Recall Rate in Congenital Hypothyroidism Screening: Influence of the Day of Sample Collection and Lower Cutoff.

INTRODUCTION: The recall rate in congenital hypothyroidism (CH) newborn screening programs depends on several factors such as primary screening strategy, sample collection guidelines, and cut-off. A recall rate of 0.05% is recommended but recall rates of 0.01-13% are reported worldwide. OBJECTIVE: The aim of the study was to assess the recall rate in association with the age of the newborn at sample collection and with a lower cut-off. DESIGN: This was a retrospective correlational study concerning TSH results in CH screening program. SUBJECTS AND METHODS: All newborns from a tertiary center in Targu Mures, Romania between 2013-2018 were included. Four groups were created and a correlation test between TSH median value and age in days was performed. The recall rate was calculated using three cut-off levels for 8182 TSH results performed in 2018. RESULTS: 90% of the DBS were collected in days 3-5 after birth and 1/79 live births from this group had TSH above the lower cut-off used (10 mUI/L). 2% of the samples were collected in less than 48 hours after birth and 1/21 live birth from this group had TSH > 10 mUI/L. The recall rate in our center in 2018 was 0.08%, higher than the recommended rate of 0.05%. With the cut-off value recommended by the Health Ministry a 0.03% recall rate was obtained. CONCLUSIONS: Sample collection in less than 48 hours increases the recall rate in CH screening with TSH primary testing strategy. A lower cut-off raises the recall rate with a higher rate of false-positive cases (94.12%) but with 100% negative predictive value.

MONITORING OF RECURRENCE IN PATIENTS RADICALLY OPERATED FOR PANCREATIC CANCER.

Pancreatic cancer is a diagnosis that carries a poor prognosis. It is the fourth leading cause of cancer death in Europe and the United States, despite advances in operative technique and postoperative management. Furthermore, there is no consensus on the optimal follow-up schedule of patients after surgery for pancreatic cancer, all recommendations on surveillance being based on low level evidence or no evidence and the leading societies propose different guidelines. As a consequence, follow-up strategies may differ between hospitals depending on preference of physicians. The vast majority of patients develop recurrence within 2 years after surgery, suggesting the necessity of a more intensive follow-up the first 2 years after surgery. It usually occurs after surgery as migratory metastases along major upper abdominal arteries and veins to the liver or peritoneum (70%) and less commonly as loco regional disease as masses closely applied to the surgical margins in the neck or body of the pancreas (30%). Currently, there are no effective means to prevent pancreatic cancer recurrence, despite the fact that it is responsible for the majority of postoperative deaths.

POSSUM, a potentially useful tool for prediction of morbidity in patients undergoing central pancreatectomy.

AIM: Central pancreatectomy is a pancreas-sparing alternative to standard pancreatic resections, and it is associated with substantial morbidity. The aim of the present study is to assess the utility of the POSSUM scoring system in the prediction of the postoperative complications after central pancreatectomy, which would help identify the patients who are at the highest risk of developing complications. METHODS: A retrospective analysis of 24 patients who underwent central pancreatectomies (2002-2010) was performed. The POSSUM score was calculated for each patient and was correlated with observed morbidity. RESULTS: The mean POSSUM score was 32, thus predicting morbidity in 9 out of 24 patients. This risk assessment proved to be quite accurate, as 13 patients (54%) actually developed postoperative complications (chi-squared = 3.2101, p = 0.073). The predictive value of the POSSUM was strongest for the < or = 20%, 60-80% and > or = 80% morbidity risk cohorts (O/E ratio 1). CONCLUSIONS: The identification of a scoring system to predict the development of severe complications after central pancreatectomy may stratify the patients' risk and lead to a tailored approach of this surgical procedure. Although POSSUM seems to predict morbidity after central pancreatectomy, further studies involving larger numbers of patients should be conducted to confirm this effect.

Youngsters do not pay attention to conversational rules: is this so for nonhuman primates?

The potentiality to find precursors of human language in nonhuman primates is questioned because of differences related to the genetic determinism of human and nonhuman primate acoustic structures. Limiting the debate to production and acoustic plasticity might have led to underestimating parallels between human and nonhuman primates. Adult-young differences concerning vocal usage have been reported in various primate species. A key feature of language is the ability to converse, respecting turn-taking rules. Turn-taking structures some nonhuman primates' adult vocal exchanges, but the development and the cognitive relevancy of this rule have never been investigated in monkeys. Our observations of Campbell's monkeys' spontaneous vocal utterances revealed that juveniles broke the turn-taking rule more often than did experienced adults. Only adults displayed different levels of interest when hearing playbacks of vocal exchanges respecting or not the turn-taking rule. This study strengthens parallels between human conversations and nonhuman primate vocal exchanges.

[Pancreatic fistula after distal pancreatectomy: risk factors analysis]. / Fistula pancreatica dupa pancreatectomia distala: analiza factorilor de risc.

Distal pancreatectomy represents the standard surgical procedure for the body and tail pancreatic tumors. This operation is associated with a high number of postoperative complications, especially pancreatic fistula. The purpose of this paper is to analyse the risk factors that predispose to the pancreatic fistula after distal pancreatectomy and to present the proposed methods of prevention for this complication.

[Ultrasound guided percutaneous drainage in the treatment of local septic complications of chronic pancreatitis]. / Utilizarea drenajului percutan ecoghidat în tratamentul complicatiilor septice locale ale pancreatitei cronice.

AIM: To evaluate results of ultrasound guided percutaneous catheter drainage (PCD) for local septic complications of chronic pancreatitis. MATERIAL AND METHOD: Between 1999 and 2002, PCD was used in 19 patients with chronic pancreatitis for 6 infected acute pseudocysts, 3 post-necrotic abscesses, 3 abscesses following pancreatic resections, 6 abscesses with none of the precipitating factors present (no acute episode or recent surgical/endoscopic interventions) and a tuberculous peritoneal empyema. In 17 patients, collections were unilocular. RESULTS: Trocar technique was used in 14 patients and Seldinger technique in 5. Sixteen patients were successfully treated with PCD alone (mean drainage duration = 32 days) without abscess recurrence during the follow-up period (mean = 35.6 month). Surgical treatment was necessary in 3 patients. Pseudocyst recurrence occurred in another patient after 9 months. CONCLUSION: PCD should be considered as the initial therapy for chronic pancreatitis local septic complications. Surgery is reserved for patients in whom PCD fails.

Spontaneous external fistula of a hydatid liver cyst in a diabetic patient.

BACKGROUND: The liver is the most common site of hydatid disease. Complications like cyst rupture and infection may occur, sites of rupture including: bile ducts, gastrointestinal tract, bronchi, peritoneal and pleural cavity. Rupture into the subcutaneous tissue followed by external fistula is an extremely rare complication. CASE REPORT: A 71-year-old diabetic woman was referred for a progressive growing mass in the right hypochondrium, with a central fistula draining clear liquid with cystic elements and white membranes. No history of fever or jaundice was present. Abdominal ultrasound (followed by CT scan) revealed a liver hydatid cyst in the right lobe, in contact with the anterior abdominal wall, and a parietal fistula track. Cystic fluid exam showed protoscolices and serological ELISA test was positive for hydatid disease. At surgery, the lesion was approached through an incision starting from the fistula site. Partial cystectomy and external drainage of the residual cavity were performed. The fistula track was totally resected. After an uneventful recovery and six months of anti - parasitic treatment, the patient is symptoms- free (3 years after surgery). CONCLUSIONS: Spontaneous cyst-cutaneous fistula is an extremely rare complication of hydatid liver cyst, usually occurring silently, in elder people. Surgery is required to achieve complete evacuation of the cyst contents and resolution of the residual cavity. To the best of our knowledge, this is the seventh case published, and the first one in the Romanian literature.

[Natural history of alcoholic chronic pancreatitis in north-western Romania]. / Evolutia pancreatitei cronice de etiologie etanolica la bolnavii din nord-vestul României.

AIM: To describe the natural history of alcoholic chronic pancreatitis (ACP) patients form north-western Romania. METHODS: We performed a retrospective analysis and a subsequent prospective follow-up (mean = 7.3 years) of 99 patients with ACP. Average duration of ACP was 15.6 years. RESULTS: Patients were mostly men (93%), with a mean age of 42.9 years at the time of operation and 35.7 years at the disease onset. Indications for surgery were: intractable pain (12%), complications (83%) and suspicion of malignancy (5%). During the evolution, 35 patients needed two to four surgical procedures. Calcifications developed in 63.6% of patients, steatorrhea in 41.4% and secondary diabetes in 43.4%. CONCLUSION: ACP in north-western Romania is characterized by early onset of the disease and a severe evolution with multiple complications needing repeated surgery. The "burnout" of the disease, with calcifications, secondary diabetes and marked exocrine insufficiency leads to lasting pain relief.