Metastatic neuroendocrine pancreatic tumor - Case report.

Rationale.Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that develop from the endocrine tissues of the pancreas. They have a better overall prognosis than pancreatic adenocarcinoma. However, all commonly used classification systems reflect a separation between more indolent, well-differentiated tumors and far more aggressive poorly differentiated types that behave clinically more like small-cell carcinoma of the lung. Objective.To present the case of a 62-year-old man with an aggressive pancreatic NET, with liver, splenic and bone metastases who underwent multidisciplinary treatment including several lines of chemotherapy, somatostatin analogs and radiotherapy. Methods and Results.The patient is a smoker and an occasional drinker, known with type two diabetes mellitus (DM), receiving insulin therapy. He was diagnosed by contrast-enhanced computed tomography (CT) in January 2015 with a locally invasive pancreatic body mass, intraabdominal adenopathies and liver nodules, suggestive of metastases. Histopathological diagnosis was obtained through liver biopsy: neuroendocrine tumor with a 10-15% Ki67 proliferation index. Palliative chemotherapy with oxaliplatin and capecitabine was started in March 2015. In June 2015, Sandostatin LAR was added. In March 2016, he had progressive disease. Subsequently, in September 2016, bone metastasis was found within the T10 vertebra. He underwent radiotherapy for multiple bone metastases in February 2017. Progressive disease was again found during a CT examination in May 2017. His performance status has gradually worsened since then and he died in July 2017. Discussion.As a group, well-differentiated gastroenteropancreatic NETs are generally indolent malignancies with prolonged natural history. Intermediate-grade NETs have a slightly worse prognosis than low-grade tumors. Abbreviations: NETs - neuroendocrine tumors, NEC - neuroendocrine carcinoma, CT - computed tomography, MRI - magnetic resonance imaging, DM - diabetes mellitus, WHO - World Health Organisation, HCV - hepatitis C virus, CEA - carcinoembryonic antigen, AFP - alpha-fetoprotein, 5-HIAA - 5-Hydroxyindoleacetic acid, IHC - immunohistochemistry, EUS - endoscopic ultrasonography, EUS FNA - endoscopic ultrasonography with fine needle aspiration, CgA - chromogranin A, PRRT - peptide receptor radioligand therapy.

Parameters of oxidative stress variation depending on the concentration of inorganic zinc compounds.

Zinc deficiency is a problem faced by a large number of people, a U.S. study showing that only 46% of the population aged over 71 years has the best amount of zinc in the body. Due to the very complex role of zinc deficiency in this trace, it can occur through a variety of symptoms affecting multiple body functions. Zinc was demonstrated to have the ability to neutralize free radicals protecting the body from the harmful effects of these effects, ultimately leading to atherosclerosis and cardiovascular disease derived from premature aging, the immune and immune disorders and increased risk of cancer. The purpose of the paper is to identify the role of antioxidant systems, with Zn2+ ions in the center of defense and decrease oxidative stress in dynamic interaction with malignant transformed cells.

The evaluation of non-enzymatic antioxidants effects in limiting tumor- associated oxidative stress, in a tumor rat model.

Active oxygen species are produced as a consequence of normal aerobic metabolism. Of these, free radicals are usually metabolized or inactivated in vivo by a team of antioxidants. Individual members are a trained team fighting antioxidants to prevent the generation of ROS, destroy or oxidizing potential of capture. In terms of physiological oxidative stress, induced tissue attack is minimal. A relative or absolute deficiency in the antioxidant defense may lead to increased oxidative stress and this event is associated with both the causes and consequences of diseases and cancer, included here. The aim of the study is to identify the role of antioxidant defense systems and the reduction of oxidative stress in dynamic growth and development of malignant tumors. Our in vivo study was developed and referred to carcinosarcoma carriers Wistar rats treated with non-enzymatic antioxidants: vitamin C, vitamin A, zinc salt (II), and arginine in various combinations. Treatment was initiated three weeks before tumor induction.

Fetal death as a result of placental immune reconstitution inflammatory syndrome.

A 26-year-old woman was HIV-1 diagnosed at 11 weeks of pregnancy (CD4 = 7/mm(3), HIV-1 RNA = 108,000 copies/mL) with immunity against toxoplasmosis (Toxoplasma IgG = 1800 UI/mL). A fetal death was diagnosed 7 weeks after starting HAART (CD4 = 185/mm(3), HIV-1 RNA = 391 copies/mL) with a positive Toxoplasma PCR on fetal tissues and amniotic fluid. The absence of severe toxoplasmic foetopathy, the very exaggerated and atypical placental inflammation and the immune restoration context led to the diagnosis of placental IRIS associated with Toxoplasma gondii reactivation. This outcome remains undescribed and could represent an issue in resource-limited settings where HIV-pregnant patients are often severely immunodeficient and infected with opportunistic pathogens.

[Epidemiological considerations of the arbo- and arenaviruses]. / Unele consideratii epidemiologice asupra arbo si arenavirozelor.

The complex epidemiological process of arboviral and arenaviral diseases, their dependence on a multitudine of etiologic agents, the risk of severe manifestations, absence of a specific treatment and difficulties in preparing the vaccines, place these diseases among those of high concern at national and international level. The multidisciplinary investigations carried out in Moldavia by M. Duca, Eugenia Duca, Gr. Teodorovici, Alla Vâta, St. Dumitriu, V. Luca, D. Buiuc, A. Ivan and others have elucidated numerous aspects regarding the epidemiology and prevention of arboviral diseases. The increased morbidity by meningitis and meningoencephalitis recorded in Romania the interval summer--early fall 1996 was attributed based on serologic diagnosis, to West Nile virus. The etiological investigations were done both in our country (Cantacuzino Institute, Institute of Virology, Laboratory of the Ministry of National Defence) and abroad (Pasteur Institute at Paris, Colindale Institute London, CDC, Atlanta, USA). For the Romanian population the risk for a periodical re-emergence of some arbovirus diseases is due to favorable local conditions with the relationships with geographical areas were these diseases have and endemic-epidemic evolution are added.

[Epidemiological evaluations of the incidence of posttransfusion hepatitis in Iasi County in 1985-1995]. / Unele evaluari epidemiologice asupra incidentei hepatitei posttransfuzionale în judetul Iasi, în perioada 1985-1995.

In the interval 1985-1995 the morbidity rate of viral hepatitis of various causes showed yearly variations, an average of 181 cases being recorded. The performed investigations revealed markers for viral hepatitis B in an yearly average of 154 cases for the 11 years under study. Posttransfusion hepatitis had an average incidence of 43 cases per year, in 59.1% the markers for viral hepatitis B being absent. 93.3% of the cases with posttransfusion hepatitis belonged to the age groups over 20 years and workers presented a mean yearly incidence of 28.3% of all cases. In 1995 the blood donors with viral hepatitis C antibodies represented 4.05% and 75% of them belonged to the age groups 21-60 years, 50% of them being industrial workers and 40% having the A II blood group. Of the 321 admitted cases, 26.7% presented AgHBs, 8.4% AcVHC, in 2.3% markers for both viruses were evidenced and in 62.8% of the cases the diagnosis was made on epidemiological criteria and serologic exclusion (non A, B, C) without excluding the possible intervention of other hepatitic viruses.

[Multidisciplinary epidemiological observations on the role of mineral elements and other environmental factors in inducing essential arterial hypertension]. / Observatii epidemiologice multidisciplinare asupra rolului unor elemente minerale si altor factori ambientali în inducerea hipertensiunii arteriale esentiale.

The results of a pluridisciplinary epidemiological study carried out on a series of 225 adults from rural areas, in whom the prevalence of arterial hypertension disease (AHTD) and borderline (AHTB) was of 19.0% and 14.4%, respectively, are presented. In 19.0% of the carriers of over five associated risk factors for cardiovascular disease, the classical lipid constants (triglycerides-TG. total lipids-TL. total cholesterol-TC. HDL-cholesterol-HDL-c), plasma (PML) and erythrocyte magnesium level (EML), as compared to the degree of drinking water mineralization were determined. The environmental conditions, also expressed in water hardness (21.650 G) or magnesium water intake (85.13 mg/l) correlate in 41.0% of the subjects with a decrease in PML (1.8 mg/l) and in 70.48 with a decrease in EML (4.8 mg/l) through the association of some behavioral or metabolic risk factors: stress, consumption of atherogenic foods, excess alcohol and lipid dysmetabolism (TG: 130-140 mg/l = 59.5%; TL: 8 g%-30.9%; TC: 220 mg/l = 19%; HDL-c: 35 mg/l + 1.9%).

[An epidemiological assessment of acute diarrheal diseases in Iasi city and County (1985-1994)]. / Evaluari epidemiologice asupra bolii diareice acute în municipiul si judetul Iasi (1985-1994).

Acute diarrhoea, with a remarkable etiologic, clinic and epidemiologic polymorphism represents, for various reasons, an important concern for health preservation both in industrialised countries and, mainly, in the developing ones. It is that, at world level, 1.2-1.5 milliards of diarrhoea episodes, of which 750-950 millions in children, causing death in over 4 millions aged 0-5 years, are recorded. In Romania, although the real data of morbidity by acute diarrhoea are not known, the reports show a significant decrease in the past 10 years. In 1993, 420.2 cases at 100,000 inhabitants were reported, the most commonly affected being the children age 0-4 years. In Moldavia (Romania), numerous extensive studies on the epidemiology of acute diarrhoea have been carried out. This paper present and aims rendering evident some epidemiological aspects of acute diarrhoea cases reported in the interval 1985-1994 in Iasi County and town.

[Seroepidemiological considerations of the incidence of viral hepatitis C in some population groups]. / Consideratii sero-epidemiologice privind incidenta hepatitei virale C în unele grupuri populationale.

In the interval 1985-1994, in the Iasi district, the reported cases of viral hepatitis (VH) have recorded annual morbidity rates ranging between 67/100,000 inhabitants in 1993 and 373/100,000 in 1990. VH attributed to HAV and HBV has represented, with yearly differences, 62% to 94% of all cases. Posttransfusion viral hepatitis (PTVH) has determined a morbidity of 0.51/100,000 inhabitants in 1986 and 8.34/100,000 in 1994. PTVH without AgHBs ranged from 16.3% in 1993 to 94.0% in 1987, as compared to 6.0% in 1987 and 1988 and 75.0% in 1985 for PTVH with AgHBs. In the interval under study 70.9% of the PTVH cases were most likely determined by HCV and 28.9% by HBV (AgHBs+). From all PTVH cases, 64.0% were from urban areas, 59.3% were females, 92.5% belonged to over 20 years age groups, and 31.3% were industrial workers, the remainder belonging to other 5 occupational groups. In 241 patients (18.2%) admitted for liver disorders, posttransfusion hepatitis included, AcHCV was present in 39.4%, of which 45.2% belonged to the age groups 20-60 years. The results of some investigations carried out on 4471 blood donors (72.4% males, 85.4% aged between 21 ad 50 years, 86.4% from urban areas, 62.1% workers in industry and building) are presented. Out of these, 217 (4.9%) presented to hepatitis C virus (AcHCV). Occupational distribution of AcHCV possessors shows that 44.2% are workers in the heavy industry, 14.8% in the light industry and 12.9% unemployed. Sera were tested by Monolisa New Antigens, and those with AcHCV were reassessed with Monolisa, Murex anti HCV, ORTO-HCV 3.0 and confirmed by Immunoblot DECISCAN, with 5 antigens.

[Epidemiological observations on the evolution of influenza in the city of Iasi in the epidemic season of 1993-1994]. / Observatii epidemiologice privind evolutia gripei în municipiul Iasi în sezonul epidemic 1993-1994.

The epidemiological, clinical and laboratory data of influenza and other respiratory diseases recorded during the epidemic season 1993-1994, as they resulted from the comparative analysis of the cases reported weekly and those recorded through the "sentinel" collectivities method, are presented. The findings at admissions to the Infectious Diseases Hospital, Military Hospital, Diagnosis and Treatment Centre for Pupils and Students and the solicitation for medical care at the Emergency Ambulance Service were also interpreted. The involvement of A/Beijing/32/92/(H3N2) influenza virus was confirmed by evidencing the seroconversion on two serum samples tested through RIH, while for others antigens anamnestic reactions were recorded. The influenza epidemic had affected all age groups, with horizontal extension, a first rise in December 1993 followed by the decline determined by winter vacation being notice. A second epidemic rise, much stronger, started beginning with the last month of January and reached a peak at mid February, followed by a marked decline.

[Effectiveness of transcutaneous levator resection in congenital ptosis of the upper lid]. / Die Wirksamkeit der transkutanen Levatorresektion bei der kongenitalen Ptosis des Oberlides.

Thirteen patients (15 eyes) were treated for simple congenital blepharoptosis by means of transcutaneous levator resection. The patients' ages ranged from 6 to 23 years, the postoperative follow-up period from 29 to 63 months. In 2 cases the operation was performed because of residual ptosis following transconjunctival levator resection. In 11 eyes the results were very good, with postoperative ptosis of between 0 and +/- 0.5 mm and complete lid closure. In 3 eyes the results were good, with ptosis between greater than + 0.5 mm and + 1.5 mm and complete lid closure; and there was one failure, with postsurgical ptosis of greater than + 1.5 mm. The major cosmetic defect in all cases was lid lag on extreme downward gaze. In view of these good results and the multiple advantages of the anterior transcutaneous levator resection procedure as compared to the posterior (conjunctival) approach, the authors feel able to claim that transcutaneous levator resection is the method of choice for most types of simple ptosis. The operation is extremely laborious but fully justified by the good results.