A Statistical Analysis of Risk Groups in Colorectal Cancer Patients

Colorectal cancer (CRC) is considered a major global health concern due to an increasing number of new cases and cancer-related deaths each year, strong link to dietary habits prevalent in middle and high-income countries and limited therapeutic options especially in locally-advanced and metastatic settings. To counter this growing problem, the scientific community has strived to underpin the major molecular mechanisms behind the aggressive phenotype displayed by CRC and also develop new agents to selectively target and inhibit these core drivers. This evolution has allowed the separation of patients according to different risk groups in concordance with epidemiological parameters alongside novel biomarkers such as gene alterations, protein overexpression and aberrant signaling pathways. In this study we included 20 patients who underwent colonoscopy and were later received histopathologic confirmation of CRC. The statistical anamnestic data obtained from the patients (age, gender, home distribution, signs and symptoms) was corroborated with the results obtained from the histopathologic and immunohistochemical analysis of the samples obtained via colonoscopy. The average age was 63.8 years, the male: female ratio was 2.33 and the origin of 2/3 of the patients was urban and the most encountered symptoms were transit disorders (75%). In terms of colonoscopy results, the majority of tumors were found on the rectum (85%), 90% of tumors were adenocarcinomas, having a vegetant aspect in 60% of the cases and a moderate degree of differentiation in 50% of situations.

Colon cancer: clinical, macroscopic and microscopic aspects

Although in developed countries the incidence of colorectal cancer is decreasing through the introduction of well-designed screening systems, the worrying worldwide increase of the mortality rate by colorectal neoplasm indicates the need for a thorough characterization of this pathology. Clinical, endoscopic, histopathological and immunohistochemical data provide important information for creating categories of patients that can benefit from intensive screening methods and for establishing the prognosis based on these data. Approximately 80% of the colorectal cancer develops from adenomas, which shows that early detection of premalignant lesions is an important step in reducing global incidence and mortality. Our study aims at providing information about the clinical, imaging and histopathological characterization of colorectal neoplasm and premalignant lesions. A total of 98 patients were evaluated, including 72 patients diagnosed with colorectal cancer and 26 with premalignant lesions. Patients underwent colonoscopy with biopsy specimens that were examined histopathologically. From the epidemiological data, we observe a higher incidence in men with a men/women ratio of 2/1, with a median age in colorectal cancer patients of 63.93 years. Different data on signs and symptoms were observed according to the colonoscopy location, with a slight difference between symptoms of patients with premalignant lesions compared to those diagnosed with colorectal neoplasm. Endoscopy showed that the rectum was the most frequent location, followed by the left colon, the tumor having a vegetative aspect in most cases. Histopathology confirms that the most common subtype is adenocarcinoma, described in 67 of the studied cases. The moderate differentiation degree is present in more than half of the cases.

Hyponatremia - unfavourable prognostic factor in hepatic cirrhosis

Hyponatremia is defined by a level of Na in serum below or equal to 136 mEq/L while in hepatic cirrhosis it is classically considered as relevant only at a level of Na below 130 mEq/L. Hyponatremia frequently occurs in patients with end-stage hepatic disease. The frequency and severity are variable but it has been estimated that it occurs with a frequency of 57% in hospitalized patients with cirrhosis and in those on waiting lists for hepatic transplants. Signs and symptoms of hyponatremia are related to dysfunctions of the central nervous system, due to migration of the water from intravascular space to the brain cells, resulting in the occurrence of cerebral edema. Therapeutic options in hyponatremia are limited and are based on restriction of water consumption, exclusion of diuretics and vaptans. Hepatic transplant remains the only definitive treatment for end-stage hepatic diseases in which hyponatremia has occurred.

Hepatorenal Syndrome: Diagnosis and Treatment - newsreel

Hepatorenal syndrome (HRS) is defined as renal failure that occurs in the presence of severe acute or chronic liver disease in the absence of underlying renal pathology. Due to the functional nature of the disease and the absence of specific diagnostic markers, HRS diagnosis is determined based on positive criteria associated with excluding other causes of renal failure in patients with liver cirrhosis and ascites. Differentiation from other types of acute or chronic renal disease is extremely difficult and therapeutic options are limited, prophylactic behavior is most appropriate in patients with severe hepatic disease and risk factors for the installation of hepatorenal syndrome. Highlighting all precipitating factors of acute renal insufficiency and therapeutic modalities in order to minimize adverse events is an important step in improving the follow-up of the patients with liver cirrhosis. The prognosis is reserved especially for type 1 HRS. Liver transplantation is the best option for patients without contraindications. The therapies introduced in recent years, such as vasoconstrictor drugs or transjugular intrahepatic portosystemic shunt are effective methods in the renal function improvement.

Peritumoral inflammatory reaction in colon cancer. Histological and immunohistochemical study

Colorectal cancer is one of the most frequent malignancies with an increasing incidence and prevalence. As in other malignancies, nor etiology, neither pathogenesis of colorectal cancer are well known. The link between inflammation and colorectal cancer has become a major concern in the past 20 years, since several clinical trials have shown that patients with chronic inflammatory intestinal diseases have a much higher risk of colorectal neoplasm development. In our study, we analyzed peritumoral inflammatory reaction from histological and immunohistochemical point of view, in 23 cases of stage III colon adenocarcinoma, operated during 2014. The immunohistochemical techniques were used in order to emphasize B-lymphocytes, T-lymphocytes, macrophages, mast cells and blood vessels. In all cases, we have noted the involvement of inflammatory cells present in peritumoral and tumoral stroma, in variable degrees, regardless the differentiation of the neoplasm or other known histological feature. In particular, the macrophages were the most numerous, especially in areas of tumoral necrosis, but also present in the lumen of tumoral glands, or even within tumoral cell islands. Mast cells appeared more abundant in the tumor stroma around blood vessels and were absent in the areas of tumor necrosis, while B-cells were almost absent. Tumor stroma showed a well-developed vascular network, consisting mainly of small vessels that do not seem to correlate with the intensity of the inflammatory reaction.

Dendritic cells and hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents a major health burden in the modern world. Because current treatment options for HCC are capable of providing good survival rates to only a limited number of patients, new therapeutic opportunities should be looked upon. The particularities of dendritic cells (DC) populations existing in the liver, and their consecutive selective activation of certain immunotolerant T-cell subgroups, account for the high success rate of allogeneic hepatic transplantation, currently the most efficient treatment for HCC. The particularities of dendritic cells (DCs) populations existing in the liver, and their consecutive selective activation of certain immunotolerant T-cell subgroups, account for the high success rate of allogeneic hepatic transplantation for HCC. These molecular mechanisms also open new paths towards cancer preventing and cancer curative vaccines, as well as successful immunotherapy. Our aim was to summarize the main aspects of the biology of DCs populations, especially those present in the liver, and to draw attention to their current and future roles in the curative treatment of hepatocarcinoma.

Gastric eosinophilia--clinical and morphological correlations

Eosinophils of the gastrointestinal tract are involved in the host immune response that occurs in the presence of the pathogens in the digestive lumen, taking part in maintaining the homeostasis of the gastrointestinal epithelium. Their involvement in inflammatory processes of chronic gastritis is less known. In our study, we identified the presence of eosinophils in chorion gastric mucosa (lamina propria) in over 34% of chronic gastritis. Eosinophils were more numerous in atrophic gastritis with intestinal metaplasia. More than 65% of chronic gastritis associated with Helicobacter pylori also had eosinophils in the gastric mucosa.

Immunohistochemical expression of EGF, c-erbB-2 and EGFR in intestinal variant of gastric adenocarcinomas

In this study, we aimed to determine EGF, c-erbB-2 and EGFR expression in 25 specimens of intestinal gastric adenocarcinomas by standardized immunohistochemistry and to establish correlations with the major clinico-morphological parameters of these patients. We observed EGF reactivity in 22 (88%) cases, a c-erbB-2 protein expression in eight (32%) cases and an EGFR reactivity in 13 (46.42%) cases. The EGF expression was significantly correlated with the tumor degree of differentiation, but not with other investigated clinico-morphological parameters and nor with c-erbB-2 and EGFR1 expression. However, we noticed the existence of a dependence between c-erbB-2 and EGFR1 expression in the main tumor mass. Such immunoprofile suggests the possible intervention of autocrine and paracrine loops in the developing of intestinal variant of gastric adenocarcinomas.

Synchronous diagnosis of signet ring cell colon carcinoma and transitional carcinoma of the left distal ureter

The presence of synchronous multiple primary carcinomas, although recognized, remains very uncommon. Their etiopathogeny is unclear. The wide spread of imaging techniques currently facilitates diagnosis of simultaneous tumors. We present the rare case of a signet ring cell colon carcinoma coexisting with a transitional cell carcinoma (TCC) of the ureter, which debuted with symptoms of intestinal obstruction in a 75-year-old male patient, with no prior relevant history. Computed tomography showed signs of a tumor mass on the transverse colon, as well as left hydronephrosis with a tumor in the lower third of the ureter, which prompted for immediate emergency surgery. After the appropriate surgical maneuvers, tissue collected from both tumors underwent usual histological preparation and Hematoxylin-Eosin staining, as well as multiple immunostaining with a complex panel of markers. The patient had a favorable postoperative course and during a six-month follow-up, we did not detect any signs of illness.

Chronic gastritis with intestinal metaplasia: clinico-statistical, histological and immunohistochemical study

Chronic gastritis has a high incidence in adults, causing progressive destruction of glandular structures, favoring the development of gastric atrophy. The association of chronic gastritis with intestinal type metaplasia of gastric mucosa has a poor outcome as intestinal metaplasia is regarded as a precancerous lesion. Metaplasia is common in patients with Helicobacter pylori infection and also heavy smokers. The aim of our study was to evaluate the relationship between chronic gastritis and intestinal metaplasia. The study was conducted on a total of 1218 patients, aged between 5 and 90 years, who presented for dyspeptic disorders in the period 2007-2010 and were examined clinically and endoscopically. During the gastroscopic examination, fragments of gastric mucosa were collected for the histopathological study and for highlighting the H. pylori infection. For the histopathological study, the Hematoxylin-Eosin and PAS-Alcian Blue stains were performed, while for the immunohistochemical study the anti-TAG72 and anti-PCNA antibodies were used. A diagnosis of gastritis was established in 615 patients, representing approximately 50.5% of all cases. Most cases with gastritis were found in people of middle age. Gastritis was present in almost all age groups, from teenagers to the elders. Of the 615 cases of gastritis, urease test was positive in 353 patients, representing approximately 57.40% of all patients with gastritis. Histopathological examination identified the presence of intestinal metaplasia in 61.60% of patients with chronic gastritis, mostly complete metaplasia. PCNA immunohistochemistry revealed that cell proliferation processes are intensified in intestinal metaplasia. This study highlights the importance of chronic gastritis, intestinal metaplasia, and H. pylori infection in the etiopathogeny of gastric cancer.

The composite lymphoma: chronic lymphocytic leukemia--classic Hodgkin's lymphoma

The composite lymphoma (CL) is defined by the presence in the same tissue or organ of two distinct histological aspects of non-Hodgkin's lymphoma (NHL), or NHL and Hodgkin's lymphoma (HL). The definition of the CL has evolved, requesting the identification of the immunophenotypic pattern and clonal distinct aspects for the two-lymphoproliferative lesions. We present a case of a 73-year-old farmer who presented with B-symptoms and multiple adenomegaly. The biopsy of a left cervical lymph node reveal a CL: a histological and immunophenotypic aspect of HL-mixed cellularity (CD15+, CD30+, CD20-) and a diffuse small cell infiltrate which meet the criteria for B-CLL (CD20+, CD23+, and CD5+). The lymphocytes in peripheral blood over 15 000/mm(3) and marrow infiltrate with small lymphocytes also sustain the B-CLL diagnosis. The relationship between the two lymphoproliferations is discussed reported to the case above, but also considering the literature data. In most of the cases the two proliferative processes are clonal related which means they have a commune lymphoid progenitor, pre-GC or early-GC with individual detachment and transit through GC (also, the afferent related processes). It is also possible that the two proliferations, which form the composite lesion to have different cellular origins, possibility sustained by the analysis of the IgH rearrangements and of the somatic mutations identified in the two clones. The EBV-role in HL-pathogeny is related to the way of salvage or/and initiation of a clonal process in a GC-cell which has major deletions in the variable part of IgH.

The genotoxicity study of resveratrol in primary gastric adenocarcinoma cell cultures

Gastric cancer is the second most common cause of cancer-related death in the world. Some studies indicate that polyphenolic compounds and antioxidants exert a protective action against gastric cancer. Among the polyphenolic compounds tested and proven effective against gastric cancer is resveratrol, a natural polyphenol present in red wines and various human food items. Resveratrol has been shown to suppress proliferation of a wide variety of tumor cells. We tested the genotoxic activity of resveratrol in primary cell cultures from gastric adenocarcinoma, obtained by mucosal biopsy at upper digestive endoscopy. The adenocarcinoma cells were analyzed for the presence of micronuclei at different concentrations of resveratrol at 48 hours and at 72 hours. The results showed that resveratrol induced micronuclei dose-dependently. The frequency of micronuclei increased progressively with the dose of resveratrol used, the high frequency is in the primary culture initiated from gastric adenocarcinoma: signet ring cell type. The high frequency of micronuclei is at 72 hours at the 20 microg/mL resveratrol and is decreased at low concentrations (5 microg/mL, 10 microg/mL resveratrol). This results show the genotoxic activity of resveratrol in adenocarcinoma gastric cell and the anticancer property of this substance.

Correlations between gonadotropins level, vaginal cytology and menopause vessel-active phenomena

INTRODUCTION

Vessel active phenomena from menopause as hot flushes have unknown cause but is demonstrated that the hormone substitution treatment has a very good efficiency in the disproof of the symptomatology.

OBJECTIVES

To establish if there is a correlation between gonadotropins level, the presence of the vessel active manifestations and the atrophy of the vaginal epithelium in menopause.

MATERIAL AND METHODS

The study design is cross-sectional, done on the 40 and 60-year-old women from the general population list of a family doctor. We studied the blood values of LH and FSH and the vagina cytology and the relations of these parameters with the presence of hot flushes and others vessel active phenomena in menopause.

RESULTS

The group consists of 136 women aged between 40 and 60-year-old. Their blood tests prove: LH with normal levels in 79% of cases, FSH has high values in 85%, the vagina cytology marked out the epithelium atrophy in 76% of cases.

DISCUSSION

The augmentation of the FSH values is associated with the presence of hot flashes. The ratio LH/FSH under 0.40 is strong associated with vessel active phenomena (p-value 0.000012). We could not establish a statistical correlation between the presence of the vessel active phenomena and vagina atrophy (p-value 0.098).

CONCLUSIONS

Vessel active manifestations on the menopause have morphological substratum. The increase of FSH is statistic correlated to the vessel active disorders. It is possible that FRH be the trigger for the hypothalamic thermo detection.

Nonalcoholic fatty liver disease and metabolic syndrome: a concise review

Non-alcoholic fatty liver disease (NAFLD) is a clinicopathological entity increasingly recognized as a major health burden in developed countries. In the last decade, several studies have independently provided evidence for a strong association between NAFLD and each component of the metabolic syndrome, including central obesity, hyperglycemia, dyslipidemia, and hypertension. This article focuses on epidemiological, clinical, pathogenic and therapeutic aspects, which link these two syndromes.

Drug-induced hepatitis - morphological and ultrastructural aspects

Frequency of drug-induced liver diseases is increasingly, more than 200 different drugs being incriminated in hepatic disorders. We performed a retrospective study on 65 cases of deaths due to drug intoxications and an experimental model of subacute hepatitis induced by acetaminophen. In our experimental model, we observed various histological lesions: granular degeneration, vascular congestion, lymphoplasmocyte infiltration, cytonecrosis. Histological criteria are not specifically, but very usefully, because based on these criteria we can suspect a drug etiology in hepatic disorders when any other cause is absent. Ultrastructural study of hepatocytes revealed some modifications, in addition to data provided by optical microscopy.

The endoscopic and morphological forms of early gastric cancer

The early gastric cancer is an endoscopic notion in which gastric cancer is strictly placed to mucosis and submucosis without extensive manifestations. It is the form with favorable prognosis and better survival at 5 and 10 years. Our study tries to systematize the debut forms of early gastric cancer and their association with the lesions with malignisation risk. We also try to evaluate the incidence of endoscopic and histopathologic forms of early gastric cancer found in an internal medicine division. Our study included 435 patients with gastric cancer endoscopic and histologic diagnosed. Statistically, 64.36% were men and 35.64% were women, the mean age 48 +/- 7 years. The endoscopic forms of early gastric cancer were type I: protruded in 19 cases, type II: superficially in eight cases, type III: excavated in six cases. Early gastric cancer is diagnosed with difficulty, it represents in 7.58% of the gastric cancer, being most frequently asymptomatic. The endoscopic forms frequently found in early gastric cancer in the population were type I: protruded and type IIa: superficially elevated. The histopathological examination is compulsory at this form of gastric cancer, while in advanced gastric cancer endoscopy is often sufficient for diagnosis. Analysing the histopathological results of cases diagnosed with early gastric cancer we found: 22 cases with intestinal type and 11 cases diffuse type. Microscopically, 15 were intramucosal and 18 had submucosal invasion. I and IIa lesions were predominantly located at the antrum and are histologically differentiated adenocarcinoma. Differentiated carcinoma frequently produces an elevated lesion and the border is well demarcated. There are frequent opportunities to detect gastric cancer in the early phase and the patient can expect a complete cure by the surgical operation or endoscopical mucosal resection.

Microvolt T wave alternans (MTWA)--a new non-invasive predictor of sudden cardiac death

Over 10 million people are at high risk of sudden cardiac death (SCD). In order to stratify the risk of SCD due to ventricular tachyarrhythmia, additional methods are required. In the past years, the development of implantable cardioverter/defibrillator (ICD) has become an effective therapeutic option for patients at high risk for SCD, albeit ICD is both expensive and invasive. The Microvolt T-Wave Alternans Test (MTWA, Cambridge Heart Inc.) is a non-invasive method with a stronger positive predictive value in the assessment of arrhythmic risk, when compared to invasive electrophysiological studies (EPS). MTWA has been proved at least an equivalent or even a more sensitive risk predictor of ventricular tachyarrhythmia and/or SCD. MTWA may be considered as a first-line screening test for patients with ventricular arrhythmia history, in order to discriminate the high risk / low risk subgroups, prior to invasive EPS and/or treatment.