Objectives: A number of biological, cytogenetic, molecular and clinical factors influence the evolution of patients with multiple myeloma. The study intends to evaluate prognostic value of beta-2 microglobulin in terms of survival of patients and response to chemotherapy and correlation with the main biological factors.
Material and method: The study analyses 44 patients diagnosed and treated between January 2006 and December 2010. Statistical analysis consisted of calculating correlation coefficient „r” (Pearson Bravais) and survival analysis using Kaplan-Meier curves.
Results: Beta-2 microglobulin was directly correlated with creatinine, hypercalcemia, percentage of bone marrow plasma cells, hyperproteinemia, monoclonal gradient, immunoglobulin G and inversely correlated with haemoglobin and low serum albumin. Median survival at patients having beta-2 microglobulin <3.5 mg/l was of 48 months, of 43 months at those having beta-2 microglobulin between 3.5 and 5.55 mg/l and 20 months at patients having beta-2 microglobulin >5.5 mg/l. Patients with beta-2 microglobulin <5.5 mg/l had complete remission in 52.38% of cases and 4.76% of patients did not respond to treatment as compared to patients having beta-2 microglobulin >5.5 mg/l, who had complete remission in 39.13% of cases while 30.43% showed no response. Median survival of patients with beta-2 microglobulin >5.5 mg/l was of 56 months at patients who
completely responded to chemotherapy and of 4 months at no responsive patients.
Conclusions: The high level of beta-2 microglobulin is a negative prognostic factor in the evolution of multiple myeloma patients, adversely influencing therapeutic response rates and reducing the survival of patients with multiple myeloma.
Objectives: The study assesses the results of the cardiac arrest resuscitations performed by the medical staff of the Emergency Department of The Clinical Emergency County Hospital from Târgu-Mureş in the year 2009.
Method: We conducted a prospective study between 01.01-31.12.2009, including the cardiac arrest cases occurred in the ED or brought with ongoing resuscitation from the pre-hospital setting. For the statistical study we used SPSS program, version 17; the χ2 tests and p values were determined to compare the data.
Results: We had a total of 186 cases of cardiac arrest, representing 0.47% of the total 39.074 patients assisted in the ED in 2009. The gender distribution of the cases showed a higher incidence in male (61%) and the most affected age groups ranged between 60–80 years. The patients with cardiac arrests presented various diagnosis: the highest incidence is acute coronary syndrome 32 patients (17%), followed by sepsis/MSOF 20 (11%), pneumonia/asthma 17 (9%), pulmonary embolism 17 (9%), stroke 13 (7%), etc. We have resuscitated successfully 42 patients, representing 22.58 % of the total 186 cases. All 42 patients were transferred to the hospitals departments. Out of the hospitalized patients, 25 died later on the wards and 17 (40.47%) survived and were discharged home, 6 from the Intensive Care Department and 11 from the Coronary Unit.
Conclusions: The results are comparable with the reported international data. The cases with cardiac arrest due to acute coronary syndrome, ventricular rhythms and those witnessed and treated early in the ED are having a better outcome.
Introduction: New onset diabetes mellitus in patients with heart transplant is a known complication with importance in the long term survival.
Material and methods: We have studied the incidence of new onset diabetes in a group of 38 patients with heart transplant that are included database of Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, between 1999–2011.
Results: The incidence of new onset diabetes was of 24.32% in the 1st month of posttransplant evolution, 22.58% at 1 year of evolution, 18.18% at 3 years of evolution and 10% at 5 years of posttransplant evolution. We have studied these posttransplant complications in relation with the risk factors and the most important complications in the evolution of these patients.
Conclusions: New onset diabetes in heart transplant recipients is a serious complication with high incidence and with serious implications in their evolution, requiring an accurate screening of the recipients in the waiting list and a periodical posttransplant evaluation, an early detection and a prompt and efficient treatment.
Objectives: Even though the correlation between the degree of therapeutic response and overall survival was studied for a long time, there are still contradictory opinions. This study intends to evaluate the prognostic value of response to chemotherapy in terms of patient survival and depending on the type of therapy.
Material and method: The study analyses 110 patients diagnosed and treated between January 2006 and September 2012. Descriptive analysis of cases was performed and survival analysis was realised using Kaplan-Meier curves compared to logrank test.
Results: The median survival was 18 months when the patients were treated with vincristine + adriamycin + dexamethasone, 20 months with melphan + prednisone, 71 months with melphalan + cyclophosphamide + vincristine + prednisone (p = 0.020), 33 months with Bortezomib and 4 months with dexamethasone. A percent of 38.18% of patients responded near completely to therapy, partial response occurred in 29.09% of cases and no response/ refractory disease in 32.72%. The patients had a median survival of 62 months for near complete response to therapy, 20 months for partial response and 4 months for no response/ refractory disease (p < 0.0001). The time to disease progression was of 24 months regardless of the used therapy. The most common adverse effect was anaemia.
Conclusions: Lack of response to treatment is a negative prognostic factor in the evolution of multiple myeloma patients.
Introduction: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the gastrointestinal tract. This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients.
Methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program, and survival analysis was done by Kaplan Meyer.
Results: During this period we analyzed a total of 28 cases, including 13 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (15 cases; 53%), small intestine in ten cases (36%) and other sites in three patients ( 11%). Multivariate analysis revealed that tumor size (P <0,05), criterion for admission (P<0,05) and secondary dissemination (P<0,05) are independed prognostic factors.
Conclusions: Factors like: age and sex of patients, size and tumor site, presence or absence of metastasis, are prognostic risk factors with significant differences in the evolution of patients with operable GIST. The small number of patients and retrospective nature of the study have created difficulties in the estimation where we concluded the need of a prospective multicentric study.