Clinical, Histological and Prognosis Correlations in Diagnosis and Treatment of Gastric Cancer.

Purpose The study authors have proposed to highlight the main epidemiologic and prognostic aspects of digestive malignancies in the Dolj county population, justifying the need for permanent and detailed estimate of this phenomenon. Methods The authors of the study have proposed to outline a descriptive epidemiological panel, characteristic for the population groups at risk of developing gastric cancers and establishing clinical factors (tumor location, disease stage, type of surgery) and histological factors (histopathological type, degree of tumor differentiation) with prognostic significance having as landmark, survival rate at 5 years or disease-free survival of 5 years. Results The study was conducted on a sample of 458 patients with gastric tumors endoscopically detected, histologically confirmed and treated between 2000-2010. The epidemiological study allowed us to outline the descriptive epidemiological panel characteristic for the group of patients at risk of developing gastric cancer. Analysis of correlation between clinical parameters and histopathological parameters reached statistical threshold in multivariate statistical analysis of the localization of tumor, disease stage and histological type (p <0.0001) and the degree of differentiation of gastric carcinomas (p <0.005). Multivariate statistical analysis has detected statistically significant differences in terms of survival rate at 5 years (p> 0.001) and free interval of disease at 5 years (p> 0.001), depending on the location of the tumor, correlated with other clinical factors (disease stage, type of surgery) and histological factors (histopathological type, tumor differentiation grade), which allowed us to outline clinical, histological and prognostic groups. Conclusions Defining the clinical, histological and prognostic groups, allows an accurate assessment of patient prognosis from the time of randomization and initiation of treatment, type of surgery in advanced loco-regional, reconverted to operability, after neoadjuvant polychemotherapy being dictated by the location of the tumor (1/3 superior vs. 1 / 3 medium vs. 1/3 lower stomach).

Therapeutical Attitude and Analysis of Results in Brain Metastases.

Objectives - The aim of this study is to assess therapeutic outcomes in patients presenting with brain metastases as the first manifestation of malignancies either as a final stage in the evolution of malignancies. Materials and methods - We've performed a complex retrospective study on a total of 81 patients with brain metastases treated in Medical Oncology Clinic of the Emergency County Hospital Craiova between 1 January 2005-31 December 2010. Results - The average age of women (55 years) was statistically significantly low compared to men (64 years) (p = 0.000). The most affected age group was 51-60 years in women with maximum frequency of breast cancer and 61-70 years for men, with predominance of lung cancer. Most cases were presented with multiple metastases (90.12%) and the average latency-free interval from primary tumor detection to onset of symptoms was 29.8 months. Clinical manifestations, in most cases, occurred in less than 6 months after diagnosis of the primary tumor being a consequence of the evolution of disease at distance (36 patients / 62 patients in oncological evidence 58.06%) and 12 months after diagnosis survival rate was low being detected in patients with a controlled primary tumor and distant resumption of the disease (14 patients / 62 patients in oncological evidence-22.58%).Median survival in patients with irradiated brain metastases was 7 months. Multivariate statistical analysis of the survival rate has detected statistically significant differences depending on the type of the primary tumor (p = 0.000) and the manner of the onset of brain metastases as the first manifestation or evolution of neoplastic disease (p = 0.000).Survival was affected, without statistical significance threshold, by the number of metastases, patient gender and the loco-regional status of the primary tumor.

Evaluation of women knowledge and attitude regarding cervical cancer early detection.

At European level, Romania unfortunately comes first as far as mortality due to cervical cancer is concerned, mortality rate recording a continuous increase due to disease detection in advanced stages. In this context, we followed an assessment of women's cognitive and attitudinal fund in relation to early detection of cervical cancer, through the application of a questionnaire on a batch of 617 women with ages from 18 to 75-year-old, with various levels of education, residents of Craiova City and communes from Dolj County. Statistic processing of their answers indicates that 43.3% of the inquired subjects have not had a routine gynecological exam for at least seven years (or even never), which is more often found in the subgroup of women from the rural environment, with ages over 35 years and with an elementary educational level (p<0.001). 65.8% of the women have not done a Babes-Papanicolau test for seven years or even never, residence area, age and education level being once again discrimination factors between the subgroups. The reasons usually put forward as a justification for the failure to do the cytological test for the past three years are negligence (23.8%), the lack of information on the existence of such an investigation (18.2%), the absence of a genital pathology (12.8%) or of a medical recommendation (11.8%). Results suggest the need to provide uniform accessibility of the population to health services, by developing and implementing new strategies of educational and sanitary intervention mainly in rural communities.

Immunological approach in the diagnosis, therapy and prognosis of the exocrine pancreatic cancer.

The aim of the paper is to outline the most important up-to-date methods regarding the immunological approach in the diagnosis, treatment and prognosis of the exocrine pancreatic cancer, keeping in mind that this localisation of neoplastic disease represents the 5th cause of cancer-related death and especially, an important cause of morbidity. This disease, diagnosed in the past in later stages, being therefore associated with poor results, has turned to be characterized by increasing survival rates due to the improvements in diagnostic and therapeutic methods. Regarding the diagnosis strategy, progress was made in imagistic sphera, aiming: 1. an early diagnosis of pancreatic cancer and, implicitly, a high resectability rate of tumor, and 2. an evaluation of the timing for palliative therapeutic methods. So that, if in the past the diagnostic algorithm meant endoscopic retrograde-cholangio-pancreatography, computed tomography and angiography, at present it means nuclear magnetic resonance and helicoidal tomography. Concerning the treatment, it has to be multidisciplinary (surgery, radiotherapy, chemotherapy, immunotherapy), complex, because, after a resection for cure (R0), the main stay of the treatment, the mean survival at 5 years is 3%-28% and the rate of recurrences is 33%-80%. Biological therapy (sometimes called immunotherapy, biotherapy or biological response modifier therapy) is a relatively new addition to the family of cancer treatments that also includes surgery, chemotherapy and radiation therapy. Biological therapies are designed to repair, stimulate or enhance the immune system responses. We shall try to point out how the exocrine pancreatic cancers, the same stages and undergoing the same approaches, have had different responses due to a different biological behavior and how the biological response modifiers (interferons, interleukins, colony-stimulating factors, monoclonal antibodies and vaccines) can improve the results in pancreatic cancer.

[The descriptive epidemiological aspects of bronchopulmonary neoplasms in Dolj County]. / Aspecte epidemiologice descriptive ale neoplasmului bronhopulmonar în judetul Dolj.

This study represents a descriptive epidemiologic analysis of the morbidity and mortality incidence by lung cancer in Dolj. The usual processing of the registered values in primary evidences (report of the new cases to 100,000 residents) is in accordance with the literature about the variation of the incidence depending on residential environment and sex greater values in urban environment and at man, beginning from the fifth decade of life. The epidemiologic analysis by indirect standardisation of the mortality and the morbidity emphasizes in Dolj higher incidence up to the media of the Dolj, specially in the rural environment, aspects that suggest the intervention of the environmental factors and behaviour factors in the etiology of the lung cancer.

[The diagnostic and treatment aspects in bronchopulmonary neoplasms in Dolj County]. / Unele aspecte ale diagnosticului si tratamentului în neoplasmul bronhopulmonar în judetul Dolj.

The study carried out during 1991-1995 concerns 50 subjects with lung cancer confirmed by microscopy registered in the Oncology Department of Craiova University Hospital. The patients were studied on terms of clinical stage which indicated the regime of treatment associations: surgery + chemotherapy + radiotherapy, chemo-radiotherapy, chemo-immunotherapy, in order to improve surviving. The treatment results were assayed for each group of patients according to the international criteria of treatment response evaluation. The efficiency of various cytostatics associations according to histopathologic form was finally evaluated on terms of asymptomatic period and survival duration.