Uterine Artery Doppler Flow Indices in Pregnant Women During the 11 Weeks + 0 Days and 13 Weeks + 6 Days Gestational Ages: a Study of 168 Patients.

OBJECTIVES: Uterine artery Doppler flow studies during the 11th and 14th week of pregnancy are important in the prediction of preeclampsia and intrauterine growth restriction in pregnant women as well as in the prevention thereof. METHODS: Our study on Doppler flow indices of the uterine arteries involved 168 patients examined in our clinic, with pregnancies ranging from 11 weeks + 0 days to 13 weeks + 6 days. RESULTS: There were 72 patients from 11 weeks + 0 days to 11 weeks + 6 days (42.86%), 43 from 12 weeks + 0 days to 12 weeks + 6 days (25.60%), and 53 from 13 weeks + 0 days to 13 weeks + 6 days (31.55%). The mean values of the Doppler indices were PI 1.75±0.79, 1.88± 0.81, 1.71±0.81, and 1.58±0.72 and RI 0.72±0.14, 0.75±0.14, 0.71±0.14, and 0.70±0.14 for the entire group and for the three intervals, respectively. There were 71 (42.26%), 33 (19.64%, with 18 cases or 54.55% on the right side), and 64 (38.10%) patients with bilateral, unilateral and absent uterine artery notching, respectively. The mean Doppler indices for the three aforementioned groups were 2.18±0.79, 1.63±0.72, and 1.33±0.57 for the PI, and 0.79±0.11, 0.71±0.14, and 0.66±0.14 for the RI, respectively. The indices for the 175 arteries with and 161 without notching, taken separately, in all patients, as well as for the uterine arteries with and without notching in patients with unilateral notching only were 2.16±0.76, 1.30±0.54, 2.08±0.66, and 1.17±0.43 for the PI, and 0.79±0.11, 0.65±0.14, 0.79±0.11, and 0.63±0.12 for the RI, respectively. CONCLUSIONS: The mean uterine artery PI and RI decrease from 11 weeks + 0 days-11 weeks + 6 days to 13 weeks + 0 days-13 weeks + 6 days. They also decrease from patients with bilateral uterine artery notching to those without notching. The frequency of uterine artery notching decreases with increasing gestational age. Our results are similar to those in literature.

Synchronous gastric tumors - case presentation.

Synchronous gastric tumors, and, especially the presence of an adenocarcinoma and gastrointestinal stromal tumors, are less frequent. We present the case of a 75-year-old patient, with no gastrointestinal pathology in the medical history, who was admitted for marked asthenia, nausea, coffee grounds vomiting, inappetence, dizziness, weight loss and periodical epigastralgias. The clinical and imagistic examinations highlighted an ulcerative, infiltrative, bleeding tumor formation, present on the anterior side and subcardially on the small curvature. During the surgery, there was highlighted a second tumor, whitish, of about 2.5 cm, prominent under the peritoneal serous, of firm consistency and with an adherence to the stomach muscles. For removing the two tumors, there was performed total gastrectomy with esophagus-jejunal termino-lateral anastomosis, with jejunum ansa "in omega". The histopathological and immunohistochemical examinations established that the first tumor was a poorly differentiated carcinoma, and the second was a gastrointestinal stromal tumor. The patient's evolution was a good one, both clinically and biologically, the imagistic examinations performed after six and 12 months highlighting the lack of local relapses and absence of metastases.

The assessment of matrix metalloproteinase-9 expression and angiogenesis in colorectal cancer.

Colorectal cancer (CRC) is one of the most frequent types of cancer in the world. Between tumor cells and the stroma mutual interconnections are established that favors the tumor development and metastasis. In this respect, the extracellular matrix is remodeled so that it may become totally different from a morphologic perspective than the stroma of the organ in which the tumor develops. Matrix metalloproteinases (MMPs) have an essential role in the remodeling of the tumor stroma. We assessed the expression of MMP-9 on a number of 31 stage III colorectal adenocarcinomas. Generally, MMP-9 had a high but inconstant expression in tumor cells. The highest expression was found in poorly and moderately differentiated carcinomas, with a lower expression in well-differentiated colorectal cancers. Occasionally, MMP-9 expression was identified also in peritumoral macrophages and in stromal cells. Metastasis-free lymph nodes had an intense positive reaction in both macrophages and lymphocytes. The intensely positive reaction was observed for the macrophages and lymphocytes in the tumor necrosis regions. The process of angiogenesis was generally correlated with the intensity of MMP-9 reaction.

Etiopathogenic, therapeutic and histopathological aspects upon the anterior vaginal wall prolapse.

The pelvine organ prolapse (POP) is a condition affecting million of women, with a major impact upon the social and professional life of the patients. According to various studies, it affects approximately 40% of the women aged over 50 years. About 10% of women with POP require a surgical procedure for POP or urinary incontinence. Our study comprised a number of 14 patients, aged between 55 and 70 years, hospitalized and treated in the Clinic of Urology within the Emergency County Hospital of Craiova, Romania, between 2011 and 2013, for second-degree cystocele. Of these, 11 (78.57%) patients had more than two natural deliveries, 10 suffered more than three abortions, and eight (57.14%) women suffered from obesity. The increase of abdominal pressure, induced by chronic coughing, constipation or hard physical work, was identified in more patients. Thus, six (42.8%) patients presented chronic bronchitis, four (28.57%) patients were smokers, eight (57.14%) patients presented chronic constipation, and 10 (71.42%) patients stated that they had performed hard physical work. The presence of effort urinary incontinence, associated to the cystocele, was found in eight (57.14%) cases. The surgical intervention consisted in the performance of a direct cystopexia with a synthetic tent, placed in a transobturatory way, in a "tension free" manner (Perigee System). The post-operatory evolution was a good one; the results after six months showed that 12 (85.71%) women were cured, two (14.29%) cases of cystocele relapsed, while in two patients there maintained the effort urinary incontinence. The histopathological examination of the anterior vaginal wall fragments, harvested during the surgical intervention, showed the presence of a chronic inflammatory infiltrate in the lamina propria of the uterine mucosa, which may cause the post-operatory relapses. We consider that the reduction of the inflammatory process through the administration of anti-inflammatory drugs could reduce the POP onset and progress.

Histological and immunohistochemical aspects of papillary thyroid cancer.

Papillary thyroid carcinoma is one of the most common malignancies of the endocrine system. In recent years, its incidence has increased worldwide, including children, which concerns the entire community. Although the histopathological diagnosis seems rather easy, the existence of particular forms of thyroid cancer and the inclusion of the follicular aspect as a variant of papillary carcinoma lead to diagnostic confusion. Therefore, in the last 20 years were reviewed several immunohistochemical markers, which are useful in the positive and differential diagnosis, and which offer better data on disease prognosis. Our study included a total of 27 cases of papillary carcinomas, which we evaluated the immunohistochemical expression of Ki-67, p53, p63, E-cadherin, CD56, calretinin, and bcl-2 markers. The most intense expression was found in p53, E-cadherin, and bcl-2. Ki-67 and p63 expression were moderate and inconsistent, and CD56 and calretinin had a negative expression in all cases.

Prevalence and histopathological types of skin carcinomas in Arges County, Romania.

Non-melanoma skin cancers presented a significant incidence increase in the last decades, worldwidely. Even though the impact upon mortality is a relatively low one, through the incidence increase, their impact upon the public healthcare systems is a considerable one. In our study, we evaluated 109 cases of skin carcinomas hospitalized during 2012 in the Department of Plastic Surgery of the Emergency Hospital of Pitesti, Romania, for a surgical treatment. The gender distribution showed slight lesion predominance in women, being recorded 56 (51.38%) tumors in women and 53 (48.62%) in men. The highest incidence of skin carcinomas (75.23%) was recorded in the persons aged over 60-year-old. Of 109 cases of skin carcinomas, 80 (73.4%) carcinomas developed on indignant tegument areas, while 29 (26.6%) on premalignant skin lesions (fiberconjunctive papillomas, keratocantomas, keratosic verrucas). The histopathological study highlighted the fact that of 109 skin carcinomas, 87 (79.82%) were basal cell carcinomas and only 22 (20.18%) were squamous cell carcinomas. The immunohistochemical reaction to 34ßE12 cytokeratin was highly positive in the cells of the basal cell carcinomas and well-differentiated squamous cell carcinomas (except for the "keratosic pearls") and moderately positive in the moderately differentiated squamous cell carcinoma.

Liver steatosis associated with chronic hepatitis C.

Hepatic steatosis is a common histological finding in chronic liver diseases. One of the pathological entities in which hepatic steatosis has been found is chronic hepatitis C. The prevalence of steatosis in these patients ranges from 40% to 86%, with an average of 55%, which is two times higher than the steatosis seen in adults uninfected with hepatitis C. Many studies have shown that hepatic steatosis is a medical condition that may progress to steatohepatitis, progressive hepatic failure, hepatic cirrhosis, and is a risk factor for development of hepatocellular carcinoma. We have proposed to evaluate the severity of steatosis in patients with chronic hepatitis C and to correlate it with necroinflammatory processes and fibrosis. We included 259 patients diagnosed with chronic hepatitis C and proven histological steatosis. Age of patients with hepatic steatosis varied from 20 to 69 years. Most cases of steatosis associated with chronic hepatitis C (47.87%) were diagnosed in the age group 50-59 years. Of 259 patients, 141 (54.44%) were female and 118 (45.56%) male. Slight steatosis was identified in 130 cases (50.19%), moderate fatty changes were present in 54 (20.85%) patients and severe steatosis in 75 (28.96%) patients. The appearance of steatosis was macrovesicular and predominantly affected the third zone of the hepatic lobe. Most cases of hepatic steatosis were associated with necroinflammatory activity and low and moderate fibrosis. Cases of marked steatosis associated with intense activity accounted for about 10%, while marked steatosis was associated with severe fibrosis in less than 5% of cases.

Evaluation of parameters with potential prognosis impact in patients with primary gastric diffuse large B-cell lymphoma (PG-DLBCL).

BACKGROUND: Primary gastric lymphoma is the most common malignancy of the stomach after gastric adenocarcinoma. Most cases are represented by the aggressive histological type (diffuse large B-cell lymphoma). AIM: Identification of factors with potential prognosis impact in the aggressive primary gastric lymphoma and the prognosis profile of the patient with impact on the response to therapy and overall survival. PATIENTS AND METHODS: The study group is composed of 49 patients diagnosed with primary gastric diffuse large-cell non-Hodgkin's malignant lymphoma at "Fundeni" Hematology Clinic of Bucharest and at the Hematology Clinic of Craiova, Romania, in the period 2005-2010. There were evaluated the following parameters in the attempt to establish correlations between the various studied parameters and the response to treatment, in order to establish the prognosis factors: erythrocyte sedimentation rate (ESR), hemoglobin, serum albumin, serum lactate dehydrogenase (LDH), beta-2 microglobulin, presence of serous infiltration, presence of locoregional adenopathies, bulky tumor, stage of disease, international prognostic index (IPI), quick response to therapy (reduction of >50% in tumor volume after two courses), presence of disease relapses, type of treatment - resection + chemotherapy versus chemotherapy alone, chemotherapy versus chemotherapy + Rituximab. RESULTS: We found the following negative prognosis factors: the presence of disease relapse, the value of beta-2 microglobulin higher than 3 mg/dL, the presence of serous infiltration, IPI 3. CONCLUSIONS: Identifying prognostic factors is important for personalized therapy approach to obtain optimal response with minimal adverse reaction.

Fibroepithelial polyps - a rare pathology of the upper urinary tract.

Ureteral fibroepithelial polyps are a rather uncommon pathological entity. However, an increase of their incidence was recorded during the recent period, probably due to better access to the investigative methods. The aim of this study was to assess the diagnosis and endoscopic treatment particularities of these cases. Our experience was based on 11 cases evaluated in the last 12 years. The mean patients' age was 43 years (between 26 and 54). Hematuria, flank pain, suprapubic discomfort and urinary frequency were the main symptoms. Diagnosis was based on ultrasonography, IVP (intravenous pyelography), cystoscopy and ureteroscopy and confirmed by histopathology. In four cases, smooth polypoid masses covered by apparently normal urothelium and protruding through the ureteral orifice were discovered. In six cases, the fibroepithelial polyps appeared as a large filling defect in the ureter. In another case, a large, organized, blood clot protruding from the left orifice imposed ureteroscopy with the identification of a mid-ureteral polyp. Ten cases were treated by ureteroscopic laser ablation, while transureteral resection was applied in one case. After complete excision of the polypoid base, a double-J stent was indwelled for six weeks. Histology described the lesions as fibroepithelial polyps: hyperplastic urothelium overlying an intact basement membrane with extensive submucosal edema, dilated blood vessels, chronic inflammatory cells and fibrous stroma. No recurrences were found during a follow-up period of 56 months (between 6 and 72 months). Ureteral fibroepithelial polyps represent a rare pathology, ureteroscopy being the gold standard diagnostic method. The appearance and location of the lesions are pathognomonic, and complete excision may be performed by ureteroscopic approach. Recurrences seem to be rare in these tumors.

Improvements in Cesarean Section Techniques: Arad's Obstetrics Department Experience on Adapting the Vejnovic Cesarean Section Technique.

OBJECTIVES: Cesarean section has become recently the first choice for delivery in many clinics in Romania and worldwide. The purpose of our study is to assess the benefits of introducing the adapted Vejnovic uterine suture technique into daily practice. MATERIAL AND METHODS: A total of 1703 out of the 1776 cesarean section performed in the period January, 2012 - March, 2013 in the Obstetric Department of the Emergency Clinical County Hospital of Arad were retrospectively analyzed based on the cesarean section registries, birth registries and patient's personal medical records. We compared results between the group of patients undergoing adapted Vejnovic cesarean section technique and the group of patients operated in a classic manner. OUTCOMES: The cesarean section rate in the studied period was 56.48%. Adapted Vejnovic cesarean section technique was performed in 548 cases (30.86% of the cases), furthermore in the last 3 months studied it reached 57.27%. Mean APGAR score was better in the adapted Vejnovic cesarean section group (8.43) compared with the reference group (8.34). No significant differences were seen between the two groups regarding maternal age, gestation, weeks of gestation, newborn weight, anesthesia and indications for cesarean section. Exteriorizing the uterus helped the incidental diagnosis of 35 uterine myoma, 22 adnexal masses and 13 uterine malformations. CONCLUSION: In a society with a constant growth of cesarean rate, the adapted Vejnovic cesarean section technique is becoming popular amongst clinicians for its advantages, but further studies need to be developed for its standardization.

Bilateral primary fallopian tube carcinoma: a case report.

Primary cancer of the fallopian tube is a very rare tumor nowadays, accounting for approximately 0.14-0.3% of all tumors of the female genital tract. From these, bilateral primary cancer is found in less than 25% of all cases. We report here a case of bilateral primary cancer of the fallopian tube in a 48-year-old woman, associating uterine fibromatosis.

Cervical intraepithelial neoplasia in the "dr. Salvator vuia" clinical obstetrics and gynecology hospital - arad during the 2000-2009 period.

OBJECTIVES: This study intends to analyze some statistical data concerning Cervical Intraepithelial Neoplasia diagnosed in our hospital. MATERIAL AND METHODS: Our study concerning the incidence of Cervical Intraepithelial Neoplasia (CIN) covers the 2000-2009 time-span, the data being collected from the Histopathology Exams (HPE) registers. RESULTS: During this period, CIN lesions were discovered in 1256 cases and Cervical Intraglandular Dysplasia (CIGD) in 53 cases. CIN I, CIN II and CIN III lesions represented 65.92%(828 cases), 19.67% (247 cases), and 14.41% (181 cases) of the total CIN cases, respectively. There were 26 cases combined with cervical carcinoma (2.07% of all CIN cases, 3.56% of the 731 cervical cancer cases). The mean patients' age was 44.65± 9.83 years for all cervical dysplasia cases, 44.58± 9.75 years for all CIN cases, 43.81±9.22, 46.50±10.17, and 45.46±11.05 years for CIN I, CIN II, and CIN III, respectively, and 46.45 ± 11.63 years for CIGD. The t-test revealed the following significant differences: all cases versus CIN I (p<0.05) and CIN II (p<0.01), CIGD versus CIN I (p<0.05), all cases versus CIN II (p<0.01), CIN I versus CIN II (p<0.0001) and versus CIN III (p<0.05). The mean age of the 731 cervical cancer cases diagnosed in our hospital during that same period was 52.94±12.96 years,and it was statistically significantly different from the mean ages of patients with CIN I, II and III (p <0.00000001) and with CIGD (p<0.0005). CONCLUSIONS: Early detection of CIN is of utmost importance for preventing cervical cancer, a serious and frequent health problem in Romania.

Gynecological Cancer Age Groups at the "Dr. Salvator Vuia" Clinical Obstetrics and Gynecology Hospital during the 2000-2009 Period.

OBJECTIVES: The purpose of this study is to statistically compare the mean ages of the patients with gynecologic cancer in our hospital during the 2000-2009 interval. MATERIAL AND METHODS: The data was collected from the Histopathology Exams (HPE) registers. RESULTS: Gynecologic cancer was discovered in 1244 cases: 731 cervical cancers, 392 uterine cancers, 82 ovarian cancers, 31 vulvar cancers and eight vaginal cancers.The mean ages were 52.94±12.96 years for cervical cancer (age range 22-87 years), 61.71±9.06 years for uterine cancer (age range 38-85 years), 51.46±14.28 years for ovarian cancer (age range 18-77 years), and 65.90±9.65 years for vulvar cancer (age range 39-81 years).After performing Student's test, the statistically significant differences were: cervical vs uterine (p<0.000001), cervical vs vulvar (<0.000001), uterine vs ovarian (<0.000001), uterine vs vulvar (<0.05), and ovarian vs vulvar (p=0.000001). Cervical and ovarian cancer mean ages were not significantly different (p=0.33). CONCLUSIONS: The mean ages of the patients from the groups with five gynecological cancer types from our study are similar to those in literature. Existing screening measures must be applied and new ones must be implemented in order to reduce the burden of gynaecological cancers.