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Apostol I.,Dr Victor Babes Foundation Bucharest | Baban A.,Babes - Bolyai University | Nicula F.,Ion Chiricuta Cancer Institute Cluj Napoca | Suteu O.,Ion Chiricuta Cancer Institute Cluj Napoca | And 4 more authors.
Tumori | Year: 2010

Background. Inside the European project EUROCHIP-2, the Romania team has ruled out an assessment study regarding cervical cancer screening programs (CCS) in Romania, in Nov 2006-March 2007. The general purpose was to be aliened to European Council recommendations that states that an organized cervical screening program should be offered in all member states, in order to reduce the specific incidence and mortality. The aim of the study was to assess cervical cancer burden and current cervical cancer screening status in Romania and in various sub-regions (DR), and also to identify problems and barriers and to propose solutions for implementing an organized cervical cancer screening program at national level. Methods. The study was based on a statistical survey and a comprehensive literature review of the most important European, national and regional papers or studies completed in this field. Results. Over 2000-2006, a total number of 22,830 new cases and 12,763 deaths from cervical cancer was registered in Romania. In 2005, the crude rate of incidence varied largely in the 8 DR between 17.8-31.3 and mortality varied between 12.3-21.5. The proportion of women tested by DRs on total female population varied between 3.2%-0.6%; the highest screening activity was observed in region VI, where run the only organized CCS in Romania. In 2005, there were one GP per 578 female population aged 25-65; regarding the specialists in 2007 per country we had: 3,012 women aged 25-65 per one gynecologist, 21,195 women per one oncologist and 13,258 women per one histopathologist. Discussion and conclusion. There were no major changes in policy screening over 2000-2006 correlated with no major difference in specific mortality in Romania. Significant differences in incidence and mortality between DRs were observed in 2005, which impose deeper analyzes of local conditions and resources and local strategies to be adopted. The burden of cervical cancer is particularly high in Romania and is related to the absence of an organized CCS program or the ineffectiveness of the opportunistic screening programs. It is needed that European Council recommendations be implemented and quality assurance strategies to be checked and maintained at all screening levels in Romania.

Dima D.,Ion Chiricuta Cancer Institute Cluj Napoca | Frinc I.C.,Ion Chiricuta Cancer Institute Cluj Napoca | Patiu M.,Ion Chiricuta Cancer Institute Cluj Napoca | Patiu M.,University of Medicine and Pharmacy, Cluj-Napoca | And 2 more authors.
Revista Romana de Medicina de Laborator | Year: 2012

Thrombotic thrombocytopenic purpura (TTP) is caused in a majority of cases by auto-antibodies that inhibit the von Willebrand factor (vWF) multimer cleaving enzyme (ADAMTS13); the abnormal persistence of these vWF multimers determines disseminated aggregation of platelets, leading to disseminated thrombosis as well as hemorrhage through platelet consumption. The natural history of the disease is severe, but with plasmapheresis followed by massive plasma transfusions (plasma exchange) and immunosuppressive treatment, TTP can be cured in a majority of cases. RL, 50 years old presented in December 2010, at the emergency room with confusion associated with headache. The neurological examination revealed confusion, bradylalia, without any focal signs. Clinical examination showed marked cutaneo-mucous pallor, hepatomegaly 4-5 cm and splenomegaly 3 cm under the costal margin. The hematological examination showed normocytic anemia (Hb 6 g/dl), moderate thrombocytopenia (28×10 9/L), reticulocytosis (13%) and the presence of schizocytes. Biochemically there was indirect hyperbilirubinemia, mild hepatocytolysis, elevated lactatedehydrogenase (LDH) at 2637 U/L, normal renal function. Based on the clinical and hematological data, a diagnosis of TTP was established and treatment with plasma exchange (PEX) was urgently initiated in association with dexamethasone 16 mg/day and antiplatelet treatment with aspirin 75 mg/day. The response to PEX was prompt with rapid normalization of platelet count and reticulocytes, and the gradual disappearance of schizocytes. About 6 weeks later, after the reduction of the corticosteroid dose, concomitantly with an episode of acute enterocolitis with Klebsiella spp, followed by acute pneumonia with Enterococcus faecalis and Klebsiella pneumoniae, the platelet count dropped to 35×10 9/L, with reappearance of schizocytes on the blood smear and reticulocytosis. Dexamethasone 16 mg/day and PEX were resumed; vincristine and cyclophosphamide were also associated but no significant response was observed. We decided therefore to associate rituximab 375 mg/m 2 (700 mg)/week. Four rituximab doses were administered, with a favourable outcome, with normalization of the platelet count and subsequent disappearance of schizocytes. Presently, the patient is in remission at 19 months after completing the treatment with rituximab. This case report illustrates the fact that in some TTP cases, classical treatment with plasma exchange and corticosteroids may not lead to lasting results. The association of B-cell specific immunosuppression anti-CD20 monoclonal antibodies (rituximab) may be an effective alternative.

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