Heat treatment of serum samples from stray dogs naturally exposed to Dirofilaria immitis and Dirofilaria repens in Romania.

Pre-heating of serum samples has been shown to reverse false negative antigen tests for Dirofilaria immitis infection in dogs. Here the authors report the results of serum sampling in a population of dogs naturally exposed to D. immitis and Dirofilaria repens infection by testing in ELISA before and after heat treatment. Of 194 dogs sampled from four cities in Romania, D. immitis circulating antigens were found in 16 (8.2%) non heated samples and in 52 (26.8%) heated samples. Of the 108 dogs examined by Knott test, 24 dogs (22.2%) were positive for circulating mf. Subsequent PCR identification showed six dogs had D. immitis mf only, 12 dogs, had only D. repens mf, and 5 were positive for both. Fifty% of dogs with circulating D. immitis mf had positive antigen tests before and after heating, while the other 50% reverted to positive only after heat treatment. Sixty% of dogs with mixed D. immitis/D. repens infection were antigen positive before and after heating, while the other 40% converted to positive after heating. Antigen testing for D. immitis in the 12 dogs with only D. repens mf gave conflicting results. Only two dogs (16%) were antigen negative both before and after heat treatment. Six dogs (50%) became antigen positive after heating and four dogs (30%) were antigen positive both before and after heat treatment. Results would suggest that: false negative result for antigen testing can be reverted by heating of the serum sample; dogs infected with D. repens may have also an occult infection with D. immitis; heat treatment of serum from D. repens-infected dogs can reveal an occult infection with D. immitis.

A randomized, double-blind, placebo-controlled phase II study to assess the efficacy and safety of mapatumumab with sorafenib in patients with advanced hepatocellular carcinoma.

BACKGROUND: This randomized, double-blind, placebo-controlled, phase II study evaluated the efficacy and safety of mapatumumab (a human agonistic monoclonal antibody against tumor necrosis factor-related apoptosis-inducing ligand receptor 1) in combination with sorafenib in patients with advanced hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Patients with advanced HCC (stratified by Barcelona Clinic Liver Cancer stage and Eastern Cooperative Oncology Group performance status) were randomized 1:1 to receive sorafenib (400 mg, twice daily per 21-day cycle) and either placebo (placebo-sorafenib arm) or mapatumumab (30 mg/kg on day 1 per 21-day cycle; mapatumumab-sorafenib arm). The primary end point was time to (radiologic) progression (TTP), assessed by blinded independent central review. Key secondary end points included progression-free survival, overall survival, and objective response. RESULTS: In total, 101 patients were randomized (placebo-sorafenib arm: N = 51; mapatumumab-sorafenib arm: N = 50). There was no significant difference in median TTP between both arms [5.6 versus 4.1 months, respectively; adjusted hazard ratio (one-sided 90% confidence interval) 1.192 (0-1.737)]. No mapatumumab-related benefit was identified when TTP was evaluated in the stratified subgroups. The addition of mapatumumab to sorafenib did not demonstrate improvement in the secondary efficacy end points. The reported frequency of adverse events (AEs) and serious AEs was comparable in both treatment arms. CONCLUSIONS: The addition of mapatumumab to sorafenib did not improve TTP or other efficacy end points, nor did it substantially change the toxicity profile of sorafenib in patients with advanced HCC. Based on these results, further development of the combination of mapatumumab and sorafenib in HCC is not planned.

Epidemiological evaluation of the outcomes after video-assisted thoracoscopic talcage in neoplastic pleurisy.

AIM: Clinical-epidemiological investigations for further assessing the importance of video-assisted thoracoscopy in the treatment y of patients with neoplastic pleurisy. MATERIALS AND METHODS: The researches included a group of 72 patients (31.9% men and 68.1% women aged 31-81 years, mean age ± 60 years) with neoplastic pleurisy who underwent pleural symphysis by video-assisted thoracoscopic talcage. For statistical-mathematical processing and interpretation the Pearson correlation index with the level of significance at p = 0.05 and highly significant at p < 0.005 was used. RESULTS: Neoplastic pleurisy prevalently affected the age groups 51-80 years (84.9%). Dyspnea was present in all cases, and patient history at the time of admission revealed 14 conditions, of which 25% were lung cancers. Macroscopically nodular and vegetative tumors were found in 66.7% of cases. An amount of 1000-2000 ml of pleural fluid was found in 44.5% of the cases and a serocitrin appearance in 50%. In 23.6% of the cases cytology results were positive for malignancy and in 13.8% suspicious. In 65.2% of the cases the pleural fluid was exudative and anatomopathology was suggestive of adenocarcinoma in 34.7% of the cases and breast cancer in 18%. The prevalence of recurrences varied from 1 month to more than 7 months, with 36.4% for 1-2 months. CONCLUSIONS: The obtained additional data support the important role of pleural symphysis by video-assisted thoracoscopic talcage in the patients with neoplastic pleurisy.

Clinical-epidemiological study on advanced non-small cell lung cancer.

AIM: To assess the clinical and epidemiological features of all three main histological types of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The study included 34 patients with NSCLC admitted to specialized units of the Iasi Regional Cancer Institute (IRCI) in the interval May 2012 - May 2014. Data were collected electronically based on a clinical-epidemiological survey form. The obtained data were then processed and interpreted by statistical-mathematical methods using the correlation index (significant at p < or = 0.05 and highly significant at p < 0.005), chi-square and Y tests. Data were analyzed using SPSS 13.0 (SPSS Inc. Chicago, Illinois, USA). RESULTS: Most NSCLC patients were aged 56-71 years, the Pearson correlation index between age and diagnosis being p = 0.01. Sex difference was highly significant (p = < 0.001) and so was the relationship between heavy smoking and age groups. Most cases were histogenetically classified as adenocarcinomas (22%). Four patients (21%) were in stage IIIA NSCLC, 4 (21%) IIIB, 9 (47.3%) IV, and 15 (79%) unspecified stage. All patients received primary chemotherapy. Single or associated complications included anemia and other hematologic disorders (26-74.6%), respiratory failure, hemoptysis, cachexia, atelectasis, etc. Surgery was performed in 5 (14.7%) stage IIIA NSCLC patients. CONCLUSIONS: NSCLC showed a highly significant predominance in the age groups 56-71 years, and the most common histologic type was adenocarcinoma. All patients received primary chemotherapy, and patients with stage IIIA underwent surgery. Anemia and other hematologic disorders were the most common complications.

Investigations in associated protozoa-bacterial infections of cyprinids from a fish farm situated on the Jijia river in N-E of Romania / Investigações sobre infecções protozoárias-bacterianas associadas a ciprinídeos da exploração piscícola no rio Jijia, situado no NE da Romênia

In autumn 2011 in cyprinid farms located in Iasi on the Jijia river, several infections with bacterial strains and macroscopical external cysts on the skin were diagnosedwhich developed as a result of the stress induced by biotic and abiotic factors. On the examination of the cyst contents the presence of numerous spores was observed, mostly of the Dermocystidium sp genusThe samples were taken from the common carp (Cyprinus carpio) and crucian carp (Carassius auratus gibelio) species from the fish farm as well as from the Jijia River. 35 fish were examined, all of them showing cysts, fragmentation of their dorsal fin and congestion of the gills. Histological examination of the skin showed a field of multiple dermal cysts with round light eosinophilic formations (14-16µm) containing a central refractable body similar to that reported for Dermocystidium sp. Gills samples were taken from the affected areas for the SEM examination with the purpose of evaluating not only aspects of normal morphology, but also aspects of some modifications of the affected areas as well as the presence of the etiologically incriminated bacteria Pseudomonas fluorescens. The isolates were identified through phenotypic methods. All the strains that showed mobility and oxidase-positivity were tested using API 20 NE strip. Consequently, they were taxonomically grouped into the species Pseudomonas fluorescens. The scanning electron microscope (SEM) was used for the first time in the characterization of the bacterial lesions produced by Pseudomonas strains on Cyprinus carpio and Carassius auratus gibelio gills. The diagnosis of septicemia with conditional pathogen species of Pseudomonas fluorescens was correlated with the results of the physico-chemical investigations of water and the data concerning the breeding conditions of the investigated livestock...

No outono de 2011, em fazendas de ciprinídeos localizadas em Iasi, no rio Jijia, diversas infecções bacterianas e cistos externos macroscópicos na pele se desenvolveram como resultado do estresse induzido por fatores bióticos e abióticos. No exame do conteúdo dos cistos, a presença de diversos esporos foi observada, a maioria do gênero Dermocystidium sp. As amostras foram colhidas das seguintes espécies: carpa comum (Cyprinus carpio) e carpa cruciana (Carassius auratus gibelio) de fazenda piscícola, além do rio Jijia. Assim sendo, 35 peixes foram examinados, todos demonstrando cistos, fragmentação da barbatana dorsal e congestão das guelras. O exame histológico da pele mostrou um campo de múltiplos cistos dérmicos com formações circulares claras eosinofílicas (14-16µm) contendo corpo central refratado similar ao relatado para Dermocystidium sp. Amostras de guelras foram retiradas das áreas afetadas para exame MEV, com o propósito de se avaliar não apenas os aspectos da morfologia normal, mas também os aspectos de algumas modificações das áreas afetadas, além da presença da bactéria etiologicamente incriminada: Pseudomonas fluorescens. Os isolados foram identificados por meio de métodos fenotípicos. Todas as amostras que mostraram mobilidade e positividade-oxidase foram testadas usando-se fita API 20 NE. Consequentemente, estas foram taxonomicamente agrupadas na espécie Pseudomonas fluorescens. O microscópio eletrônico de varredura (MEV) foi usado pela primeira vez na caracterização de lesões bacterianas produzidas por Pseudomonas nas guelras de Cyprinus carpio e Carassius auratus gibelio. O diagnóstico de septicemia com espécies condicionais de patogênico de Pseudomonas fluorescens foi correlacionado com os resultados das investigações físico-químicas da água e de dados sobre as condições de reprodução dos animais investigados...

Clostridium difficile epidemic outbreak in an oncology unit.

AIMS: Contributions to the knowledge of some peculiarities of C. difficile involvement in human pathology, nosocomial infections (NI) included. MATERIAL AND METHODS: This clinico-epidemiological and laboratory study included 14 patients admitted to the Medical Clinic of the Iasi Regional Cancer Institute with the diagnosis of C. difficile NI based on detection of toxins A and B in stool samples. The data were assessed and interpreted using an algorithm which revealed the peculiarities of C. difficile NI outbreak occurrence and evolution. RESULTS: Of the 14 cases included in the study, 5 (35.8 %) had community-onset infections and 9 (64.3%) oncology unit-onset infections. The average hospital stay was 22 days. Immunocompromised condition and the use of antibiotics in the ciprofloxacin, colistin and cefotaxime group for 4 - 10 days were the main risk factors. CONCLUSIONS: This epidemic C. difficile NI outbreak which affected immunocompromised patients with high susceptibility to infection, common finding in oncology care was brought under control by active preventive measures associated with concomitant antimicrobial therapy effective in C. difficile infections.

Clinical-epidemiological study on the incidence of postoperative complications after pulmonary resection for lung cancer.

AIM: To determine the relationship between the characteristics of a group of lung cancer patients, lung cancer surgeries, and the incidence of early and/or late postoperative complications. MATERIAL AND METHODS: The study included a group of 115 lung cancer patients aged 40 to 85 years, 76.5% men, 60.91% living in urban areas, who received surgical treatment in the interval January 2013-August 2014. Data were collected from electronic medical records and survey sheets and processed and interpreted using Pearson correlation index (p-value of 0.05 was considered statistically significant and of <0.005 highly statistically significant), and chi2, y, 1c = 25% tests. All statistical analyses were performed using the SPSS statistical software package version 13.0. RESULTS: Of the 115 patients 7.8% were in the 40-50 years age group and 87.8% in the 51-75 years age group (p < or = 0.001). Most patients were males (76.5%, p < 0.001), and 60.9% of the patients were living in urban areas (p < or = 0.05). The difference in the prevalence of smokers (76.5%) vs. non smokers (23.5%) was highly statistically significant (p < 0.005). Active smoking of one pack of cigarettes per day for more than 10 years was recorded in 54.8%. The presence of co morbidities (17 events) and the distribution of neoplastic lesions in the five anatomical areas required the performance of lobectomies, bilobectomies or pneumectomies. The incidence of early (14 entities) and late postoperative complications (7 entities) depended on patient's general condition, nature of co morbidities, location and stage of neoplastic lesions, and surgical complexity. CONCLUSIONS: Lung cancer, in various locations and stages, most commonly affected males aged 40-85 years, from urban areas, smokers, with various co morbidities. Surgeries performed in these patients were often laborious and with a relatively low incidence of postoperative complications.

Childhood rhabdomyosarcoma. Anatomo-clinical and therapeutic study on 25 cases. Surgical implications.

UNLABELLED: Rhabdomyosarcomas (RMS) are the most frequent soft tissue sarcomas of childhood. Despite advances in knowledge about biological pathways of tumorigenesis, risk stratification and multimodal treatment, the immediate and long-term prognosis of these lesions in many countries with limited resources is still poor. PATIENTS AND METHODS: Twenty-five histologically confirmed pediatric RMS were recorded during the period of study. Demography, clinical presentation, diagnostic means, pretreatment staging and post-surgical grouping, histological type, therapy and outcome were evaluated. RESULTS: The mean age was 6.7 years; the group included 12 boys and 13 girls. Twelve lesions were localized in the genitourinary tract, eight in the trunk and extremities, two cases each in head and neck and retroperitoneum and one case in biliary tract. Primary surgical attempt was performed in 15 patients but only in nine of them underwent complete resection (three with free margins) other six cases achieving removal with residual disease. In 10 cases, solely biopsy was possible. Twenty-four patients received chemotherapy but only four cases performed radiation therapy. Overall survival rate was only 36% (nine cases). CONCLUSIONS: As mean feature children from our series had late presentation with locally extended (bulky and node positive) lesions and unfavorable sites. Improved multimodal management of RMS in recent years will probably lead to better survival curves in an increasing number of cases and an outstanding outcome in children with locally advanced disease.

Research on aromatase gene (CYP19A1) polymorphisms as a predictor of endocrine therapy effectiveness in breast cancer.

UNLABELLED: Single nucleotide polymorphisms (SNPs) of the CYP19A1 gene have shown the ability to modify its activity, but no association has been established with aromatase inhibitor (AI) efficiency in hormone receptor positive breast cancer (BC). MATERIAL AND METHODS: The study included blood samples from 53 patients (p) with BC and 1 control (male DNA); 22p. (investigational group) were administered an Al and followed up. RESULTS: Homozygous (hh) -CC and TT -, and heterozygous (hz) - TC - genotypes of the rs10046 SNP were balanced. Response to treatment or progression were not affected (p=0.630) in patients with T allele 1; local relapse occurred significantly more rarely and overall survival (OS) was superior (p=0.046). For rs4646, genotypes were mainly hhGG (57%), with no implication to study parameters (p>0.05). For rs727479 SNP, major genotypes were hhTT (40%) and hzTG (45%). Therapeutic response was better in patients with T allele 2 (p=0.040), T allele 1 was associated with reduced local recurrence (p=0.047) and TT genotype with better OS (p = 0.008). In rs700518 SNP, genotype was mostly hzGA (49%). Local recurrence rates were reduced in the presence of G allele 1 (p=0.047) and GG homozygosity. CONCLUSIONS: At this stage, the study was purely exploratory and hypothesis generating. Genotyping of at least three of the four CYP19A1 SNPs evaluated (except rs4646) may have an impact in clinical practice, providing better criteria for patient selection, prognosis and therapeutic decision in BC.

Prevalence of liver complications in children receiving long-term parenteral nutrition.

BACKGROUND/OBJECTIVES: The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. The objective was to study outcome data in home TPN-dependent children and to describe precisely their liver biopsies in the attempt to analyze risk factors for biochemical and histological hepatic abnormalities. SUBJECTS/METHODS: Medical records of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home total parenteral center were reviewed. Hepatic biochemical abnormalities were analyzed. Hepatic biopsies were classified by two independent pathologists. RESULTS: Duration of TPN was 7.9±0.8 years (mean±s.e.m.), with an average age at onset of 1.5±0.5 years. A total of 24 patients (57%) developed biochemical liver abnormalities in an average of 2.9±0.4 years after starting TPN. Risk factors for biochemical abnormalities were younger age at TPN commencement, longer duration of TPN, higher rate of catheter-related infections and higher volume and energy content of TPN. Liver biopsies were carried out in 43% of patients (mean age 3.2±0.9 years). Almost all patients had fibrosis (94%). Risk factors were dependent on each histological abnormality: fibrosis was significantly associated with a shorter length of bowel and a longer duration of TPN; cholestasis correlated with a lower percentage of total parenteral energy intake due to lipids; and steatosis had no risk factor identified. CONCLUSION: Our study reports a high rate of histological liver abnormalities and analyzes risk factors in children who underwent very long-term home TPN.

[Breast cancer in the male]. / Cancerul mamar la barbat.

UNLABELLED: The aim of this study is to point out the late diagnosis and initiation of treatment in male with breast cancer. At the same time, to show the importance of the correlation between different markers in assessing the prognostic, as well as the treatment for the patient. MATERIAL AND METHODS: Retrospective study on a group of 15 males with breast cancer, out of 1043 patients with the disease, in a period of 10 years. Eight patients were stage III of disease, 2 were stage II, one was stage I, and in other 3 cases the evaluation of the tumor and of the axillary lymph nodes was performed only by echography, considered stage II. RESULTS: All patients underwent radically modified Madden mastectomy; 4 patients needed a partial resection of the great pectoralis muscle. Adjuvant chemotherapy was performed in 9 patients, and neoadjuvant chemotherapy in 2 cases. Three patients refused the chemotherapy, and one patient chose an alternative paramedical treatment. The treatment with Tamoxifen was done in 11 patients with high values of Progesterone and Estrogen Receptors (PR, ER). At the date of our study, 8 patients were alive, without clinical signs of disease (free of disease), while in 3 patients, alive, clinical signs of disease were detected (recurrence). Survival rate couldn't be evaluated in 4 patients. CONCLUSIONS: Breast cancer in male is usually discovered in locally advanced stages, although most of the patients are regularly screened for chronic hepatitis. Use of biological markers allows a more accurate evaluation of the aggressiveness of the tumor, as well as a more specific treatment for each patient. Modified radical mastectomy type Madden remains the preferred surgical approach. Surgical approach should be considered even in locally advanced cases, as well as in elder patients.

Laryngotracheal non-Hodgkin's lymphoma.

OBJECTIVES: Malignant lymphomas of larynx and trachea are rare tumors and require special diagnostic and therapeutic attention. The authors present an unexpected case of nonHodgkin Lymphoma localized in the subglottic larynx and upper cervical trachea. The clinical presentation, diagnostic and therapeutic approach, evolution and prognosis are discussed. METHOD: We report a case of 25-year-old male patient, with progressive dyspnea, presented in our ENT Department with severe airway obstruction caused by a large subglottic tumoral mass migrated in the glottic space during an accidental fall. An emergency tracheotomy was performed. The flexible endoscopy and CT-scan revealed a large mass arising from the subglottic larynx and anterior wall of upper cervical trachea with the obstruction of 2/3 of the laryngotracheal lumen. RESULTS: After a complex assessment, the tumor was excised by external approach (median thyrotomy). The histopathologic exam of the surgical specimen showed malignant nonHodgkin lymphoma and the immunohistochemical profiles were evaluated in order to establish the therapeutic strategy including chemotherapy in the Department of Oncology. CONCLUSIONS: Invasion of the subglottic larynx and trachea by lymphoma is an uncommon problem which can cause severe airway obstruction and requires multidisciplinary approach (ENT, pneumology, oncology/hematology). The clinicopathological features of this case have been described and compared with previously reported cases.

Early recurrence in favorable stage II breast cancer--which approach is the best?

AIM: Changing the sequence of therapeutic options in stage II breast cancer: first, a core biopsy, followed by the evaluation of the tumoral markers, adaptation of the chemotherapy scheme and finally, surgical approach. Thus would be possible to improve the hope of life in some stage II breast cancer patients, in whom survival is poorer than in some stage III patients. MATERIAL AND METHOD: 144 patients in stage II breast cancer were included in this study, over a period of 5 years (2000-2004). In all these patients the first therapeutic option was surgery (radically modified mastectomy type Madden), followed by systemic chemotherapy-FAC or FEC, 6 cycles, and finally Tamoxifen. RESULTS: 34 out of them developed metastases in a period between 6 and 72 months, most of them in the first 26 months; 25 out of these 34 didn't have metastases in the axillary lymph nodes, and in 18 patients estrogen--and progesterone--receptors were highly positive. HER 2 neu was negative or low expressed in patients with metastases. CD 34 wasn't evaluate in the whole group. CONCLUSIONS: Early onset of metastases in the studied patients, in whom tumoral aggressiveness markers were not obvious, impose the evaluation of the angiogenesis markers and, when positive, chemotherapy as the first therapeutic option.

Immunoproliferative small intestinal disease versus colonic monoblastic sarcoma in a 2-year-old boy.

The authors present a case of colonic monoblastic sarcoma, previously treated for other digestive abnormalities (malabsorbtion, Hirschprung's disease). Important similitudes with immunoproliferative small intestinal disease (IPSID) lymphoma were demonstrated for this patient (male, 2-year-old). His main admission complaints were failure to thrive, recurrent episodes of enterocolitis and malabsorbtion syndrome. Some particularities of this case are the young age and the extremely rapid development of the malignant disease in a patient with no previous signs of acute non-lymphoblastic leukemia. The initial diagnosis was of malabsorbtion syndrome, based on the clinical exam at presentation, and then the patient was thought to have a form of Hirschprung's disease, due to a functional intestinal disorder (slow transit). After the necropsy, pathologists diagnosed an immunoproliferative small intestinal disease, and four years later, they performed a more appropriate pathological exam, which explained better clinical symptoms associated to this complex case.

[High blood and urine concentration of hepatotoxic mycotoxins (aflatoxin B1, sterigmatocystin) in patients with liver cirrhosis]. / Detectarea micotoxinelor hepatotoxice la pacienti cu ciroza Hepatica.

UNLABELLED: Aflatoxins and sterigmatocystin are potent carcinogens, certainly involved in pathogenesis of liver cancer. AIM: To evaluate the risk of mycotoxin intake and to determine the presence of aflatoxin B1 (AFB1) and sterigmatocystin (STC) in patients with liver cirrhosis. MATERIAL AND METHOD: The study included 92 patients (33 controls, 59 liver cirrhosis) that completed a food frequency questionnaire (FFQ). Blood and urine samples were collected and mycotoxins determined by high performance liquid chromatography. RESULTS: 18.18% samples in controls and 72.88% in cirrhosis group presented detectable levels of mycotoxins. The mean values of AFB1 in blood were 0.7 ng/mL in controls and 1.67 ng/mL in test group (p = 0.11); STC presented 60 times higher levels in second group (p < 0.01). AFB1 presented a mean level of 1.2 ng/mL in urine of test group (not detected in controls); STC presented 256 time higher concentration in urine of cirrhotic patients, with a perfect correlation between blood and urine levels in control (r=1) and no correlation in test group (r = 0.05). There were no correlations between mycotoxin, liver enzymes, alpha-fetoprotein and mycotoxin intake risk estimated by FFQ. CONCLUSION: Most of the patients presented detectable levels of mycotoxins, significantly increased in cases with liver cirrhosis, probable due to a specific metabolic pattern.

[Triple-negative breast cancer--towards a new entity]. / Cancerul mamar triplu negativ--spre o noua entitate.

UNLABELLED: Breast cancer is considered today as a heterogeneous group of diseases, with a wide spectrum of clinical, pathologic and molecular features. A new classification of breast carcinomas, based on gene expression profiles technologies (cDNA microarray), shows impact on the diagnosis and prognostic classification of tumors, prediction of response of individual patients to specific chemotherapeutic regimens, and identification of novel tumor targets. AIM: To identify the proportion of basal-like ("triple-negative") tumors in patients treated for breast carcinoma. OBJECTIVES: To evaluate the impact of molecular subtyping on treatment response, disease-free survival and overall survival of patients, and to establish and correlate particular biologic, clinical and diagnostic features of these cancers. METHODS: 96 patients with breast cancer, aged 28-78 years, were retrospectively selected using specific criteria from cases treated between 2001 and 2007 in the Oncology Department of the "Sf. Spiridon" Hospital Iasi. Tumors were divided into molecular subtypes using immunohistochemistry data. RESULTS: The most frequent pathology was ductal carcinoma (77 patients, 80.2%), and most tumors were intermediately or poorly differentiated (G2 43 patients, 44.8%; G3 37 patients, 38.5%) The proportion of basal-like tumors in the population sample analyzed was 15.62% (15 patients). Histological type (p=0.85), pTNM stage (p=0.618), and tumor differentiation grading (p=0.54) did not correlate with molecular subtype. Patients with basal-like tumors had lower time-to-progression (mean 31.2 months, 95%CI 18.5-43.8, p=0.005), disease free survival (mean 24.46 months, 95%CI 12.6-36.3, p=0.016), and overall survival (mean 39.26 months, 95%CI 26.7-51.7, p=0.023). CONCLUSION: We have demonstrated, using the simple commonly available immunohistochemical markers ER, PR and HER2/neu, that patients with triple negative breast cancers have relatively poor prognosis, with significantly shorter survival and a poorer response to standard treatment strategies.

[Controversies regarding intraperitoneal chemotherapy for advanced ovarian cancer]. / Controverse privind chimioterapia intraperitoneala in cancerele ovariene avansate.

Ovarian cancer is unique among solid tumors in its propensity to remain localized in the peritoneal cavity for much of its natural history. There is now a growing body of clinical data demonstrating a survival advantage for patients with advanced stages of ovarian cancer treated by intraperitoneal (i.p.) chemotherapy compared with standard intravenous (i.v.) treatment route. Cytotoxic agents administered directly into the peritoneal cavity, however, have limited potential for penetrating bulky tumor masses. On the basis of the results of three randomized, phase III clinical trials, i.p. chemotherapy has now been shown to be superior to standard i.v. chemotherapy in the primary setting of chemotherapeutic management of advanced epithelial ovarian cancer, with small residual volume after surgery. Despite the fact that i.p. chemotherapy has been shown to determine an improvement in survival, many investigators feel that the formidable toxicity, complexity, and quality of life alterations associated with i.p. therapy make it mandatory that it should be compared prospectively to a less toxic and more convenient regimen of i.v. carboplatin/paclitaxel. The barriers to implementing this treatment into clinical practice appear to be toxicity concerns, and a lack of technical expertise with the peritoneal infusion devices. It is critically important to state that a large body of exiting data revels this is a management approach that can be administered safely, but not in routine oncology practice, outside the setting of a clinical trial or tertiary medical center.

[Scintigraphic visualization of Pgp protein: a non-invasive method to evaluate the MDR cellular character]. / Vizualizarea prin scintigrafie a proteinei Pgp--metoda neinvaziva de evaluare a caracterului MDR tumoral.

The MDR character is a major factor that influence the effectiveness of cancer chemotherapy. This feature can be noninvasively evaluated through 99mTc isonitrils (MIBI, Tetrofosmin) scintigraphy, because these radiotracers cellular efflux is mediated by the Pgp membranar active transport system, the same that mediate chemotherapy drugs cellular efflux. The Pgp glycoprotein overexpression in the case of the MDR positive tumoral cells will determine both the chemotherapic drug and the isonitrile radiotracer quickly efflux from the cell. This paper present, based both on the literature and personal authors research work, the principle of the method, radiotracers structural characteristics and cellular uptake mechanism, practical protocol details from the acquisition untill the qualitative and quantitative image processing and results interpretation. Quantification indexes are proposed for the radiotracer cellular uptake quantitative evaluation on the scintigraphic image. The results could bring the possibility to make MDR positive patient diagnosis and further selection for the MDR modulators drug therapy.

[Statistical study of the evolution over ten years of the clinical and therapeutic approach in childhood soft tissue sarcoma]. / Studiul statistic clinico-terapeutic si evolutiv pe 10 ani in sarcoamele de tesuturi moi la copii si tineri.

UNLABELLED: Soft tissue sarcoma has a primitive mesenchymal origin and represents a heterogeneous group of malignant entities with a continuous rising frequency in the age range below 18. Rhabdomyosarcoma (RMS) constitutes 5.8% from the whole amount of pediatric solid tumors, taking the fourth place after CNS tumors, neuroblastoma, and Wilms tumors. The other category of non-rhabdomyosarcoma tumors in children and teenagers represents 3% of the solid malignancies under 18 years old. Our study looks at the particularities of the pathological, clinical, therapeutic aspects and the statistical correlation with prognosis. We included in the study a well-known category of soft tissue tumors called of uncertain malignancy. MATERIAL AND METHOD: The study was made between January 1995 and July 2005 in the Pediatric Department of Hematology and Oncology of the "Sf. Maria" Clinical Emergency Hospital Iasi on a group of 58 de patients ranging between 0 and 18 years old. RESULTS: Positive diagnostic confirmation was established on pathological grounds in optic microscopy and immuno-histo-enzymology performed on bioptic samples in Department of Pediatric Surgery and analyzed in Pathology Laboratory of "Sf. Maria" Clinical Emergency Hospital Iasi. Based on histological examination 19 cases (32.75%) were of rhabdomyosarcoma type with following subtypes: alveolar--7 patients, embryonic-- 9 cases, fusiform - 2 cases, bothrioid--1 case), 8 cases were undifferentiated soft tissue sarcomas and one patient had a tumor of pleiomorphic type; 13 children (22.41%) had non-rhabdomyosarcoma soft tissue sarcomas: 6 fibrosarcomas, 2 synovial sarcomas, 1 leiomyosarcoma, 1 Kaposi sarcoma, 1 case of malignant peripheral nerve sheath tumor, 1 case of angioma tumor, one liposarcoma; 16 cases were included in soft tissue tumors of uncertain origin (fibromatosis--6 cases, fibrous histiocytoma--4 cases, hamartoma--cases, myoblastoma--1 case, fibro-xanthoma--1 case, hemangioendothelioma--1 case); 1 PPNET (Askin tumor). CONCLUSIONS: The continuously augmented incidence of soft tissue sarcoma in young ages and the advanced stages initial presentations of tumors require a much more serious and rhythmic survey at general practitioner level. An improvement of diagnostic means is useful, taking into account the limits of optic microscopy. Therapy must be stage and histology adapted; lowering risk toxicity of good prognosis cases and enhancing doses when required are the only reasonable options to avoid over treatment and to have a much better survival rate.

[Age-related prognostic factors and treatment results for advanced non-small cell lung cancer (NSCLC)]. / Factorii prognostici si evolutia pacientilor vârstnici cu cancere bronho-pulmonare non-microcelulare avansate.

UNLABELLED: There is much debate whether the choice of management for elderly patients with locally advanced, inoperable NSCLC with good performance status (PS) should be made entirely on terms of age. MATERIAL AND METHOD: We compared the results of chemotherapy (CT), radiotherapy (RT) and chemoradiotherapy (CT-RT) of the elderly with those of younger patients, and studied predictive factors for survival in these age groups. 231 patients with advanced NSCLC were included in this study, being grouped by age: > 65 years (148p, 64.1%) versus < 65 years old (83p, 35.9%). Univariate analysis and Cox regression models were used to assess significance of variables for prediction of survival. RESULTS: Mean overall survival (OS) for the whole group was 11.48 months (median 9.0 months); no significant difference in median OS was found between elderly and younger patients (11.55 vs. 11.65 months, p = 0.537). Univariate analysis revealed significant survival benefits in both age groups as per weight loss < 5%, absence of comorbidities, earlier clinical stage, high initial Hb levels, longer time-to-progression (TTP) and good PS. Treatment type had different survival impact on the age groups; best median survival in patients > 65 years (14.0 months) was obtained by CT alone, while patients < 65 years benefited more (13.35 months) from sequential CT-RT. Logistic regression model identified 5 variables to be significant for survival in all patients: PS, extent of disease, hemoglobin (Hb), TTP and age. When applied to the elderly group, only 4 variables had predictive value: extent of disease, Hb, TTP and presence of comorbidities. Treatment toxicity did not differ significantly between age subsets, except for renal toxicity, which was greater in elderly patients. Age should not be a choice-limiting item for the treatment of advanced NSCLC. CONCLUSION: An active therapeutic approach, such as chemotherapy, can be feasible, effective and well tolerated in selected elderly NSCLC patients with a good PS and no associated comorbidities.