Archive issue

1. A Comparison of Endoscopic Ultrasound Guided Biopsy and Positron Emission Tomography with Integrated Computed Tomography in Lung Cancer Staging

S.S. Larsen(1), P. Vilmann(1), M. Krasnik(2), Asger Dirksen(3), P. Clementsen(3), Birgit G. Skov(4), Grete Krag Jacobsen(4), U. Lassen(5), Annika Eigtved(6), Anne Kiil Berthelsen(6), J. Mortensen(7), Liselotte Hoejgaard(7)

Background and study aims: Exact staging of patients with non-small-cell lung cancer (NSCLC) is important to improve selection of resectable and curable patients for surgery. Positron emission tomography with integrated computed tomography (PET/CT) and endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) are new and promising methods, but indications in lung cancer staging are controversial. Only few studies have compared the 2 methods. The aim of this study was to assess and compare the diagnostic values of PET/CT and EUS-FNA for diagnosing advanced lung cancer in patients, who had both procedures performed. Patients and methods: 27 patients considered to be potential candidates for resection of NSCLC underwent PET/CT and EUS-FNA. Diagnoses were confirmed either by open thoracotomy, mediastinoscopy or clinical follow-up. Advanced lung cancer was defined as tumour-stage ? IIIA(N2), corresponding to T4- and/or N2-N3- and/or M1 disease. Diagnostic values of PET/CT and EUS-FNA, with regard to the diagnosis of advanced lung cancer, were assessed and compared. Results: The sensitivity of PET/CT and EUS-FNA were respectively 60% and 60% for T4 disease, 56% versus 100% for N2-N3 disease (p=0.12) and 100% versus 33% for M1 disease (p=0.50). For diagnosing advanced lung cancer PET/CT had a sensitivity of 79%, specificity of 61%, positive predictive value (PPV) of 69%, negative predictive value (NPV) of 73%, and an accuracy of 70%. EUS-FNA had a sensitivity of 79%, specificity of 100%, PPV of 100%, NPV of 81%, and an accuracy of 89% for advanced lung cancer. Conclusions: PET/CT and EUS-FNA had a comparable sensitivity and NPV for diagnosing advanced lung cancer, but EUS-FNA had superior specificity and PPV. The two methods seem to complement each other.

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2. Management of Non-Variceal Upper Gastrointestinal Bleeding – from Theory to Practice

Sevastita Iordache(1), A. Saftoiu(1), S. Cazacu(1), T. Ciurea(1)

The upper gastrointestinal bleeding (UGIB) represents one of the most frequent medical and surgical emergencies. Upper GI endoscopy allows the treatment of the majority of lesions being associated with low transfusion requirement and decreasing of number of hospitalization days. Aim and method The aim of our study was to assess the clinical application of the elaborated guidelines for the management of upper GI bleeding in the Clinical County Emergency Hospital of Craiova. We assessed 100 consecutive patients with non-variceal upper gastrointestinal bleeding admitted through the Emergency Department. Results Upper GI endoscopy was performed in the first 24 hours in 50 % and as an elective procedure in 36 % of the patients. Therapeutic endoscopy was applied in 13.95% of the patients submitted for upper GI endoscopy Successful endoscopic haemostasis was performed in 85.7 % of cases, with re-bleeding and inefficient haemostasis in 14.3 %. Immediate surgery was necessary in 7 % of cases, 5 % of the patients were operated without previous upper GI endoscopy and 2 % after the failure of endoscopic haemostasis. Conclusion Although the algorithms of diagnosis and treatment were clearly designed, the assessment of the patients with non-variceal bleeding is incomplete and incorrect, in the absence of emergency endoscopy departments and dedicated intensive care compartments.

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3. Diagnosis Performance of Different MR Imaging Signs of Cirrhosis: the Caudate to Right Lobe Ratio, the Posterior Right Hepatic Notch, and the Expanded Gallbladder Fossa

N. Bolog(1), I. Oancea(1), G. Andreisek(2), Angelica Mangrau(1), F. Caruntu(3)

Background & Aims The purpose of the study is to evaluate the accuracy of the C/RL, RPN, and EGF in diagnosing cirrhosis. Methods The study population included 95 cirrhotic patients in the cirrhosis group (56 men, 39 women, age range 14-76;mean age 52.3) and 57 subjects in the control group (26 men, 31 women, age range 18-83;mean age 51). All MR examinations were performed by using the same protocol. Two radiologists independently assessed data sets in two different reading sessions. The sensitivity, specificity, and accuracy and the relative risk of the signs in diagnosing cirrhosis were calculated. The diagnosis accuracy of the C/RL sign was calculated using the ROC curve. The statistical significance of any difference of each sign between different classes of cirrhosis was also calculated. Results The interobserver agreement between the readers was excellent (?? 0.81;95% CI:0.92, 1.0). There was a significant statistical difference of the diagnostic value of C/RL, RPN, and EGF between cirrhotic patients and control group (p<0.001). The sensitivity, specificity, and accuracy of C/RL were 72%, 87%, and 78%; 67%, 87%, and 75% for RPN; and 49%, 91%, and 65% for EGF. C/RL (OR=18.95) and RPN (OR=14.74) showed a higher risk for cirrhosis compared to EGF (OR=14.74). There was a statistical significance difference between C/RL and EGF (p=0.002) and between RPN and EGF for Child A class of cirrhosis (p-0.037). ConclusionThe C/RL and RPN have similar performance regarding the diagnosis of cirrhosis having a higher diagnostic performance compared to EGF in cirrhosis.

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4. Imaging of Avascular Necrosis of Femoral Head: Familiar Methods and Newer Trends

Zoia Stoica(1), Daniela Dumitrescu(1), M. Popescu(1), Ioana Gheonea(1), Mihaela Gabor(2), N. Bogdan(2)

Avascular necrosis of the femoral head (AVN) is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Although patients are initially asymptomatic, AVN usually progresses to joint destruction, requiring total hip replacement, usually before the fifth decade. Avascular necrosis is characterized by osseous cell death due to vascular compromise. Avascular necrosis of bone results generally from corticosteroid use, trauma, pancreatitis, alcoholism, radiation, sickle cell disease, infiltrative diseases (e.g. Gaucher’s disease), and Caisson disease. The most commonly affected site is the femoral head and patients usually present with hip and referred knee pain. The aim of diagnostic imaging procedures in avascular femoral head necrosis is to provide the patient with a stage-adapted therapy. Therefore, a differentiated diagnostic work-up is needed. Native radiography of the hip in two planes is still the first step. Over the past years, the diagnosis of femoral head necrosis has experienced tremendous improvement due to the use of MRI and CT scans. Because of these improvements the correct stage can be diagnosed early and the appropriate therapy can be initiated immediately. Today, MRI is the most sensitive diagnostic imaging procedure. CT scans can be particularly useful to exclude subchondral fractures. The use of bone scintigraphy is restricted to exceptional cases. In Europe, the ARCO classification of avascular femoral head necrosis has been widely accepted. In this overview, we describe the specific characteristics of the different diagnostic imaging procedures and illustrate them with appropriate imaging material.

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5. Pituitary Macroadenomas - Imagistic Evaluation

Simona Bondari(1), Dana-Maria Albulescu(2), Adriana Iliescu(1)

As regarding the pituitary pathology, lesions of adenoma types are the most frequent; for many types are the most frequent; for many time diagnoses is complex, including the imagistic one. Pituitary lesions secreting or non-secreting macroadenomas have been characterized by a greater or smaller degree of invasivity. Those lesions extrasellar extension is well appreciated by imagistic methods giving minute information on the tumoral process ranging and on affecting the adjacent anatomical structures. In present paper suggests an imagistic aspects analysis of the macroadenomas extension, by computer tomography and magnetic resonance, each of the methods having its own specificity concerning the correct diagnosis of the pituitary pathology.

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6. Epidemiology Cervical Cancer in Dolj County during 1987-2007

Badulescu F , Crisan Anda, Schenker M

In the situation of cervical cancer on second place like cause of death in the world, the authors propose a descriptive epidemiology study in a range considered significant for 21 years between 1987 and 2007, on a number of aspects of the incidence this disease in Dolj County, whose population distribution by sex and age group suitable conclusions with direct implications in screening, treatment and survival in patients with cervical cancer. As in the incidence is observed followed a net increase since 2002 with the introduction of Order 219/1980 declaring a nominal cancer patients. Such active involvement of the family doctor on one hand, and declared by updating the files ONC1 specialist on the other hand, it requires urgent. Also important in screening programs for cervical cancer in order to found early stages, it is high in percentage of patients diagnosed in stages with clear therapeutic potential, with direct implications on survival patients. A brawl involving a oncology medical practitioner is required urgently, increasing diagnostic accuracy, and taking biopic material by experienced specialists, with the possibility discovery histopathological factors with implications in the correctly therapy and prognosis of patients.

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7. Assessment of Extracorporeal Shock Wave Lithotripsy (ESWL) Therapeutic Efficiency in Urolithiasis

P. Tomescu, A. Panus, G. Mitroi, O. Dragoescu, L. Stoica, S. Dena, M. Enache

Extracorporeal shock wave lithotripsy (ESWL) revolutionized the treatment of urolithiasis and gradually became the favorite treatment option so that today it is considered to be the first line of treatment for more than 75% of the patients with urolithiasis. The purpose of this study was the assessment of the therapeutic efficiency, complications and limitations of ESWL in urolithiasis in the initial experience using a third generation electromagnetic lithotripter. Between 2007 and 2008 we performed ESWL for 167 patients with urolithiasis. We recorded 92 patients with single stone (55.1%) and 72 with multiple lithiasis (44.9%). Stone size varied between 7 and 24 mm with an average of 12.3±7.1 mm. Radioopac stones were found in 104 patients (62.3%) while radiolucent stones in 63 only (37.6%). Complete stone disintegration and clearance was achieved in most cases (86.2%). Complications were mostly minor and rare (transitory haematuria, renal colic). Severe complications (renal hematoma, steinstrasse) were diagnosed for a limited number of patients (3.6%) and their management was mostly nonsurgical or minimally invasive (retrograde ureteroscopy). ESWL is therefore the first line of treatment for urolithiasis with stone size smaller than 2.5 cm. It has an efficiency rate above 85%, low procedure time, high safety and good tolerability (new generation lithotripters do not require anesthesia) and minimal complications.

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8. Histopathological Study of Epithelial Metaplasias in Endometrial Hyperplasia

Camelia Firoiu(1), Cristiana Simionescu(2), Diana Stanculescu(3), Florentina Cheznoiu(1), A. Stepan (2)

Objective: The aim of this paperwork is a histopathological study focused on the association of endometrial hyperplasia with epithelial metaplasia to evaluate the ethiopathological relation between these conditions. Material and methods: The material we studied was endometrial tissue obtained from biopsies, curetting and hysterectomy specimens from 624 patients investigated in Gynaecologic Ambulatory and hospitalised in Gynaecologic surgery of Emergency Hospital Tg-Jiu and diagnosed with endometrial hyperplasia in a period of 5 years, between 2004 and 2008, cases which were revaluated for epithelial metaplasias. This material was processed by classical technique of paraffin embedding and Haematoxylin-eosin staining in the Laboratory of Anatomopathology in the same hospital. Results: From the 624 endometrial hyperplasias, 333 cases were associated with different variants of epithelial changes as follow: ciliated metaplasia (144 cases), eosinophilic metaplasia (107 cases), squamous /morular metaplasia (78 cases), clear cell metaplasia (23 cases) and mucinous metaplasia (7 cases); these epithelial metaplasias were observed either as unique change (more frequently) or associated each other (most frequently ciliated and eosinophilic). Referred to the histological type of endometrial hyperplasia, the ciliated metaplasia and eosinophilic metaplasia were the most frequent epithelial changes associated with simple hyperplasia without atypia (72.90% and 71.02% respectively). In majority, squamous metaplasia and clear cell metaplasia were found in complex hyperplasia without and with atypia (83.33% and 82.60% respectively), while the mucinous metaplasia was associated with atypical complex hyperplasia in all cases. Conclusions: The increased frequency of association between endometrial hyperplasia and epithelial metaplasia in this study stand for one common etiopatogenic factor of the two lesion, namely persistent estrogenic stimulus. Generally, the most frequent variants of epithelial changes found in endometrial hyperplasias were ciliated and eosinophilic metaplasias. The significant endometrial lesions, namely atypical complex hyperplasia, have shown an increased propensity to associate squamous and mucinous metaplasia; however, these changes cannot be considered indicators of either synchronous or subsequent endometrial carcinoma.

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9. Histopathological Study of Renal Cell Carcinoma

A. C. Stinga(1), Alina Simona Stinga(1), Cristiana Simionescu(2), C. Margaritescu(2), M. Cruce(3)

Background. Prognostic markers for renal cell carcinoma (RCC), such as tumor stage, grade, and necrosis or microvascular invasion are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Hence, the objective of the current study was to evaluate these pathological variables and also we attempted to establish possible correlations between them. Patients and Methods. Seventy-two patients from the Pathology Department of Emergency County Hospital no. 1 from Craiova, Romania, were included in this retrospective study. Age, sex, histologic subtype, pT stage, Fuhrman grade, tumor necrosis and microvascular invasion were determined in all cases. Results. Clear cell, papillary, chromophobe carcinomas and renal oncocytoma accounted for 53 (73.61%), 12 (16.66%), 3 (4.16%) and 3 (4.6%) cases, respectively. Fuhrman grade 2 and pT3 stage were predominant features, tumor necrosis was identified in one third of investigated tumors and microvascular invasion in 9 tumors (12.5%).Conclusions. Most tumors were clear cell type and had a predilection for G2 and pT3 categories, instead papillary form, the second as frequency, had higher values regarding grading and tumor necrosis, but lower stage. Tumor necrosis correlates with higher grade and tumor stage.

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10. Access Cavity- the First Step in a Successful Endodontic Treatment

Lelia Gheorghita(1), Mihaela Tuculina(1), Oana Diaconu(1), Victoria Andrei(1), Iren Moraru(1), Marilena Bataiosu(1)

The purpose of this paper is to prove that corect access cavity is an important step in endodontic treatment and all the other steps depend on this preliminary phase.Material and method. In our study we used a number of 50 monoradicular and pluriradicular teeth, with different grades of radicular curvature. Cavity access was made using the adequate burs in order to obtain outline form and facilitate the action of canal instruments. Results. In order to obtain outline form cavity walls often have to be extended to permit both corect cleaning and shaping and corect tridimensional obturation. Discussions. An access cavity that has been prepared improperly in terms of position, depth or extent will hamper the achievement of proper results in endodontic treatment and will ultimately lead to failure by either root perforation, „ledge” or „shelf” formation within the canal, instrument breakage, zipping or apical transportation. Conclusions. Complete control of the clinician over the enlarging instruments is very important and this is very easy to obtain by creating a corect access cavity

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11. Contributions on the Study of the Compressive Strength of the Light-Cured Composite Resins

H. Manolea(1), Sonia Degeratu(2), V. Deva(1), Evantia Coles(1), Emma Draghici(1)

The mechanical properties of the light-cured composite resins are related to the material composition, but also vary according to the light-source characteristics used for polymerization. In this study we followed the compressive strength variation for a light-cured composite resin according to the time of exposure to the curing light. With that end in view,18 test pieces were made from a light-cured hybrid composite material (Filtek Z250). The test pieces where then submitted to a compressive force by a mechanical properties universal testing machine. Our results didn’t show an increase of the compressive strength according to the light-curing time increasing, than only in the light-curing time limit indicated by the manufacturer. A longer light-curing time may induce a shrinkage polymerization growth with the formation of internal tensions inside the material. The composite materials light-curing in short layers as long as there is indicated by the manufacturer seems to be a safer method to make the best from a resin qualities, then an exaggerated increase of the light-curing time. The light-curing is indicated to be done in the direction of the compressive forces. To confirm this supposition other mechanical tests are also necessary.

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12. Pulmonary Artery Thrombus Thrombolysed WITH Reteplase

Alina Giuca(1), I. Donoiu(2)

We present the case of a 70 years old woman, admitted in Craiova Cardiology Center for repeated fainting, hypotension, thoracic discomfort and cough, which appeared suddenly the same day. The clinical exam showed: cold, pale, sweated skin, tachypnoea, tachycardia, a diastolic murmur in the third intercostal space near the sternum edge, a third degree systolic murmur above the lower sternum, and a blood pressure of 80/60 mmHg. The electrocardiogram showed signs of right ventricular overload. Emergency echocardiography revealed a hypoechoic thrombus in the right pulmonary artery, of 33/15 mm, mobile, starting from the origin of the artery, with a remaining free lumen of 15-20% and a hypoechoic thrombus in the right common femoral vein. We decided to administer Reteplase (two boluses of 10 U at 30 minutes), with immediate favorable evolution. The echocardiography repeated at 24 hours showed the persistent thrombus in the right pulmonary artery, but with smaller dimensions, and a free lumen of 60%.

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13. Hepato-Renal Syndrome in Patients with Hepatic Cirrhosis

Daniela Parvulescu(1), Maria Stoica(2)

Hepatorenal syndrome is a particular form of functional renal failure which may develop in patients with liver cirrhosis. Precise diagnostic criteria have been established to clearly define this entity, whereas recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms. During the course of cirrhosis, sinusoidal portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arterial blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. Innovative therapies have shown promise to prolong survival in patients with hepatorenal syndrome, including the administration of analogs of vasopressin, the insertion of transjugular intrahepatic portosystemic shunts. On a preventive viewpoint, several simple measures have been shown to reduce the risk of hepatorenal syndrome in cirrhotic patients including the appropriate use of diuretics, the avoidance of nephrotoxic drugs, the prophylaxis of spontaneaous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis.

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14. Clinical Consequence of the Physicochemical Properties of LDL Particles in Type 2 Diabetes

Floriana Ionica(1), Florica Popescu(1), Catalina Pisoschi(1), Eliza Gofita(1)

Atherosclerosis is the major cause of death in type 2 diabetes. LDL cholesterol and atherosclerosis are correlated, both in nondiabetes people and those with diabetes, but people with diabetes are more given to atheroma, even though their LDL cholesterol levels are similar. This review analysed the evidence that modification of physicochemical properties of LDL play a role in the accelerated athero-sclerosis associated with type 2 diabetes.

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