Poor predictive value of positive interim FDG-PET/CT in primary mediastinal large B-cell lymphoma.

PURPOSE: Though commonly used to assess response to therapy, the prognostic value of interim FDG-PET/CT in Primary Mediastinal Large B-cell Lymphoma (PMBCL) is unclear. METHODS: We conducted a retrospective study on 36 consecutive patients treated at our institution for a PMBCL between 2006 and 2014. All patients with a positive interim FDG-PET/CT had undergone histological restaging consisting either in a surgical debulking of the residual lesion (15 patients) or a CT-guided core needle biopsy (two patients). All FDG-PET/CT were secondarily reviewed according to the more recent Deauville criteria. RESULTS: Interim FDG-PET/CT was considered positive in 17/36 patients using visual evaluation. Among these patients, 14 had a Deauville score of 4. Histological restaging was negative in all but one case, showing inflammation and/or fibrosis. After a median follow-up of 48.5 months, a total of five patients have relapsed, two patients in the positive FDG-PET/CT group, and three patients in the negative FDG-PET/CT group, respectively. CONCLUSIONS: These data indicate that a positive interim FDG-PET/CT does not reflect persistence of active disease in the vast majority of PMBCL cases. The relapse rate appears similar regardless of interim FDG-PET/CT results and interpretation criteria. This suggests that interim FDG-PET/CT has a poor positive predictive value, thus kt should be used with caution in PMBCL.

[Obesity prevention--is there any limits for primary care medicine]. / Preventia obezitatii--posibilitati si limite in medicina primara.

What does obesity mean? One of the people's health markers is the nutritional steady-state, the mean ponderal equilibrium. The normal weight means the longest life expectancy assuring body weight, from all points of view. The body weight increasing means adipose tissue accumulation and the onset of obesity. Obesity quantification could be made by BMI (body mass index)--normal range 22-24 kg/m2- waist to hip ratio--normal range 0.8-0.9--and abdominal perimeter--normal range up to 80 cm. Why should we do obesity prevention? Because obesity means a high risk factor for cardio-vascular disease, cancer, bone diseases, general mortality. By 10 kg weight loss, real benefits are achieved: left ventricle hypertrophy reduction, decreasing of cardio-vascular risk, pulmonary function improve, reducing of atherosclerotic symptoms by 91%, of arterial pressure by 10-20 mmHg, of diabetes mortality by 30%, cancer by 40% and general mortality by 20%. In our country, 53% of population is overweight and obese, predominantly urban population. Obesity costs are high: about 4-8% of health budget are spent for screening, diagnosis and obesity management, including economical losses. When should we do obesity prevention? Primary care physicians must control all health indexes. If the patient passes over normal ranges of body weight, we should take account and intervene efficiently, by specific and non-specific therapeutic methods. How could we do obesity prevention? General care physicians and specialists could prevent efficiently this disease by taking apart obesity causes and risk factors: genetics, life-style, drug intake, smoking, professional and endocrine factors. Primary and secondary care physicians have to screen high risk persons, to analyze professional, familial and social conditions, to appreciate educational and economical status. All these realize an integral obesity management, together with the psychologist and the sociologist. Secondary prevention means obesity treatment, in order to prevent complications and, in the same time, to maintain normal body weight after ponderal excess loss. Obesity prevention is an important and complex social problem to debate. We have to mobilize political and economical factors, food industry, education. Obesity control means protection against one of the most aggressive health risk factors.

[Metabolic syndrome and breast cancer risk in post-menopausal women]. / Sindromul metabolic si cancerul mamar la vârsta menopauzei.

UNLABELLED: Lipid metabolism disorders--breast cancer risk association in postmenopausal women was searched in many studies; the HDL-cholesterol value triggered most of controversies. Some authors plead for increased breast cancer risk in overweight/obese postmenopausal women if HDL is higher while others plead for higher risk if HDL is lower then in general population. MATERIAL AND METHOD: We studied a 110 subjects female population aged between 41 and 69, and determined height, weight, body mass index (BMI), abdominal perimeter (AP), lipid parameters (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). All women performed mammography and breast echography. Imagery divided the subjects in three groups: 30 breast cancer patients (first diagnosis)--group 1, 50 breast dysplasia women--group 2, and normal breast patients--group 3. RESULTS: HDL-cholesterol proved significantly higher in group 2 compared to group 3 (control group), by the third and the fourth quartile; the same when it came to overweight/obese post-menopausal women. Nevertheless, more lipid disorders clustered in group 1 obese/overweight postmenopausal women. CONCLUSIONS: High HDL in breast dysplasia women is reported in international studies too. High menopause prevalence in group 3, implying abdominal obesity and lipid disorders may explain the small difference between group 1 (breast cancer patients) and group 3 (control group). High clustering in group 1 pleads for increased breast cancer risk in metabolic syndrome postmenopausal women. Comparing HDL values and the clustering phenomenon in group 1 to the other two groups considered as a control population (as done in international published studies), we can conclude that low HDL--abdominal obesity association increases breast cancer risk after the menopausal age.

[Android obesity and breast cancer risk]. / Obezitatea androida si riscul aparitiei cancerului mamar.

UNLABELLED: The 1998 report on the occasion of the 4th anniversary of International obesity Task Force emphasized that overweight (BMI > 25) is also linked to the increasing incidence of some neoplasias--breast, colon, endometer, prostate or kidney. Carmichael and Bates showed an inverse relationship between BMI and perimenopausal breast cancer. MATERIAL AND METHOD: We studied a group of 110 patients divided in three subgroups--30 patients who had just been diagnosed with breast cancer; 50 patients with breast dysplasia diagnosed by mammography and mammary echography; 30 patients with no modifications on mammography or breast echography. Height, weight, abdominal and hip perimeter have been measured. All have performed complete lipidogramme as well as serum estradiol. RESULTS: 15 of the 30 breast cancer patients (50%) were obese with a WHR > 0.8 compared to 23 (46%) in the mastosis group and 20 (66%) in the reference group. The prevalence differences were not significant, but the association between abdominal obesity and increased serum estradiol is highly significant for group I compared to the other groups (p < 0.01). CONCLUSION: Our study confirms that android obesity and estrogens are linked to breast carcinogenesis promotion by synergic or common pathways.

[Metabolic syndrome. Some specifics of diagnosis for cardiovascular prevention]. / Sindromul metabolic. Particularitati de diagnostic în preventia cardio-vasculara la obezi.

AIM OF THE STUDY: To analyse obesity and metabolical complications (cardiovascular disease) in an obese population, Iasi county compared to the nonobese population of the same locality. MATERIAL AND METHOD: Cross-sectional study on two groups: group 1--the witness group--48 cases normal weight and group 2--the study group--50 obese patients. RESULTS AND CONCLUSIONS: High values of abdominal perimeter (AP) associate with high glycemia, high triglycerides and low HDL-col in obese patients; higher evidence of X syndrome elements association in the obese population; higher global risk for the obesity in modern life conditions; teenagers obesity trigger are small birthweight and perinatal malnutrition in 30% of cases.

[Prevalence of type 2 diabetes mellitus in an internal medicine ambulatory care department]. / Prevalenta diabetului zaharat tip 2 în ambulatorul de medicina interna.

The aim of the study was to evaluate Glico regulation disturbances prevalence (glycemia over 126 mg/dl). We analyzed, in a retrospective study, 3051 patients hospitalized in Internal Medicine Ambulatory Care Department, "St. Spiridon" Hospital, during a period of two years, 2000-2001. Our department was design for one-week spitalization for diagnostic, so the patients are not on emergency condition. The medium age was 53 +/- 3 years, 24% males, and 76% females. We were looking for clinical and biological criteria of diabetes and co-morbidities (hypertension, dyslipidemias, ischaemic heart diseases). We also studied symptoms of admission and complications as infections. We found a jeune glycemia l126 mg/dl on 151 cases, 4.8% of total cases, predominantly women, 88 cases (58.3%), 63 males (41.7%). 44 cases were less than 50 years old and the rest over, 107 cases (70%). We excluded type 1 diabetes mellitus already known. The evaluation of BMI shows us the predominance of overweight and obesity (83.44%), 126 cases. 125 cases had cholesterol level over 200 mg/dl, 82.78%, and only 26 cases had lower. From these, 32% had triglycerides > 150 mg/dl. Study of co-morbidities revealed 42 cases with normal arterial tension, the rest had arterial hypertension, ischaemic heart diseases, 109 cases, 72.18%. More than a half had infections, especially urinary and pulmonary. Admission had relevant accuses: 34.27% came for diabetes suspicions, 28.31% had cardiovascular diseases, 12.36% had symptoms which were relevant for diabetes. We concluded that from the group of patients that are searching for diagnostic, on an internal medicine department, 4.8% had type 2 diabetes. We underline strong association with dyslipidemia and obesity.

[Obesity prevalence in Iasi county]. / Prevalenta obezitatii în judetul Iasi.

UNLABELLED: Our study is a part of a national study initiated by ARSO (Romanian Association for Study of Obesity). We selected a statistically representative sample (1500 cases). Study was built upon a questionnaire, made by primary care physicians. Anthropometrical data evaluated the obesity (weight, waist circumference and body mass index, BMI) and we considered associated risk factors (cholesterol levels, diabetes, and hypertension). BMI, more than 25 and 30, defines overweight and obesity. Waist more than 80 cm, for women and 94 cm for men, was considered abdominal obesity. Prevalence of obesity was globally 28.69%, by BMI and abdominal obesity, 57.87%. Non-obese cases are mostly on 20-29 years (2:1), both sex and 30-39 years, mostly on women. After these decades, percents for overweight and obesity are, constantly, more on women (48%) than men (31.03%). Abdominal obesity rises constantly with age, between 42.8% and 73.04%. A lot of patient didn't know theirs cholesterol values, over 25%. The highest percent of high cholesterol is located on 50-59 years (42%) and 35.63% on previous decade. High number of menopausal women can explain this. CONCLUSIONS: 1. We consider a high prevalence of obesity, 28.69%, predominant on women and aged persons. 2. Abdominal obesity has higher prevalence, 57.87%. 3. There are multiple risk factors, especially on 50-59 years decades but are not searched sufficiently.

[Importance of mild dyslipidemias determining the cardio-vascular risk factors]. / Rolul dislipidemiilor medii ca factor de risc cardio-vascular.

The aim of our study was to correlate "medium" dyslipidemias with cardio-vascular diseases, especially essential hypertension (EHT). We selected 488 cases using randomization, from a population of hypertensive people. About 210 cases benefited by lipidograms and risk assessment, using special diagrams. When cholesterol was 200-250 mg/dl, 72% of cases had EHT and over 300 mg/dl, 57% had EHT. Comparing LDL chol with EHT, we obtained that arterial tension over 160 mmHg is correlated with LDL over 190 mg/dl on 12%, when LDL was less than 190 mg/dl but more than 150 mg/dl, we found EHT on 16% cases. EHT was very strong correlated with HDL < 40 mg/dl, 88%. On 5% of cases the only one dyslipidemia was marked by low HDL chol and all this cases had EHT. A particular risk was represented by the dyslipidemia with low HDL chol and high triglycerides (28% of cases). We concluded that the highest prevalence was for medium hypercholesterolemia with/or low HDL chol and, the same time, extreme values had comparable prevalences with medium values.