Category Archives: Original Research

Does the Result of Completion Axillary Lymph Node Dissection Influence the Recommendation for Adjuvant Treatment in Sentinel Lymph Node Positive Patients?

Sávolt Á1, Mátrai Z1, Tóth L1, Polgár C2, Musonda P3, Szabó É4, Horváth Z5, Kásler M6, Péley G7

1 Department of General and Thoracic Surgical Oncology, National Institute of Oncology, Budapest, Hungary
2 Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
3 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
4 Department of Diagnostic Radiology , National Institute of Oncology, Budapest, Hungary
5 Department of Medical Oncology, National Institute of Oncology, Budapest, Hungary
6 National Institute of Oncology, Budapest, Hungary
7 Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK

Aims: The Hungarian National Institute of Oncology has just closed a single-centre randomized clinical study. The OTOASOR (Optimal Treatment of the Axilla – Surgery or Radiotherapy) trial compares completion axillary lymph node dissection (ALND) to regional nodal irradiation (RNI) in patients with sentinel lymph node-positive (SLN+) primary invasive breast cancer. In the investigational treatment arm patients received 50 Gy RNI instead of completion ALND. In these patients we had information only about the SLN status, but the further axillary nodal involvement remained unknown. The aim of this study was to investigate whether the result of completion ALND influenced the recommendation for adjuvant treatment in SLN+ breast cancer patients.
Patients and methods: Patients with SLN+ primary breast cancer were randomized for completion ALND (arm A-standard treatment) or RNI (arm B-investigational treatment). Adjuvant systemic treatments was given according to the standard institutional protocol and patients were followed according to the actual institutional guidelines.
Results: Between August 2002 and June 2009, 474 SLN+ patients were randomized to completion ALND (arm A-standard treatment, 244 patients) or RNI (arm B-investigational treatment, 230 patients). There were no significant differences in terms of major prognostic factors between the two arms. Two-hundred and fourty-two patients (99.6%) on arm A and 229 patients (99.6%) on arm B received adjuvant systemic treatments including chemotherapy and/or endocrine treatment (p=NS). One-hundred and ninety-four patients (79.5%) received adjuvant chemotherapy on arm A and 159 patients (69.1%) on arm B (p=0.031). Two-hundred and four patients (83.6%) received adjuvant endocrine treatment on arm A and 196 patients (85.2%) on arm B (p=NS). Six patients (2.5%) received adjuvant trastuzumab treatment on arm A and 13 patients (5.7%) on arm B (p=NS).
Conclusions: The result of completion ALND after positive SLNB appears to have no major impact on the administration of adjuvant systemic therapy.

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TNF-α and MMP-8 as Biomarkers for Diagnosing Knee Cartilage Lesions — Preliminary Results

Russu OM1, Gergely I1, Zazgyva Ancuţa1, Zuh SGy1, Nagy E2, Nagy Ö1, Pop TS1

1 Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: To analyse the correlations between the levels of Tumor Necrosis Factor α, Matrix Metalloproteinase 8, Interleukin 6 and the presence of cartilage lesions in the knee.
Methods: We studied 79 individuals divided in three groups – a group with cartilage lesions, a group with meniscal lesions and a control group. All patients underwent arthroscopic surgical interventions – either diagnostic or therapeutic. Venous blood samples and synovial fluid samples were obtained and we determined the levels of TNF-α, MMP-8 and IL-6 respectively. All study participants filled out the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Score questionnaire, based on which the IKDC score was calculated.
Results: we found higher levels of MMP-8 in both serum and synovial fluid for groups 1 and 2 compared to the control group, but no correlation between the serum and synovial fluid levels of MMP-8. The serum MMP-8 levels showed a significant negative correlation with the highest level of activity without pain and significant giving way. The synovial MMP-8 could be correlated to the IKDC score. Serum levels and synovial levels of TNF-α were in strong correlation. We found no association between serum and/or synovial TNF-α and MMP-8 levels.
Conclusions: We found that synovial MMP-8 concentrations showed a reverse correlation with the IKDC scores (an activity-based score) – thus MMP-8 might be a diagnostic and prognostic marker in knee osteoarthritis.

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Revascularization Therapy in Stable Coronary Artery Disease

Pretorian A1, Borda Angela2, Dobreanu D3, Pretorian Ana-Maria1

1 Department of Cardiology, Municipal Hospital, Gheorgheni, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania
3 Department of Cardiology, Institute of Cardiovascular Diseases and Transplantation, Târgu Mureş, Romania

Introduction: In patients with stable coronary artery disease, there are controversial studies that compare the optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events.
Material and method: The study included 221 patients with stable coronary artery disease who underwent coronarography and had objective evidence of significant coronary disease. Of these, 73 underwent percutaneous coronary intervention, 71 underwent coronary artery bypass grafting, both subgroups with optimal medical therapy, and 77 received optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 4.5 years. Secondary outcomes were persistent disabling angina (quality of life) and the need for repeat revascularization.
Results: There were 15 primary events in the medical-therapy group, 5 events in the surgical group and 5 events in the percutaneous coronary intervention group. In subgroups analysis, among patients with non-high risk criteria (one or two-vessel disease, without significant ventricular dysfunction), the primary outcome was 2.5% in the medical group and 1.78% in the PCI group, while the persistent disabling angina occurred in 22.5% in the medical group versus 12.50% in the interventional group versus 18.75% in the coronary artery bypass grafting group (p = 0.42). Among high-risk criteria patients there was a tendency for increased repeat target vessel revascularization in the interventional group vs surgical group (17.64% vs 5.45%). The primary outcome was similar in both groups (11.76% vs 9.09%).
Conclusion: For patients with stable angina that is not significantly interfering with the quality of life and without high-risk characteristics, medical therapy rather than immediate revascularization seems to be the right option. Patients with high-risk criteria benefit from a more complete revascularization by coronary artery bypass grafting, but most often the patient will prefer the interventional aproach.

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Accelerated Partial Breast Irradiation with Multicatheter Brachytherapy: 15-year Results of a Phase II Clinical Trial

Polgár C1, Major T1, Fodor J1, Sulyok Z2, Somogyi A1, Németh Gy1, Kásler M3

1 Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
2 Department of General and Thoracic Surgery, National Institute of Oncology, Budapest, Hungary
3 National Institute of Oncology, Budapest, Hungary

Background and purpose: To report the 15-year updated results of accelerated partial breast irradiation (APBI) using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT).
Patients and methods: Forty-five prospectively selected patients with T1N0-N1mi, nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI after breast-conserving surgery (BCS) using interstitial HDR BT. A total dose of 30.3 Gy (n=8) and 36.4 Gy (n=37) in seven fractions within 4 days was delivered to the tumour bed plus a 1–2 cm margin. The median follow-up time was 166 months for surviving patients. Local control, disease-free (DFS), cancer-specific (CSS), and overall survival (OS), as well as late side effects, and cosmetic results were assessed.
Results: Five (11.1%) ipsilateral breast tumour recurrences were observed, for a 5-year, 10-year, and 15-year actuarial rate of 4.4%, 9.4%, and 11.9%, respectively. The 15-year DFS, CSS, and OS was 75.4%, 86.2%, and 82.0%, respectively. Grade 3 fibrosis was observed in 1 patient (2.2%). No patient developed grade 3 teleangiectasia. Fat necrosis requiring surgical intervention occurred in 1 woman (2.2%). Cosmetic results were rated excellent or good in 36 patients (80%).
Conclusions: Fifteen-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumour control, survival, and cosmetic results with a low-rate of late side effects.

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Value of Liver Contrast-enhanced Sonography to Diagnose Malignant or Benign Tumors

Pascarenco Ofelia1, Dobru Daniela2, Boeriu Alina2, Pascarenco G³, David Cristina1, Brusnic Olga1

¹ Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
² Department of Gastroenterology, Emergency County Hospital, Tîrgu Mureș, Romania
³ Department of Surgery I, Emergency County Hospital, Tîrgu Mureș, Romania

Purpose: To evaluate the diagnostic benefit of contrast-enhanced ultrasound for the differential diagnosis of liver tumors in clinical practice.
Methods: From January 2010 to October 2010, 14 patients with focal liver lesions without an accurate diagnosis based on B-mode ultrasound and power Doppler ultrasound were examined by contrast-enhanced ultrasound. All 14 patients were referred for CEUS following identification of 1 or more focal liver lesions on conventional ultrasound or CT imaging. After baseline US examination (GE LOGIQ 9), a bolus of 2.4 ml of SonoVue (Bracco, UK) was administered intravenously. The characterization as benign or malignant liver lesion was assessed based on the vascularity pattern and contrast enhancement seen in focal lesions during the arterial, portal, and late phase.
Result: The final diagnosis of liver lesions included 10 benign lesions ( hemangiomas n=6, focal nodular hyperplasia n=1, focal fatty sparing n=1, regenerating nodule n=1, hydatic cyst n=1) and 4 malignant lesions ( hepatocellular carcinoma n=3, metastases n=1).
Conclusion: Contrast-enhanced US (CEUS) allows the differentiation between benign and malignant liver lesions based on the vascularity pattern and contrast enhancement seen in focal lesions during the arterial, portal, and late phase. The sensitivity and the specificity of CEUS in detecting hepatic tumors is up to 90%.

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Psychotherapeutical Intervention in Depressive State of Detainee Women

Pașca Maria Dorina

University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Concerning the thematic of our intervention it can be said that there is a bigger susceptibility for woman to develop a major depressive episode after a life event that generates stress and which is related to her own life, or to what happens around her, determining a back stroke state. Plus, childhood experiences lived by women, like: “neurotic” features, defective relationship with the mother, maltreatment, may constitute factors that lead to depression. In the same time we can say that women are trice more affected than men by combined depression (major, plus the one of short duration) asking again ourselves: “is the woman very different by man?” In our configuration, the woman being in the detention state develops a certain behavioral state, different by the one that develops the man being in the same state. Even if the statistics show a lower feminine delinquency rate, we can remark though the positive fact that the woman is lees amenable to commit a delinquency act than man.
Materials and methods: In our intervention we used among intervention, conversation, observation, biographical dialogue also scales like: Beck’s scale of auto evaluating the depression – Woodworth test and tree test, all identifying the existence of depressive state.
Results: It was shown that the woman in detention it is more amenable to develop an increased adherence to the elements that release the apparition of depressive state and in consequence to depression itself. Identifying in/at the depressive state does not determine vindicatory the existence of correlation between: deed and detention; detention and depression; detention and therapy, even if there may be established some resemblances of concept and attitudinal-behavioral expression, all reporting to the initial context, but foreshadowing a new personality profile.
Conclusions: It is imposed: to recognize the existence of the phenomenon itself, practicing the psychotherapeutic centered programs, in our case depression, and also implementing some reintegration programs, re-socialization, reeducation and professional re-conversion, having as main character the detainee woman.

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Colon Adenomas and Polyps Developing Synchronously, Without Carcinoma

Pap Zsuzsanna1, Dénes L1, Şipos R1, Brînzaniuc Klara1, Pávai Z1, Jung J2

1 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Prevention of colorectal carcinomas is based on early detection and removal of precancerous lesions. Our goal was to perform a comparison between clinicopathological features of adenomas/polyps developed in the presence and in the absence of a colon carcinoma. Materials and methods: We studied a total of 117 colon adenomas and polyps selected from the material of the Pathology Department of the Emergency County Hospital of Tîrgu Mureș. We compared and correlated through statistic analysis the clinicopathological factors, gender, age of the patients, localization, histological type, grade of dysplasia.
Results: 24.6% of A/P develop synchronously with a carcinoma and affect especially women and patients between 50–60 and 70–80 years; these are mainly tubular adenomas, localized more frequently in the left colon. Adenomas and polyps developed without a carcinoma are more frequent in males, in patients between 60–70 years, and are mainly tubulovillous adenomas.
Conclusions: One out of 4 colon carcinomas are associated with one or more precancerous lesions.

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Ambulatory Blood Pressure Monitoring in Chronic Congestive Heart Failure in Normotensive and in Sinus Rhythm Patients with Ischemic Heart Disease

Olinic Maria, Homorodean C, Olinic D

Medical Clinic 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Objectives: The objective of this study is to analyse the blood pressure behaviour, before and after compensation by medical treatment of decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. Its main purpose is to find out whether heart failure compensation is associated with still normal blood pressures or, on the contrary, with the risk of an arterial hypotension.
Methods: Data recorded by 24 hours ambulatory blood pressure monitoring, before and after an efficient compensation of heart failure in 16 patients (13 males and 3 females) with decompensated chronic congestive heart disease secondary to ischemic heart disease in functional NYHA classes III (5 patients) or IV (11 patients) were analysed and compared.
Results: In the decompensated state, mean systolic blood pressure per 24 h was normal, but well below the superior limit accepted as normal. Significant decreases of all systolic and diastolic blood pressures, per 24 h, diurnal and nocturnal, close to or even in the domain of arterial hypotension, were recorded after the efficient compensatory treatment. None of the patients had clinical symptoms of arterial hypotension. Significant prevalence of the non-dipper state, high in the decompensated state and still present after the efficient heart failure compensation, was found. A significant decrease of the heart rate after heart failure compensation was observed. Decompensated state was associated mainly with heart rates above 70/min, while the compensated state was associated mainly with heart rates below 70/min.
Conclusions: Significant asymptomatic decrease of the blood pressure, with a tendency towards arterial hypotension, is revealed by ambulatory blood pressure monitoring, after the efficient treatment of the decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. This blood pressure decrease could add a supplementary cardiovascular risk. A high prevalence of the non-dipper state, with its negative significance, was found especially in the decompensated, but also in the compensated state of the chronic congestive heart failure.

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Determination of Triiodothyronine and Thyroxine from Plasma and Milk of Lactating Cow

Nistor Cristina1, Tero-Vescan Amelia1, Ureche Ramona2

1 Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Hygiene, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The purpose of this study was to establish a method for the determination of T3 (triiodothyronine) and T4 (thyroxin) hormone concentrations in plasma, whole milk and after ethanol extraction, as well as to calculate the partition coefficient milk/plasma.
Methods: Ten Holstein Romanian friza milking cows were used to test the efficiency of the method. T3 and T4 were determined by an immunochemical ELISA competitive assay.
Results: Medium value of T3 in plasma was 2.78 ±1.53 ng/ml (4.27±2.35 nmol/l), in whole milk 3.72±1.44 ng/ml (5.71±2.21 nmol/l) and in extracted milk 4.97±1.67 ng/ml (7.63±2.56 nmol/l). Mean value of T4 in plasma was 50.97±7.30 ng/ml (65.60±9.39 nmol/l), in whole milk 2.12±0.87 ng/ml (2.73±1.12 nmol/l) and in extracted milk 3.60±1.15 ng/ml (4.64±1.48 nmol/l). Extraction from milk presented a good efficiency of 94.39% for T3 and 101.30% for T4.
Conclusion: The values obtained are in the concentration range reported by literature data for T4 and T3 from plasma and milk.

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Upper Digestive Mucosal Changes in Patients Taking Low-dose Aspirin

Negovan Anca1, Băţagă Simona2, Sabău M3, Cozlea L1, Ţilea I1, Sárkány Z3

1 3rd Medical Clinic, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The benefits of antiplatelet therapies for treatment and prevention of cardiovascular diseases have been demonstrated in the last years, but these therapies increase the risk of mucosal damage in the gastrointestinal tract. We aimed to evaluate endoscopic mucosal lesions in patients not referred for endoscopy, with a new recommendation for long term low-dose aspirin, who have not taken the drug before endoscopy and in patients taking long-term low-dose aspirin.
Material and methods: Two-hundred twenty-five patients who had accepted an endoscopy were included (90 with low-dose aspirin, 135 with recommendation for low-dose aspirin). With few exceptions, there were no statistically significant differences in patient groups regarding social habits, chronic diseases, ulcer history, concomitant drug or digestive symptoms.
Results: Severe Lanza scores were significantly more frequent in patients with low-dose aspirin than in patients without aspirin (60% vs. 30.4%, p<0.01). In patients with chronic low-dose aspirin, H. pylori infection was significantly less frequent than in patients not taking this therapy (38.9% vs. 50.4%, p=0.05), while gastric atrophy and/or intestinal metaplasia were more frequent (48.9% vs. 36.3%, p=0.04). Active infection with H. pylori in taken biopsies was associated with more severe lesions, including ulcers, in both groups, while gastric atrophy and/or intestinal metaplasia were significantly associated with severe endoscopic lesions in patients with low-dose aspirin.
Conclusions: Patients with recommendation for long term treatment with low-dose aspirin frequently present severe mucosal endoscopic lesions and multiple risk factors for gastrointestinal complications before starting the treatment. Patients taking low-dose aspirin on a daily basis present more severe endoscopic lesions when an active H. pylori infection and premalignant histological changes are present.

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