Shape Coexistence at Zero Spin in

The low-spin structure of the semimagic ^{64}Ni nucleus has been considerably expanded: combining four experiments, several 0^{+} and 2^{+} excited states were identified below 4.5 MeV, and their properties established. The Monte Carlo shell model accounts for the results and unveils an unexpectedly complex landscape of coexisting shapes: a prolate 0^{+} excitation is located at a surprisingly high energy (3463 keV), with a collective 2^{+} state 286 keV above it, the first such observation in Ni isotopes. The evolution in excitation energy of the prolate minimum across the neutron N=40 subshell gap highlights the impact of the monopole interaction and its variation in strength with N.

Multifaceted Quadruplet of Low-Lying Spin-Zero States in

A search for shape isomers in the ^{66}Ni nucleus was performed, following old suggestions of various mean-field models and recent ones, based on state-of-the-art Monte Carlo shell model (MCSM), all considering ^{66}Ni as the lightest nuclear system with shape isomerism. By employing the two-neutron transfer reaction induced by an ^{18}O beam on a ^{64}Ni target, at the sub-Coulomb barrier energy of 39 MeV, all three lowest-excited 0^{+} states in ^{66}Ni were populated and their γ decay was observed by γ-coincidence technique. The 0^{+} states lifetimes were assessed with the plunger method, yielding for the 0_{2}^{+}, 0_{3}^{+}, and 0_{4}^{+} decay to the 2_{1}^{+} state the B(E2) values of 4.3, 0.1, and 0.2 Weisskopf units (W.u.), respectively. MCSM calculations correctly predict the existence of all three excited 0^{+} states, pointing to the oblate, spherical, and prolate nature of the consecutive excitations. In addition, they account for the hindrance of the E2 decay from the prolate 0_{4}^{+} to the spherical 2_{1}^{+} state, although overestimating its value. This result makes ^{66}Ni a unique nuclear system, apart from ^{236,238}U, in which a retarded γ transition from a 0^{+} deformed state to a spherical configuration is observed, resembling a shape-isomerlike behavior.

The histopathologic type of the periampullary tumors. Is it important for survival?

BACKGROUND: The ampulla of Vater is a junction with four histologic epithelial types: ampullary, duodenal, pancreatic and biliary. The tumors of this region are named periampullary adenocarcinomas, but the histologic type of these malignancies seems to have an important significance for survival. AIM: Our purpose is to determine whether the histologic type of the resectable vaterian adenocarcinomas is a prognostic factor. METHODS: We reviewed the medical records of 38 patients who underwent RO-R1 pancreatoduodenectomy for periampullary adenocarcinomas between 1998 and 2007 in one single surgical center. The histopathologic reports and the microscopic samples were reevaluated independently by two senior pathologists. Using our database we assessed the overall survival based on histologic type, tumor stage, lymph nodes involvement, tumor size and the level of differentiation. RESULTS: The histologic type of the adenocarcinomas was intestinal in 23 cases (60.5%) and pancreatobiliary in 15 cases (39.5%). The median overall survival was significantly higher in patients with well differentiate intestinal-type in T1-T2 stage without nodes involvement. In a multivariable Cox regression analysis the regional lymph nodes involvement and the differentiation degree remained significant prognostic factors. CONCLUSION: The intestinal type of periampullary adenocarcinomas has a long survival, but the lymph nodes involvement and the lower degree of differentiation are associated with a high risk of death in these malignancies.

Relationship between C-reactive protein and arterial stiffness in an asymptomatic population.

Plasma concentration of high sensitive C-reactive protein (hsCRP) is used as a marker for inflammatory states and is directly correlated with the risk for coronary heart disease. Evidence concerning the role of inflammation in atheroma formation has been derived from several models of atherosclerosis. Inflammation should exert its adverse vascular effects by structural changes in the artery wall and consequently alterations in arterial elasticity, which could be detected already in asymptomatic early vascular disease. We hypothesized that CRP is related to large artery elasticity, but not to small artery elasticity in early vascular disease. Therefore, we examined the association between arterial stiffness of large and small arteries and inflammation in an asymptomatic population referred for primary prevention cardiovascular screening. Studies were performed in 391 subjects (age 21-82 years; 254 men, 137 women) who underwent screening at the Cardiovascular Disease Prevention Center. Large artery (C1) and small artery (C2) elasticity indices were obtained by the CVProfiler 2000 (HDI, Eagan, MN, USA). After overnight fasting, venous samples were taken for measurement of hsCRP, lipids, glucose. There was a significant inverse correlation between hsCRP (0.29 +/- 0.40 mg/dl) and C1 (16.7 +/- 5.8 ml/mmHg), r = -0.133, P = 0.01; there was no significant correlation between hsCRP and C2 (6.6 +/- 3.2 ml/mmHg). C2, but not hsCRP, was inversely correlated with age, abnormal lipids and glucose, whereas C1, but not hsCRP, was inversely correlated with age and systolic blood pressure (SBP). In multiple regression analysis, the relationship between hsCRP and C1 was not affected by age, body mass index, SBP, serum glucose or lipids. In conclusion, these findings support the hypothesis that hsCRP, a marker for acute and low-grade inflammation, is associated with large artery but not with small artery elasticity in asymptomatic individuals undergoing primary prevention cardiovascular screening.

Beneficial pharmacokinetic interaction between cyclosporine and itraconazole in renal transplant recipients.

BACKGROUND: Itraconazole is often given for fungal prophylaxis to renal transplant recipients, who require concomitant cyclosporine in the immediate posttransplant period. We determined the extent of the pharmacokinetic interaction between cyclosporine and itraconazole oral solution in renal transplant recipients and the effect on daily drug costs. METHOD: This was a single-center, open-label, nonrandomized study. Posttransplantation, renal transplant recipients received itraconazole solution 200 mg twice daily and cyclosporine, dosed to achieve target concentrations. Once at steady state, blood samples were collected over 12 hours for pharmacokinetic evaluation of cyclosporine, itraconazole, and hydroxy-itraconazole. Itraconazole was discontinued after approximately a 3-month prophylaxis regimen. Cyclosporine doses were titrated to achieve target concentrations and cyclosporine concentrations were once again determined when steady state was achieved. A noncompartmental analysis was used to analyze cyclosporine pharmacokinetic parameters. The pharmacoeconomic impact was measured based on the percent change in dose of cyclosporine when administered with and without itraconazole. Drug costs were calculated using the average wholesale price. The cost per patient, as well as the average cost, was calculated for the cyclosporine/itraconazole combination, as well as the cyclosporine regimen alone. RESULTS: Eight renal transplant recipients completed the study. All were included for itraconazole analyses and seven for cyclosporine analyses. Mean peak and trough itraconazole levels were 1.64 +/- 0.82 and 1.23 +/- 0.90 microg/mL respectively. Mean peak and trough hydroxy-itraconazole levels were 2.37 +/- 1.55 and 2.20 +/- 1.48 microg/mL, respectively. While on itraconazole, a 48% reduction in the mean total daily dose of cyclosporine was necessary to maintain target concentrations (171 +/- 63.6 versus 329 +/- 103.5 mg, P =.003). This reduction in cyclosporine dose resulted in a discounted itraconazole daily drug cost of approximately 29.5%. CONCLUSION: Administering itraconazole with cyclosporine allows for a decrease in the cyclosporine dose, thus lowering daily drug costs and providing adequate antifungal coverage with itraconazole and hydroxy-itraconazole trough concentrations above the MIC(90) of Candida and Aspergillus spp.

Wasting as an independent predictor of mortality in patients with cystic fibrosis.

BACKGROUND: Cystic fibrosis (CF) is the most common life threatening autosomal recessive disorder in the white population. Wasting has long been recognised as a poor prognostic marker in CF. Whether it predicts survival independently of lung function and arterial blood gas tensions has not previously been reported. METHODS: 584 patients with CF (261 women) of mean (SD) age 21 (7) years were studied between 1985 and 1996, all of whom were being followed up in a tertiary referral centre. Lung function tests, body weight, arterial blood oxygen (PaO(2)) and carbon dioxide (PaCO(2)) tensions were measured. The weight was calculated as a percentage of the ideal body weight for age, height, and sex. RESULTS: Forced expiratory volume in one second (FEV(1)) recorded at the start of the study was 1.8 (1.0) l (52 (26)% predicted FEV(1)), PaO(2) 9.8 (1.9) kPa, PaCO(2) 5.0 (0.9) kPa, and % ideal weight 92 (18)%. During the follow up period (45 (27) months) 137 patients died (5 year survival 72%, 95% CI 67 to 73). FEV(1), % predicted FEV(1), PaO(2), % ideal weight (all p<0.0001), and PaCO(2) (p=0.04) predicted survival. In multivariate analysis, % predicted FEV(1) (p<0.0001), % ideal weight (p=0.004), and PaCO(2) (p=0.02) were independent predictors of outcome. Patients with >85% ideal body weight had a better prognosis at 5 years (cumulative survival 84%, 95% CI 79 to 89) than those with < or =85% ideal weight (survival 53%, 95% CI 45 to 62), p<0.0001. Percentage predicted FEV(1) (area under curve 0.83; 95% CI 0.78 to 0.87) and % ideal weight (area under curve 0.74; 95% CI 0.68 to 0.79) were accurate predictors of survival at 5 years follow up (receiver-operating characteristic analysis). CONCLUSIONS: Body wasting is a significant predictor of survival in patients with CF independent of lung function, arterial blood oxygen and carbon dioxide tensions.

[Case of cystic metastasis of the liver]. / Un caz de metastaze chistice hepatice.

The report is about a patient clinic of Iassy from oncologic clinic. He had pain in the right, back and inferior hypocondrium, with irradiation, vomitings, pain less (7 kg in 2 months), weekness. The echography shows three years ago, hepatic cysts (the patient refused the admitted in hospital). Computed tomographic (CT) exam made in jan. 1996 shows three cystic hepatic tumors (2 in right and 1 in left lobes). The CT function revealed sterile biliohematic liquid. The laparotomy made the sharp diagnosis--cephalic pancreatic tumor with cystic metastatic hepatic tumors. The surgical treatment was partial resection of pancreatic tumor and drainage of hepatic cysts, with good postoperator evolution. The intraoperative histological exam found the same kind of malignant tumor in the pancreas and liver. We present the case for his rarity.

Right ventricular dysfunction in adult severe cystic fibrosis.

STUDY OBJECTIVES: This study sought to assess the extent of impairment of cardiac function in adult patients with end-stage cystic fibrosis (CF) and to examine the relationship between cardiovascular abnormalities and the degree of hypoxemia and hypercapnia. DESIGN AND SETTING: A retrospective study in a tertiary cardiac and CF center. PARTICIPANTS AND INTERVENTIONS: A total of 103 adult patients with end-stage CF awaiting lung or heart and lung transplantation (mean age [+/- SD], 26+/-7 years; 54 men) underwent Doppler echocardiography and arterial blood gas analysis (mean PaO(2), 54+/-10 mm Hg; mean PaCO(2), 47+/-8 mm Hg). The findings were compared to those of 17 healthy control subjects (mean age, 24+/-7 years; 13 men) who had no history of cardiac or pulmonary disease. MEASUREMENTS AND RESULTS: All patients were in sinus rhythm with a mean tachycardia of 112+/-18 beats/min (control subjects, 76+/-16; p<0.0001) and had a cardiac output of 5.3 L/min (control subjects, 4.3 L/min; p<0.04). In the patient group, the left ventricular (LV) dimensions, systolic and diastolic function, and wall thickness were all within normal limits. The mean amplitude of long-axis excursion in patients was normal at the LV site, but that of the right ventricular (RV) free wall was significantly reduced as compared with control subjects (1.6+/-0.4 vs. 2.2+/-0.4 cm, respectively; p<0.001), which was found to correlate with the degree of hypoxemia (r = 0.63; p<0.02) and hypercapnia (r = -0.68; p<0.01). RV diastolic function, which was represented by the relative isovolumic relaxation time to cardiac cycle length, was longer in patients than in control subjects (8.7+/-4.8% vs. 5.0+/-3.0%, respectively; p<0.03). The pulmonary flow acceleration time (90+/-22 vs 121+/-34 ms, respectively; p<0.01) and the systolic stroke distance (7.0+/-2.2 vs. 10.5+/-1.9 cm/s(2); p<0.001) were both lower than normal. CONCLUSIONS: This study confirms the presence of significant RV systolic and diastolic dysfunction in the setting of consistent tachycardia and increased cardiac output in adult CF patients with severe disease. No specific LV abnormalities were detected in these patients.

[Colonic lipoma]. / Lipoamele colice.

The authors present 6 cases of colonic lipoma, 2 in females and 1 in male, aged between 61-62 years. The benign lipomatous tumour was in all cases unique, located in the right segment of the colon, ileocecal valve, and on the sigmoid once respectively. The right colonic lipomas had clinical signs of intestinal invagination while the sigmoidian one were characterized by abdominal pain and bleeding. The surgical solution consisted in limited ileocecal resection, right hemicolectomy, and segmentary colectomy respectively.

[Giant retroperitoneal lipoma]. / Lipoame gigante retroperitoneale.

70 retroperitoneal tumors (10 with an adipous origin out of which 8 were lipomas) have been operated upon in our clinic since 1985. Four cases of giant lipomas are presented in this paper. They weighed 4.5-7.5 kg. and had a diameter over 15 centimeters. Their close proximity with the kidney, duodenum, colon, inferior vena cava etc made there extirpate difficult. The post-operative condition of the patients was good. Although the histopathological tests proved that all these giant lipomas were benign after two to four years, their relapse required a new surgical intervention. The histopathology of the relapsed lipomas revealed a malign degeneration in 3 out of the four cases. The origin of this malign degeneration was in the fibrous part of the tumors.

[Adenocarcinoma in Barrett esophagus: its recurrence and long-term survival]. / Adenocarcinomul pe esofag Barrett: recurenta si supravietuire la distanta.

Adenocarcinoma arising in ectopic gastric mucosa has been reported more than 40 years ago. This report reviews our experience with Barrett's adenocarcinoma over 8 years. The definition remains subject to controversy. More than 50% of patients in our study had unfavorable course of disease. The hope for cure lies almost in early detection of tumors at which point a truly curative resection could be done. There is no difference in terms of survival comparing to the adenocarcinoma arising on normal esophagus.

[Klatskin's tumor]. / Tumora Klatskin.

During the period 1989-1998, 27 patients with primary proximal bile duct cancer were treated (17 females and 10 males with a mean age of 61 years). The main presenting symptoms were: jaundice (96.2%), itching (92.5%), weight loss (74%) and atypical pain (33.3%). All the patients underwent ultrasound (US) examination, 7 patients endoscopic retrograde cholangiopancreatography (ERCP) and 4 patients computed tomography (CT) examination. US examination revealed the tumor in 51% cases; most frequently a dilatation of the intrahepatic bile ducts was diagnosed with all methods. 8 patients underwent resection of the tumor and one a biliary-enteric anastomosis, in 15 cases a stent was inserted. In 3 cases the extension of the malignancy did not allowed any procedure. Three patients died during immediate postoperative period (mortality 11.2%). The mean survival was 13 months after stenting and 22 months after resection of the tumor. The authors recommended an aggressive surgical therapy for Klatskin tumors.

[The Wermer syndrome]. / Sindromul Wermer.

The difficult diagnostic and therapeutic management of patients having gastrinoma with multiple endocrine neoplasia type I (MEN I) has been discussed by reference to the literature and a personal experience of 2 patients with Wermer syndrome. The syndrome is often familial and might be inherited as an autosomal dominant trait with a high but variable degree of penetrance. Pancreatic islets, parathyroid glands and adenohypophyseal [correction of antehypophyseal] cells are the three localization main for endocrine involvement in MEN I syndrome.

[Choledochal cyst in adults and cancer of the biliary tract]. / Chistul de coledoc la adult si cancerul caii biliare.

We presented 3 cases of cystic dilatation of common bile duct classified as type IC, IVB an IVA. All 3 were women, admitted for right upper quadrant pain and jaundice. Two cases proved malignant degeneration in cystic dilatation in first cas and in gallbladder in third. Only the 3rd case had a positive preoperative diagnosis achieved through echography, TPHC, ERPC. Surgical treatment consisted of cysto-jejunal derivation in the cas of the common duct malignant cyst inoperative and cholecystectomy associated with the excision of the dilatation followed by the hepato-jejunal anastomosis in the other 2 cases. Adenocarcinoma of the gallbladder was a pathological surprise. A better knowledge of the risk of cancer on cystic dilations of the common bile duct should lead to an earlier diagnosis of this disease and a preventive treatment by radical excision of the dilatation.

[The heart: a spectator or participant in neoplasms? Neoplastic subacute cor pulmonale]. / Cordul: spectator sau participant în neoplazii? Cordul pulmonar subacut neoplazic.

Neoplastic subacute cor pulmonale is a distinct clinical syndrome that is often not too easily diagnosed. Such rapid development of cor pulmonale is observed in a patient with lymphangitis carcinomatosa of the lung consecutive to a cancer of the stomach with splenic, pancreatic and lymph nodes invasion. Diagnosis was established on transition of the normal ECG to a typical pattern of cor pulmonale and was revealed by chest roentgenographic examination (interstitial syndrome finding) and fatal evolution of severe respiratory failure. Necroptic and pathological studies confirmed histologic lung involvement by tumoral emboli and lymphangitic carcinoma the tosis and documented neoplasm in the stomach.

[Thyroid cancers]. / Les cancers thyroidiens.

We have analysed factors that influenced on the patient survival in 195 cases of thyroid cancer. The survival is essentially influenced by the histology, the papillary forms (survival after 15 years: 83.1-93%) and follicular cancers (survival after 15 years: 84-94%) having an excellent evolution. The non-differentiated and mixed cancers have a very severe prognosis that is independent of the complex therapy that have been used (survival after 5 years: 17.1% in non-differentiated forms and 32.5% in mixed ones). The prognosis is better in subjects under the age of 45 and in female subjects. The cancers in the 1-st and 2-nd stage of tumor extension have a better evolution that those in the 3-rd stage. In differentiated cancers, the total or subtotal thyroidectomy followed by radioiodine administration determine the best survival.