The role of cell adhesion molecules in the progression of bladder urothelial carcinomas.

Alteration of the intercellular adhesion system plays an essential role in the initiation and progression of bladder carcinomas. We followed the immunoexpression of adhesion molecules, E-cadherin, ß-catenin and Claudin-1, in relation to the histopathological grade and the pT category in a number of 50 urothelial carcinomas of the bladder, based on a final staining score (FSS), calculated on the basis of reaction intensity and labeled cells number. E-cadherin immunoexpression was identified in the membrane of tumor cells, low FSS being associated with invasive high-grade carcinomas. ß-catenin reactions were membranous in the case of low-grade noninvasive carcinomas and predominantly cytoplasmic and nuclear in the case of high-grade invasive ones, for which high FSS were associated. Claudin-1 was identified at the membrane level, the high FSS values being more frequent in the case of high-grade invasive carcinomas, although there were no significant statistical associations. Loss of E-cadherin expression and the associated positive linear relation of ß-catenin and Claudin-1 indicate the usefulness of the analyzed markers in identifying the invasive aggressive phenotype of urothelial bladder carcinomas.

Triglyceride and glucose index: a useful tool for non-alcoholic liver disease assessed by liver biopsy in patients with metabolic syndrome?

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic impairments, being a component of metabolic syndrome. Considering the involvement of fat accumulation and insulin resistance in NAFLD, triglyceride and glucose (TyG) index was proposed as a marker of NAFLD progression. The "gold standard" for the evaluation of liver lesions characteristic for NAFLD remains the liver biopsy. The aim of this study was to establish the links between TyG index, assessing insulin resistance, and histopathological lesions of liver samples obtained by liver biopsy in patients with metabolic syndrome. PATIENTS, MATERIALS AND METHODS: We conducted a study over a period of three years, including 113 adult patients with metabolic syndrome in whom hepatic disorders were assessed by liver biopsy and insulin resistance was evaluated by TyG index. RESULTS AND DISCUSSIONS: In our study, steatosis had a frequency of 92.03%, being identified 26 cases with mild steatosis, 48 with moderate steatosis and 31 with severe steatosis. Regarding non-alcoholic steatohepatitis (NASH), the frequency of this disorder in our study group was 29.2% in the subjects with liver steatosis, while liver fibrosis had a frequency of 53.09%. When we analyzed the relationships between TyG index and the presence of each type of lesion necessary for NASH diagnosis, we obtained statistically significant differences for the presence of hepatocyte ballooning (p=0.01) and a high statistically significance for the NAFLD activity score (NAS) (p<0.0001). CONCLUSIONS: TyG index is a facile tool that can be used to identify patients at risk for advanced NAFLD lesions evaluated by liver biopsy.

Contrast-Enhanced Ultrasound for the Characterization of Malignant versus Benign Focal Liver Lesions in a Prospective Multicenter Experience - The SRUMB Study.

AIM: This study evaluated the accuracy of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of benign vs. malignant focal liver lesions (FLL) in a real-life, multicenter experience. METHODS: This prospective study, including 14 Romanian centers, was performed over a 6 year period (February 2011- April 2017) and included 2062 FLLs assessed by CEUS. Inclusion criteria were: newly diagnosed FLL on B-mode ultrasound, less than three lesions/patient, all FLLs evaluated by CEUS and by a second-line imaging technique (contrast enhanced CT or contrast enhanced MRI) or histology, considered as reference. The trial was registered in clinicaltrials.gov (Identifier NCT01329458). RESULTS: From the 2062 FLLs included in the study, 57.2% (1179) were malignant and 42.8% (883) were benign. CEUS had 83.9% sensitivity (Se), 97.8% specificity (Sp), 98.1% positive predictive value (PPV), 82.2% negative predictive value (NPV) and a diagnostic accuracy (Ac) of 89.9% for the positive diagnosis of malignant lesions. For the benign lesions, CEUS had 97.8% Se, 83.9% Sp, 82.2% PPV, 98.1% NPV 89.9% Ac. The diagnostic performance of CEUS for hepatocellular carcinoma was 76.6% Se, 98.4% Sp, and 91.2% Ac; for hemangioma: 89.2% Se, 99% Sp, and 96.9% Ac and for metastases: 90.9% Se, 98.4% Sp, and 96.9% Ac. CONCLUSIONS: CEUS proved a high accuracy in differentiating the malignant vs. benign character of a FLL. It can be confidently used as a first line imaging method in daily practice.

Head and neck metachronous tumors - clinical, histopathological and immunohistochemical study.

Multiple primary tumors (MPT) represent an important factor affecting the survival of some patients. They present an incidence of about 0.7-11% of all carcinomas developing in any region of the human body, being either synchronous or metachronous. These tumors raise problems of differential diagnosis, with tumoral relapses and distance metastases; also, they involve problems related to chemotherapy, radiotherapy and surgical treatment. In the present paper, we studied a group of 902 patients diagnosed with head and neck tumors admitted to the Ear, Nose & Throat (ENT) Clinic of the Emergency County Hospital of Timisoara, Romania, and we identified 12 patients with metachronous tumors, representing 1.33% of the hospitalized cases. Of the 12 patients with metachronous tumors, a single case was a woman, the other 11 cases being diagnosed in men. Regarding the age of the patients with metachronous tumors, only a single patient was aged less than 60 years old; most of them (nine patients) were aged between 60 and 69 years old, while two patients were aged over 70 years old. Nine patients were alcohol consumers, while 10 (83.33%) patients were smokers of about 20 cigarettes∕day. All the metachronous tumors localized in the head and neck were squamous cell carcinomas. The second primary tumor was identified in the prostate, kidneys, ureter, lungs, salivary gland, thyroid gland, meninges, colon, rectum or skin.

Pseudorheumatoid disability man with chronic tophaceous gout: a case report.

Gout is a type of inflammatory arthropathy that affects the peripheral joints and results from the accumulation of monosodium urate (MSU) crystals in the synovial fluid and other tissues. This disease is the most common form of inflammatory arthritis in men over 40 years of age. The fundamental biochemical abnormality in gout is an increase in serum urate (SU) concentration. These needle-like crystals induce not only acute episodes of inflammatory process into the surrounding area, but also, in the long-term history of the disease, chronic inflammation that is associated with changes in articular and periarticular structures. The next step caused by deposited MSU crystals is represented by the tophus formation and chronic gouty synovitis. The presence of tophi has been associated with greater physical functional disability in gout patients. We presented a case of severe chronic tophaceous gout in a 48-year-old man with chronic hand arthritis and urolithiasis, to point the significance of complex assessment (clinical, functional, imagistic and histological exams) in the diagnosis of a soft tissue lesion, especially in hands.

Periarticular diffuse neurofibroma of the upper limb.

The diffuse neurofibroma is an uncommon subtype of neurofibroma that has received little attention in the imaging literature. Most common in ages 10-30, in males and females, with a slight predilection for the trunk, then head and neck, then limbs. May become very large, but very rarely undergo malignant transformation. Treatment of diffuse neurofibromas (not associated with NF1) is often surgical resection. Complete resection is often difficult because of the extensive and infiltrative nature of many of these lesions. To our knowledge, the diffuse neurofibroma has been reported extremely rarely within the shoulder girdle. In this report, we presented an adult patient, without NF1 diagnosed, who developed invalidate status of left upper limb due to a giant diffuse neurofibroma involving the left brachial plexus, with a high growth diffuse pattern and plexiform architecture imagistic, grossly and without results at both surgical interventions. The diagnosed was by MRI and sonographic imaging and histopathologic examination. His immediately survival perspective was not affected but the functionality of the left upper limb was severe reduced.

Pseudomyxoma peritonei.

The authors report a case of a 60 years old Romanian male with peritoneal pseudomyxoma that was discovered to have a primary location in the greater omentum. Pseudomyxoma peritonei arising into the greater omentum is very rare. It is an original case report and the new data represents a well-balanced summary of a timely subject, with reference to the literature. This it is a significantly advance in our understanding of a particular disease etiology. Until now, only a few primary greater omentum pseudomyxoma peritonei have been described. Clinical and pathologic findings of this case are presented and the topic of primary location in the great omentum of pseudomyxoma peritonei was reviewed. Preoperative ultrasound examination showed the presence of an "eyes of net" tumoral-mass formation, in the greater omentum, and a fluid collection was found in the abdomen (Morrison space and the pouch of Douglas). Notwithstanding, diagnosis of pseudomyxoma was preoperatively considered less probable due to the rarity of the affection and the advanced age. During laparotomy, the presence of the large mass observed at the ultrasound examination was revealed. Mucinous ascites was present with invasive mucinous implants in the peritoneum and in the greater omentum. Operation consisted in the total removal of the mass followed by evacuation of the mucinous ascites. Histological examination confirmed the clinical diagnosis of pseudomyxoma peritonei.

Multiple right schwannoma.

We report a case of multiple schwannoma in a 63-year-old woman, with histopathological and ultrasound analyses, treated by surgical resection. Our patient presented two masses of ulnar nerve and one mass of superficial fibular nerve, both in the right side of the body. All tumors were encapsulated and the microscopic aspects were represented through two tissue types, cellular tissue (Antoni A) with areas of nuclear palisading (Verocay bodies) and more myxoid, less cellular tissue (Antoni B). A careful clinical examination usually determines the level of involvement without identifying the exact pathology. The tumors were easy to remove without affecting the nerves. Surgical exploration is necessary both as a diagnostic and therapeutic procedure. By presenting this case we wanted to emphasize that presence of schwannoma tumors in the peripheral nerves--ulnar and superficial fibular, and suggest a schwannomatosis case--a rare form of neurofibromatosis (a genetic disorder growths of Schwann cells and other cells that support peripheral nerves), that has only recently been recognized.

P53 and PCNA immunoexpression in endometrial carcinomas.

This paper analyzes 18 endometrial carcinomas with different degrees of differentiation, the objective being to estimate involvement of p53 oncoprotein in the mechanism of endometrial carcinogenesis and the possible correlations with the tumoral proliferative activity evaluated by PCNA. The p53 immunoexpression was positive in 44.4% of the studied endometrial carcinomas, divided in three groups, the intensity of the immunostaining for p53 being increased for the low differentiated and undifferentiated endometrial carcinomas, whereas the differentiated endometrial carcinomas were moderate or low p53 positive. All the investigated tumors were PCNA positive, the PCNA index being of 40% in well-differentiated carcinomas, while in low differentiated and undifferentiated endometrial carcinomas the medium values of PCNA were of 60%, respectively 85%. Correlating the p53 and PCNA findings, we noted that PCNA was expressed especially in the cases with increased proliferative activity, without a significant statistic correlation between p53 and PCNA expression.

Contributions to the micro-anatomical evaluation of the ratio between the muscular tunic structures of the oesophagus. Biomechanical, anatomic and clinical implications.

The aim of our research is to make a microanatomical evaluation of the ratios of the structural elements of the oesophagus muscular tunic and suggest a new perspective in the general knowledge about this tubular organ. The visualisation of the structural elements was done using classical microanatomical methods Hematoxylin-Eosin for general orientation, Van Gieson for picrofuxinophile collagen fibers and Gömöri for reticuline fibers. The neurofilaments were identified using silver impregnation on Cajal block. The examination of the sections was made with the Nikon Eclipse 600 photomicroscope. The images were taken and processed using a computer with LuciaNet licensed Microsoft. The co-existence in the architecture of the oesophagus of two microcinematic systems structurally divergent, but functionally convergent represents microanatomical arguments for the nomination of a new type of muscles--the oesophageal muscle--anatomo-functionally different from the skeletal striate muscle, from the smooth visceral muscle, from the cardiac muscle or from the embryonic type muscle of the excitoconductor system. The extra cellular matrix of the muscular tunic of the oesophagus contributes to the organization of the endo- and peri-misium, as well as to the three structures involved in the biomechanics of the oesophageal muscle: the connective-vascular septa, the microtendons that have in their structure receptors of the peristaltic reflex and, finally, the lamina propria myenterica strewed with numerous neuronal structures. The co-existence of the stereo-distribution of the monostructured fascicles (skeletal muscular fibers or smooth muscular cells) with bistructured fascicles (skeletal-smooth) gives the oesophagus a heterogeneous architecture. Lamina propria myenterica, which realizes the border between the circular and longitudinal strata, contains two neuronal structures of its own, but anatomically inserted the neural myenteric plexus which is equivalent to the Auerbach plexus and the neuroganglion of the myenteric plexus, equivalent to the visceral neuroganglion Cajal-Retzius.

The survey on the practice of gastroenterology in Romania.

AIM OF THE STUDY: To get data on the current practice of Gastroenterology in Romania. MATERIAL AND METHOD: We obtained data regarding the number of gastroenterologists in Romania from the Centre of Statistics of the Ministry of Health and Family (CSMHF) and the National Centre of Training for Medical Personnel (NCTMP). We sent a questionnaire to all the Centers of Gastroenterology in Romania inquiring about the number of gastroenterologists and fellows, and about the gastroenterological procedures performed. We compared these data to that of 17 European countries. RESULTS: The total number of gastroenterologists in Romania on January 1, 2005 was 175 (123 specialists and 52 senior consultants), and the total number of fellows in training was 133. Romania has a small number of gastroenterologists - 0.83/100,000 inhabitants, expected to reach approximately 1.4/100,000 inhabitants in 2010. Regarding the abilities in gastroenterological procedures, we obtained data from 98 gastroenterologists. They have good performances in diagnostic gastroscopy (97%), colonoscopy (81.6%), abdominal ultrasound (79.6%), but a poor performance in ERCP (10.2%). Less than half of the gastroenterologists (46.9%) perform proctologic procedures. Data regarding the training program of the Romanian fellows are disappointing: only 69.1% of them perform gastroscopy, 33.8% colonoscopy, 2.9% ERCP, 64.7% abdominal ultrasound and 14.7% proctology. CONCLUSIONS: The number of gastroenterologists in Romania seems low compared with most European countries. They do not acquire a uniform satisfactory mastering of gastroenterological procedures during their training program. This should be improved according to the guidelines of the European Diploma of Gastroenterology.

Romanian subjects entered in the hypertension in the very elderly trial (HYVET).

The baseline characteristics, possibly related to cardiovascular outcome, in 94 Romanian hypertensive men and 168 women over the age of 80 entered into the Hypertension in the Very Elderly Trial (HYVET) were compared with those in 725 men and 1128 women entered into the trial in the rest of Western and Eastern Europe (mainly Russia and Bulgaria). There was a tendency for more women in the Romanian subjects (66.7% versus 60.9% (P = 0.08)) and therefore all comparisons were adjusted for this non significant difference. The Romanian subjects were slightly younger, had more previous hypertension, but more previous strokes than the rest of Europe, and consumed a similar amount of alcohol. The Romanian subjects were, on average, lighter and shorter. Romanians had higher mean concentrations of blood urea and glucose and higher concentrations of HDL cholesterol. Total cholesterol was, on average, lower in Romanian subjects than was serum creatinine. Serum sodium, blood hematocrit and hemoglobin were all, on average, lower in Romanian subjects. The Romanian subjects were recruited from predominantly rural areas and it is hypothesised that their diet may have contained less salt, iron and other haematinics. Calorie restriction, compared to the rest of Europe, may have resulted in lower stature and weight but recent increases in calorie intake may have resulted in the increasing average blood glucose in both sexes. DDT is known to block the uptake of HDL cholesterol by the liver and may explain the increased HDL concentrations in Romania. Some of these biochemical differences may reflect different methodologies employed in Romanian laboratories, but we could not confirm this possibility.

Conventional and Doppler ultrasound in thyroid disease diagnosis.

Ultrasonography is a useful tool for diagnosis diseases of the thyroid gland. The method is reliable, inexpensive and of high diagnostic efficiency. The structural information provided by the ultrasound technique complements the results of laboratory tests and other in-vivo techniques. The article reviews the indications, the accuracy and the usefulness of conventional and Doppler ultrasonography in the diagnosis of thyroid diseases. In our opinion ultrasound examinations should immediately follow the patient's history and physical examination. Additional in vivo methods should be performed according to the specified problems.