[A comparaison between the total PSA, the Gleason score and the bone scintiscan results for different age groups]. / O comparatie între valoarea PSA total, scorul Gleason si rezultatele scintigrafiei osoase la diferite grupe de vârsta.

UNLABELLED: The aim of the study is to compare de results of the bone scintigraphy of prostate cancer patients in different age groups with their total PSA (PSAt) and with their histopathological test results. MATERIALS AND METODS: Of the 180 patients with prostate cancer who were analyzed by Scintiscan in the last five years in our laboratory, 86 have a known PSAt value, and of these, 55 have a known Gleason Score. The 180 patients were divided into three age groups: (1) < or equal 60 years; (2) 60-70 years and (3) >70 years. The 86 patients with a known PSAt were also divided into five groups according to their PSAt value and the 55 patients with a known Gleason Score were divided in three groups. The scintigraphy results included all the patients in 3 groups, according to the presence, the absence or the likelihood of having bone metastasis. The 33 patients with proven bone metastasis were divided, according to their numbers, into the four Soloway groups. RESULTS: Among the patients with PSAt >20 ng/mL, considered high risk for bone metastases, according to the Recomandations of CCAF, 21 (32.81%) of the 64 patients do not show the presence of bone metastases. For PSAt >50 ng/mL, all 5 patients <60 years of age have metastases, while only 15 (62.5%) of the 24 patients over 70 years old have metastases and 1 (4%) has low likelihood. 6 (21.42%) of the 28 patients with PSAt > sau egal 100 ng/mL do not have metastases. 10 (43.4 %) of the 23 patients with a Gleason Score <7, considered low risk, do have metastases (6 patients--26%) or low probability of metastases (4 patients--17.4%). CONCLUSIONS: Our study confirms that the probability of bone metastasis for a high PSAt value is reversely proportional to age. In our study there is no direct correlation between Gleason Score and the bone scan results.

[PSA as a marker for prostate cancer progression]. / PSA CA marker in evolutia cancerului de prostata.

Monitoring the evolution of prostate cancer has crucial importance since this tip of neoplasia has a variable biology, ranging from latent cancers to extremely aggressive tumors. At the moment, PSA (prostate specific antigen) values point out to either successful or unsuccessful prostate cancer therapy. Depending on therapeutic strategies, biochemical recurrence (BCR) is differently defined. After radical prostatectomy, the PSA declines to undetectable levels in 3-4 weeks; BCR: PSA = 0.2-0.5 ng/mL for a single measurement or two consecutive values which surpass 0,2-0,4 ng/mL. PSADT < 10 months is a predictor for the progression of the disease. After external beam therapy, PSA is slowly decreasing reaching up the nadir of 0.2-0.5 ng/mL in months or years; BCR: PSA = nadir + 2 ng/mL. In the case of brachytherapy, the nadir is reached in 2-4 years; BCR: nadir + 2 ng/mL. After hormonal therapy, PSA declines in 3-6 months, maintains low values for 18-24 months, then increases, settling for hormone independency. After chemotherapy, PSA is considered normal at values < 2 ng/mL; the response of PSA represents a confirmed decreasing from the second test at 4 or more weeks after the initial decline; the length of the response is the period between first decline with 50 % of PSA to 50 % increase from nadir; the progression of PSA is shown in the increase with 25 % in comparison to the basic level. In the case of active monitoring, a PSADT < 2 years is an indication for radical prostatectomy, but there are cancers which can evoluate despite a stable PSA. The "PSA bounce" phenomenon and the "PSA surge postchimiotherapie" syndrome can complicate the assessment of biochemical recurrence.

[German influences on Romanian medical terminology]. / Influente germane asupra terminologiei medicale Românesti.

The medical terminology plays a key part both in the study of medicine as well as in its practice. Moreover, understanding the medical terms is important not only for the doctor but also for the patients who want to learn more about their condition. For these reasons we believe that the study of medical terminology is one of great interest. The aim of our paper was to evaluate the German linguistic and medical influences on the evolution of the Romanian medical terminology. Since the Romanian-German cultural contacts date back to the 12th century we had reasons to believe that the number of German medical words in Romanian would be significant. To our surprise, the Romanian language has very few German words and even less medical terms of German origin. However, when we searched the list of diseases coined after famous medical personalities, we found out that 26 % of them bore the names of German doctors and scientists. Taken together this proves that the German medical school played an important role on the evolution of Romanian medicine despite the fact that the Romanian vocabulary was slightly influenced by the German language. We explain this fact on the structural differences between the Romanian and German languages, which make it hard for German loans to be integrated in the Romanian lexis. In conclusion we state that the German influence on the Romanian medical terminology is weak despite the important contribution of the German medical school to the development of medical education and healthcare in Romania. Key

[Red cell shape--a biophysical analysis]. / Forma eritrocitului--o analiza biofizica.

Red cells have three main characteristics: specific shape--discoidal, deformability and aggregability. To give an explanation for his specific shape there are two ways: a) one, use hypothesis from mechanics, as: interfacial pressure, stress, deformability; b) the other way try to explain it by using data from molecular structure of biomembrane and cytoskeleton who are responsible of specific interactions between molecules. First direction was supported by many models, interesting but unrealized some of them because the theories from macroscopic mechanics wasn't well supported. The second direction, even more interesting then the first, was the subject of many studies but none of them gives a complete explanation for this particular shape of red cells. In present, there are many artificial data obtained experimental or in relation with pathological states. In our opinion, sustained also of literature data, the Helfrich's model is the most truth-like. After 1970, W. Helfrich tries to give an explanation of the particular shape of red cells, based on the curvature of elasticity and the grade of filled with hemoglobin. This model was proved also by experimental data, using "simplified red cells", and has also many others extensions. In the same direction are the studies of T.M. Fischer who describes a shape memory of human red blood cells, sustained experimental.

[PET in primary pulmonary or pleural cancer]. / La TEP dans les cancers bronchopulmonaires ou pleuraux primitifs.

In our hospital as in many others, primary lung cancer is the most frequent indication for FDG PET. Studies have assessed the clinical utility of this imaging modality in characterizing solitary pulmonary nodules or masses, initial staging, defining tumor volume in radiotherapy and searching for recurrence of or restaging non-small cell carcinoma; studies are currently underway to evaluate its use in early assessment of chemotherapy response. Small cell lung cancer has a high FDG uptake and PET/CT can be useful for rapid staging. False negative results may be due to pure bronchioloalveolar carcinomas and endocrine tumors. FDG-PET will certainly play a more important role in the diagnosis and follow-up of pleural cancers in the future. An unexpected positive FDG PET focus should be considered as a warning, but histological proof should precede any irrevocable decisions.

[PET-CT scan: a major progress toward fused, metabolic and functional images]. / PET-CT: un progres major în fuziunea imaginilor metabolice si anatomice.

Positron emission tomography (PET) is an imaging method that allows metabolic mapping of disease processes after a specific radiotracer administration. One of the major disadvantages of using radioactive glucose is the fact that this radiotracer is not entirely specific for tumor tissue. Also, the physiological distribution of 18F FDG makes difficult the anatomical localization. Computed tomography (CT) provides en excellent anatomic resolution but the functional information is reduced. In this circumstances PET and CT gives complementary information, and together increase the lesions localization and reduce the artifacts of interpretation. That was exactly the purpose for building the new hybrid gamma camera PET-CT. The new concept of hardware fusion between PET and CT is now commercially available from five years. By the meaning of fused anatomic and functional imaging PET-CT has already found a number of clinical applications in oncology. The new imaging technology reduces image acquisition time, improves tumor localization which is difficult if not impossible with PET alone, and calculate more accurate the target tumor volume for radiotherapy planning. This article is a review from literature data, concerning the mean indications, weaknesses, current evidence and future directions of PET-CT. In Romania, there are not available either PET or PET-CT. We believe that the aspiration at the European standards will remedy it as soon as possible.

Contralateral axillary sentinel lymph node drainage in breast cancer: a case report.

BACKGROUND: Since the introduction of sentinel node (SN) mapping in breast cancer, extra-axillary lymph node sites of breast tumor drainage are discovered in about one-quarter of cases, especially after intraparenchymal injection. In most such cases, an ipsilateral axillary SN is associated with an extra-axillary SN. Non visualization of ipsilateral axillary SN and extra-axillary SN drainage are often associated with an increased risk of axillary involvement. CASE: We report a case of contralateral axillary SN drainage on lymphoscintigraphy in a breast cancer patient with a history of bilateral reduction mammoplasty and no ipsilateral axillary lymph node involvement.

[Correlation in imaging techniques for the early detection of bone metastases in a case of breast cancer]. / Corelatia tehnicilor imagistice pentru depistarea precoce a metastazelor osoase într-un caz de cancer mamar.

The presented case is part of a pilot study performed in the Biophysics and Nuclear Medicine Service from the Tenon Hospital (Paris), chief Department Prof. J.N. Talbot. A 46 years patient, with mastectomy for a left breast cancer in 1999, followed by radiotherapy, is detected, in January 2004, through CT scan, with a tumoral mass at the left thoracic base. To confirm the rib osteolysis hypothesis a standard Rx was done; the result was the detection of a pathologic IX left rib fracture and a lacuna site on the L1 vertebra. The following bone scintigraphy make evidence of two hot spots (rib and vertebra) and also of a new pathologic site on the sternum. An 18FFDG PET image detects, despite the three known sites, another one on the left iliac bone crest. In conclusion, an extensive scintigraphic examination, including PET, is necessary to optimize the osteofil cancer metastases detection.

[Role of radioisotopic investigations in breast cancer diagnosis and follow-up]. / Rolul investigatiilor radioizotopice în diagnosticul si urmarirea evolutiei neoplasmului mamar.

Breast cancer represents the disease with the highest incidence in the female population. In the last years there was observed, in western countries, an increase of morbidity by breast tumors and in the same time, a decrease of mortality in direct relation with an earlier diagnosis. Until the spread at distance, breast cancer it's a loco-regional disease that can be curable by surgical treatment and adjuvant therapy, like chemotherapy or radiotherapy. The principal goal is to diagnose it before distal metastases appear, most frequently bone metastasis. Certain role has nuclear medicine in the diagnosis and prognosis of breast cancer because it's more sensitive and gives functional imaging. The aim of this study is to answer the question: what technique, in what indication. The detection of sentinel lymph node has now a clear place in the algorithm, the scintimammography test is important, especially for prediction of tumor resistance to chemotherapy. The bone scintigraphy (which explores the entire body in one time)is generally used in the detection of bony metastases and FDG tomoscintigraphy for the evaluation of local and distal recurrences, or response to chemotherapy. The measure of the isotopic ejection fraction, actually considered the gold standard, is very useful and also very easy to perform, in patients who will receive chemotherapy.

[18F FDG PET-Applications in Oncology]. / 18F FDG PET--aplicatii în oncologie (II).

In the first part our intention was, essentially, to present the particularities of glucose tumoral cells metabolism, PET components, the synthesis of 18F FDG and the detection of unknown cancers. This second part makes reference about mainly types of tumors who benefit by FDG-PET indications. Clinical PET has a rapid growth because of its use in cancer diagnosis and management. According with published studies all over the world, the sensibility and specificity of FDG-PET, noninvasive method, is higher than that of the conventional methods like CT, IRM, ultrasonography. PET is en excellent detection method of most of common cancer types and depends not on the histological neoplasm type; the more aggressive is the tumor, more it will uptake the radiotracer. The cost is significant, so the indications must be very precise: evaluating the malignity of solitary pulmonary nodules, evaluating the recurrences of melanoma, colon cancer diagnosis, differentiation between recurrent brain tumor and radiation injury, differential diagnosis of the benign lymph and malign lymph nodes, staging of Hodgkin's and non-Hodgkin's lymphoma, evaluation the response to therapy. Because the PET images are difficult to interpret, appears the necessity of correlation with anatomic images: this was the fusion images beginnings (the PET and CT images combination); now the physiologic information has precise anatomic localization. The growing of this method is very probably, both using 18F FDG -thanks to its highly favorable physical characteristics- and other new radiopharmaceuticals. The clinical cases that illustrate the applications are investigated at CERMEP, Lyon, France.