteritis: A Special Case Report and Review of the Literature.

Background: Takayasu's arteritis is a rare type of vasculitis with severe complications like stroke, ischemic heart disease, pulmonary hypertension, secondary hypertension, and aneurysms. Diagnosis is achieved using clinical and angiographic criteria. Treatment is medical and surgical, but unfortunately, the outcome is limited. Case presentation: A 34-year-old Caucasian woman had an ischemic stroke (2009). She was diagnosed with Takayasu's arteritis and received treatment with methotrexate, prednisolone, and antiplatelet agents, with a mild improvement in clinical state. After 6 years (2015), she experienced an ascending aorta aneurysm, pulmonary hypertension, and mild aortic regurgitation. Surgical treatment solved both the ascending aorta aneurysm and left carotid artery stenosis (ultrasound in 2009 and computed tomography angiogram in 2014). Morphopathology revealed a typical case of Takayasu's arteritis. Tumor necrosis factor inhibitors (TNF inhibitors) were prescribed with methotrexate. At 48 years old (2023), she developed coronary heart disease (angina, electrocardiogram); echocardiography revealed severe pulmonary hypertension, and angiography revealed normal coronary arteries, abdominal aorta pseudoaneurysm, and arterial-venous fistula originating in the right coronary artery with drainage in the medium pulmonary artery. The patient refused surgical/interventional treatment. She again received TNF inhibitors, methotrexate, antiplatelet agents, and statins. Conclusions: This case report presented a severe form of Takayasu's arteritis. Our patient had multiple arterial complications, as previously mentioned. She received immunosuppressive treatment, medication targeted to coronary heart disease, and surgical therapy.

PANCREATIC CANCER CT IMAGING: COMPARISON WITH SURGERY.

AIM: To establish the best protocol for pancreatic computer tomography and criteria for staging (mainly for vascular invasion). MATERIAL AND METHODS: Our research included 49 consecutive patients with pancreatic cancer examined at the Iasi "Sf. Spiridon" Hospital between January and December 2014 with a Siemens 16 Emotion CT unit. CT protocol included no enhanced CT and pancreatic phase of the superior abdomen, portal venous phase of the abdomen and pelvis. RESULTS AND DISCUSSION: The study patients were stratified into 5 age groups and the most frequently affected by pancreatic cancer were the patients aged 60 to 79 years. For T staging the extension in the per pancreatic fat tissue, into surrounding organs (5 patients had extension in other organs) and vessels was evaluated. We determined the degree of contact between the tumor and the artery, thrombosis and deformity of the veins and we have found 8 resettable lesions, 28 tumors in stage T3 and 13 pancreatic cancers in stage T4. Thirty-three patients had lymphadenopathies and 31 of them had distant metastases. CONCLUSIONS: Our study proved that computed tomography is a good method of examination for pancreatic cancer when the right imaging protocol is used; during the pancreatic phase the arteries and the tumor are well depicted, liver metastases are best evaluated during the portal venous phase. The best criterion for arterial invasion is tumor contiguity with more than half of vessel circumference, and for vein invasion deformity or thrombosis. Comparison with surgical staging was o good backup for the radiologist and depicted several differences with imaging staging, more often understating than over staging.

RETROSPECTIVE EPIDEMIOLOGIC RESEARCH ON PREVALENCE OF INFECTIONS IN SURGICALLY TREATED ONCOLOGIC PATIENTS.

UNLABELLED: The aim of this work was the retrospective study of the frequency of infections in surgically treated oncologic patients. MATERIAL AND METHODS: Our research included 753 oncologic patients treated at the Second Surgical Clinic of the Regional Institute of Oncology, Iasi, between January 2013 and December 2014, with the selection of cases which had infectious complications. RESULTS: The lot of patients was structured in 7 age groups and the most frequent oncologic patients had ages between 60-79 years. The most frequent malignancies were large bowel, breast, rectal, esophageal cancers, malignant hemopathies, gastric and liver malignant tumors. In our lot of 753 oncologic patients we depicted 113 (15.01%) infections. CONCLUSIONS: Our study proved that the anatomic location of the cancer, the hospitalization duration and the number of the hospitalizations has an important role in appearance of the infectious complications. The gastrointestinal malignant tumors were the most frequent malignancies associated with postoperative infections. The patients with gastrointestinal cancers from urban area, with ages between 50 and 79 years had the highest risk of infectious complications. For main causative organism was proved a high sensitivity for colistin. Clinical, paraclinical and epidemiological exams did not emphasize any decisive factors; we took into account the risks of infection during multiple pre-, intra- and postoperative procedures; all these have been associated with increased receptivity of immunosuppressed oncologic patients.

CAUSES OF DEATH IN PATIENTS WITH STAGE 0-II BREAST CANCER.

AIM: To analyze the main causes of death in patients with stage 0-II breast cancer who undergo breast conserving surgery or radical mastectomy, and to establish the role of imaging surveillance protocols following breast cancer treatment. MATERIAL AND METHODS: We conducted a retrospective medical record review between January 2005 and December 2012, when breast cancer was the primary cause of death for 113 inpatients. All patients were admitted to the Oncology Clinic of the Iasi Regional Cancer Institute (IRCI), Romania. Patients were stratified by clinical stage 0, I and II, of which 33 (29.2%) patients were managed by breast conservation therapy and 80 (70.8%) underwent radical mastectomy. From the patient medical records all diagnostic imaging studies performed (ultrasound, radiography and computed tomography) were identified and analyzed according to a standard protocol for imaging the postoperative breast. RESULTS: Bone, liver, lung, lymph nodes and local-regional recurrence were the most common sites for metastasis, while the most frequent cause of death were metastases to the liver, pleura, lung and brain. The time interval between recurrence and death ranged from 0-24 years among patients with one type of metastasis, and decreased to 0-3 years since the last recurrence for patients with multiple metastases. CONCLUSIONS: The current imaging protocol for monitoring the postoperative breast could be optimized to improve the prognosis and quality of life in patients with stage 0-II breast cancer.

BREAST INFECTIONS: DIAGNOSIS WITH ULTRASOUND AND MAMMOGRAPHY.

AIM: Evaluation of ultrasonographic and mammographic pattern, etiology and risk factors of breast infections. MATERIAL AND METHODS: Our study included a group of 66 female patients aged 16 to 71 years, examined by ultrasound and mammography in several medical imaging services in Iasi in the interval 2008-2014; ultrasound was performed in all 66 patients and mammography in 22. RESULTS: In our study breast infections occurred mostly during breastfeeding and the most frequent causative agent was Staphylococcus aureus; ultrasound established the correct diagnosis in 63 cases and detected one or more of the following aspects in case of breast infections: edema of the fatty tissue, hypoechoic areas in the breast tissue, dilated ducts, or fluid collections. Mammography was not necessary in puerperal mastitis and was performed only in women over 40 years old; in most cases we had encountered a focal asymmetric density which had low specificity for the diagnosis of mastitis or breast abscess. CONCLUSIONS: Our study proved that ultrasound is a valuable method for the diagnosis of mastitis, especially when an abscess is suspected and established a correct diagnosis in most cases; the abscesses appear as inhomogeneous fluid collections, with poorly defined margins, posterior acoustic enhancement, no Doppler signal inside, sometimes associated with enlarged axillary lymph nodes. Mammography was not helpful for the diagnosis.

Clinical epidemiological study on the incidence of Escherichia coli infections in the cancer patients admitted to Surgery Department II of the Iasi Regional Oncology Institute in 2013.

UNLABELLED: The aim of study was to identify pathogens involved in hospital-acquired or community-acquired infections in patients suffering from various types of cancers. MATERIAL AND METHODS: A clinical epidemiological study included a group of 355 cancer patients admitted and operated at the Surgery Department II of the Iasi Regional Oncology Institute in 2013 was performed using data from hospital statistical service and the surgery and laboratory records, then processed by epidemi ological and statistical methods. RESULTS: In cancer patients the pathogen most commonly involved in infections was E. coli, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis, Enterobacter cloacae and Acinetobacter. Analysis of bacterial resistance to antibiotics of the pathogen most commonly involved revealed that of the 29 E. coli strains 22 were tested for resistance/sensitivity to ampicillin; of these, 19 strains showed resistance, and only 3 were sensitive; 14 E. coli strains of were resistant to cephalosporins and 8 sensitive; all strains tested were sensitive to carbapenems, imipenem or meropenem and polypeptides (colistin); the 10 tested strains showed resistance to monobactams (aztreonam). CONCLUSIONS: E. coli was incriminated in most urinary tract infections, the other pathogens being identified sporadically. Surgical wound infections were caused mostly by E. coli and Staphylococcus aureus, followed by Pseudomonas aeruginosa. In our study we encountered increased resistance of E. coli to penicillins, cephalosporins, monobactams (aztreonam), fluoro-quinolones and tetracyclines.

Computerized calculation of breast density: our experience from Arcadia Medical Imaging Center.

THE AIM OF THIS STUDY: To implement a spatial fuzzy C-means algorithm for image segmentation and breast tissue density quantification and compare it with BI-RADS breast density classes determined by radiologists. MATERIAL AND METHODS: The analysis was based on 206 mammograms performed in 111 women with various breast abnormalities. Digitized mammographic films were independently double read by radiologists certified in breast diagnosis, followed by consensus with arbitration agreement (radiological ground truth). Reporting was done using the BI-RADS mammography lexicon. Using an algorithm based on a combination of spatial fuzzy C-means clustering and binary thresholding, percent mammographic density was computed in digitized mammograms. The BI-RADS breast density readings were compared with percent breast density measurements determined by computer algorithm. RESULTS: The algorithm was found to match the BI-RADS density classification in 90% of the cases, with an excellent agreement (kappa = 0.88) between the radiological ground truth versus the algorithm breast tissue density estimates. CONCLUSIONS: Our study proposed an algorithm that can be applied both to digitized and digital mammograms, which proved to be effective in breast density estimates. The method can accurately determine the percentage density removing the human observer variability. The proposed method showed an excellent agreement with radiological ground truth.

Multifactorial analysis of local and lymph node recurrences after conservative or radical surgery for stage 0-II breast cancer.

AIM: Multifactorial analysis of local and lymph node recurrences in stage 0-II breast cancer treated by conservative or radical surgery. MATERIAL AND METHODS: In the interval January 1, 2005-July 31, 2013, 477 breast cancer patients were assessed by imaging techniques at the Radiology Clinic of Iasi "Sf. Spiridon" Hospital and Radiology Service of the Iasi Regional Cancer Institute. Of these 229 (48%) patients underwent conservative surgery and 248 (52%) patients radical surgery. RESULTS: Local recurrences were 2.8 times more frequent in conservatively vs. radically treated patients, and lymph node recurrences 2 times more frequent in patients treated conservatively. Breast tumors larger than 3 cm in diameter were at higher risk for local and distant recurrence in lymph nodes. CONCLUSIONS: Assessment in patients with local and lymph nodes recurrences of the relative risk for developing other types of recurrences (bone, pleuro pulmonary, liver, brain metastases) indicated that these are a risk factor for other types of recurrences, influencing the prognosis of patients. Local recurrences showed a higher relative risk for other types of recurrences than nodal recurrences.

[Small size cephalo-pancreatic cancer. Demonstration of MRI/MRCP usefulness]. / Neoplasm cefalo-pancreatic de mici dimensiuni operabil. Demonstrarea utilitatii IRM/MRCP.

48 years old woman with obstructive jaundice has been examined by abdominal ultrasound followed by MRI. The suspicion of cephalic pancreatic cancer raised by ultrasound was confirmed by MRI and MRCP. Association of MRCP with axial and coronal T1 and T2 sequences successfully demonstrated a resectable tumor, confirmed at surgery. MRI/MRCP is demonstrating great potential in predicting resectability of cephalic pancreatic tumors.