Canadian Journal of Gastroenterology and Hepatology
Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the a... more Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the authors review and analyze the evolution of the surgical portocaval shunt (PCS). We would like to provide an insight into the past of PCS, in order to compare it with the current state of the treatment of PHT complications. As a landmark of the past, we shall present statistics of more than 500 cases of PHT operated between 1968 and 1983. From this group, 238 patients underwent surgical portocaval shunting during a fifteen-year period. The behavior of the portal hemodynamics following PCS was studied and the postoperative decrease in portal pressure (PP), as well as the residual PP, were recorded. The portal manometric determinations were made by electronic recordings using the Hellige device and direct intraoperative recordings through the catheterization of a ramus in the portal area. The results of PCS are superposable, in terms of hemodynamic efficiency, with those of the intrahepatic...
Non-traumatic perforations of the bile ducts are unfrequently encountered entities, all the more ... more Non-traumatic perforations of the bile ducts are unfrequently encountered entities, all the more when they affect the intrahepatic bile ducts, exteriorizing their biliary content in the great peritoneal cavity. Reporting such a case has determined the authors to perform a careful overview of the cases present in the literature. An observation that can be made based on these is that the obstruction of the main bile duct due to lithiasis determines, by pressure increase, the dilation of the bile system branches, all on the background of an unknown malformation of the intrahepatic bile ducts.
Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the... more Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the histological type of diffuse large B-cell lymphomas (DLBCL) being the most prevalent in adults. In about 40% of cases, the location is extranodal. Uterine cervix lymphomas of this type are extremely rare (0.5–1.5%) and represent a diagnostic challenge. A case of DLBCL of the cervix is presented here along with a review of the literature. Materials and methods: A 75-year-old patient was referred with a bleeding vegetant tumour occupying her entire vagina. The histological and pathological investigations performed following the tumour biopsy indicated a malignant, diffuse, vaguely nodular lymphoid tumour proliferation. The immunohistochemistry results were in favour of a diffuse B-cell non-Hodgkin lymphoma (DLBCL). CHOP (Cyclophosphamide, Hydroxydaunorubicin (also called doxorubicin or adriamycin), Oncovin (vincristine), Prednisone or Prednisolone) polychemotherapy and radiotherapy were e...
We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with ... more We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with haemorrhage- or perforation-induced complications. This category of ulcers, i.e., giant (over 2–3 cm) and multiple ulcers, is rarely encountered. We discuss the circumstances determining the occurrence of such lesions, their diverse aetiology and pathogenesis, their common manifestations, and the severity of their evolution. Some of the lesions are benign (chronic or acute ulcers), whereas others are neoplastic: carcinoma, stromal tumours, and lymphomas. In gastric ulcers, the characteristics of this particular and rare category of lesions strictly places them in the surgical field, requiring primary surgical intention. Conservative treatments are not effective in such cases, and preoperative biopsies are not appropriate for emergency interventions. Whether these unusual ulcers are benign or malign, they need to be surgically removed.
Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed an... more Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed annually with this disease, of which 2000 will die. The incidence is three times higher than UE average. A total of 9629 women are diagnosed with breast cancer annually, and deaths reaches 3209. Approximately 90% of these patients are diagnosed in stages II, III or IV. The high rate of cancer cases diagnosed in advanced stages is caused by the lack of an organised screening, Romania being one of the few European countries which doesn’t have implemented yet a screening program for breast cancer. Another causes are represented by the low level of health education and the difficult access to some medical services and adequate treatments. Materials and method. World Health Organization and European Cancer Leagues recommend, among the preventing measures for cervical cancer scientifically proven to be effective, the screening for active early detection, along with HPV vaccination. The Min...
According to a study realized at Johns Hopkins University, up to 50% of the patients have nutriti... more According to a study realized at Johns Hopkins University, up to 50% of the patients have nutritional deficiences when they are hospitalized, and only 20% of the patients benefit from a nutritional consult at the admission. This situation is seen in patients of all ages, but older people are very vulnerable. The nutritional deficit significantly increases the risk of postoperative complications and, consequently, the risk of death after surgery, being the main reason for hospital readmission. This is due to the lack of sufficient biological resources to deal with the catabolism determined by the systemic inflammatory response. Cancer, other chronic diseases and the surgical intervention trigger a systemic inflammatory reaction. This inflammatory response, whose intensity is determined by the extent of the surgical act, leads to the intensification of glycogen and lipid catabolism, with the release of glucose, free fatty acids and amino acids in the circulation. The routine nut...
Objective. Anastomotic fistulas in digestive surgery is a serious complication that can lead to p... more Objective. Anastomotic fistulas in digestive surgery is a serious complication that can lead to patient’s death. The identification of paraclinical laboratory samples to allow early diagnosis of fistulas would allow an optimal patient’s management. Materials and method. We conducted a prospective study on 41 cancer patients operated for gastric tumors between 2016 and 2017 in the First Clinic of General Surgery and Oncology of the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest. All patients were subjected to gastric resections or gastrojejunal anastomoses. Therefore, digestive sutures were performed. Postoperative follow-up included the determination of C-reactive protein (CRP), monitoring of leukocyte counts in the peritoneal cavity (from a biological product harvested from the chest tube), associated with the number of leukocytes in the blood. Depending on the values of these biological samples and the clinical evolution, other paraclinical investi...
Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics ... more Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics which can make the diagnosis and treatment questionable, and, which in general, have a good prognosis. In recent decades, the incidence of rectal neuroendocrine tumors has increased due to the accessibility of colonoscopy and the introduction of screening programs for colorectal tumors. We present the case of a 55-year-old patient who presented for rectal bleeding started 6 months before. At the moment of the hospital admission, the general state of the patient was good, and the clinical and paraclinical examination confirmed the diagnosis of stage IV rectal tumor. The pathology examination could not distinguish between a non-differentiated carcinoma and a neuroendocrine tumor. The diagnosis of Rectal neuroendocrine tumor with an aggressive behaviour was established via immunohistochemistry (ki 67 index of 75-80%, G3 grading). Due to the high aggressiveness of the tumor, the patient had ...
Preoperative radiotherapy is standard procedure in rectal cancer treatment protocols. Experience ... more Preoperative radiotherapy is standard procedure in rectal cancer treatment protocols. Experience and analysis of clinical and laboratory features of the results of this procedure have established that the response to radiotherapy, in order to reduce the volume of tumor and adenopathies of stations I and II is highly variable, from complete disappearance of the tumor mass, to the lack of response. The response to radiotherapy in conjunction with pathological and immunohistochemical data could allow assessment of prognosis in the rectal cancer. For this purpose we have proposed conducting a clinical trial to examine the tumor grading, immunohistochemical markers, and possible genetic changes that allow assessment of the degree of post-radic regression and the postterapeutic prognosis. Based on these criteria would be possible to establish a group of regression in which the patient stands still from the pretherapeutic phase. In this way the type of the presurgical radiation would shade...
Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed an... more Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed annually with this disease, of which 2000 will die. The incidence is three times higher than UE average. A total of 9629 women are diagnosed with breast cancer annually, and deaths reaches 3209. Approximately 90% of these patients are diagnosed in stages II, III or IV. The high rate of cancer cases diagnosed in advanced stages is caused by the lack of an organised screening, Romania being one of the few European countries which doesn’t have implemented yet a screening program for breast cancer. Another causes are represented by the low level of health education and the difficult access to some medical services and adequate treatments. Materials and method. World Health Organization and European Cancer Leagues recommend, among the preventing measures for cervical cancer scientifically proven to be effective, the screening for active early detection, along with HPV vaccination. The Min...
Objective . Anastomotic fistulas in digestive surgery is a serious complication that can lead to ... more Objective . Anastomotic fistulas in digestive surgery is a serious complication that can lead to patient’s death. The identification of paraclinical laboratory samples to allow early diagnosis of fistulas would allow an optimal patient’s management. Materials and method . We conducted a prospective study on 41 cancer patients operated for gastric tumors between 2016 and 2017 in the First Clinic of General Surgery and Oncology of the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest. All patients were subjected to gastric resections or gastrojejunal anastomoses. Therefore, digestive sutures were performed. Postoperative follow-up included the determination of C-reactive protein (CRP), monitoring of leukocyte counts in the peritoneal cavity (from a biological product harvested from the chest tube), associated with the number of leukocytes in the blood. Depending on the values of these biological samples and the clinical evolution, other paraclinical inves...
According to a study realized at Johns Hopkins University, up to 50% of the patients have nutriti... more According to a study realized at Johns Hopkins University, up to 50% of the patients have nutritional deficiences when they are hospitalized, and only 20% of the patients benefit from a nutritional consult at the admission. This situation is seen in patients of all ages, but older people are very vulnerable. The nutritional deficit significantly increases the risk of postoperative complications and, consequently, the risk of death after surgery, being the main reason for hospital readmission. This is due to the lack of sufficient biological resources to deal with the catabolism determined by the systemic inflammatory response. Cancer, other chronic diseases and the surgical intervention trigger a systemic inflammatory reaction. This inflammatory response, whose intensity is determined by the extent of the surgical act, leads to the intensification of glycogen and lipid catabolism, with the release of glucose, free fatty acids and amino acids in the circulation. The routine nut...
Canadian Journal of Gastroenterology and Hepatology
Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the a... more Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the authors review and analyze the evolution of the surgical portocaval shunt (PCS). We would like to provide an insight into the past of PCS, in order to compare it with the current state of the treatment of PHT complications. As a landmark of the past, we shall present statistics of more than 500 cases of PHT operated between 1968 and 1983. From this group, 238 patients underwent surgical portocaval shunting during a fifteen-year period. The behavior of the portal hemodynamics following PCS was studied and the postoperative decrease in portal pressure (PP), as well as the residual PP, were recorded. The portal manometric determinations were made by electronic recordings using the Hellige device and direct intraoperative recordings through the catheterization of a ramus in the portal area. The results of PCS are superposable, in terms of hemodynamic efficiency, with those of the intrahepatic...
Non-traumatic perforations of the bile ducts are unfrequently encountered entities, all the more ... more Non-traumatic perforations of the bile ducts are unfrequently encountered entities, all the more when they affect the intrahepatic bile ducts, exteriorizing their biliary content in the great peritoneal cavity. Reporting such a case has determined the authors to perform a careful overview of the cases present in the literature. An observation that can be made based on these is that the obstruction of the main bile duct due to lithiasis determines, by pressure increase, the dilation of the bile system branches, all on the background of an unknown malformation of the intrahepatic bile ducts.
Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the... more Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the histological type of diffuse large B-cell lymphomas (DLBCL) being the most prevalent in adults. In about 40% of cases, the location is extranodal. Uterine cervix lymphomas of this type are extremely rare (0.5–1.5%) and represent a diagnostic challenge. A case of DLBCL of the cervix is presented here along with a review of the literature. Materials and methods: A 75-year-old patient was referred with a bleeding vegetant tumour occupying her entire vagina. The histological and pathological investigations performed following the tumour biopsy indicated a malignant, diffuse, vaguely nodular lymphoid tumour proliferation. The immunohistochemistry results were in favour of a diffuse B-cell non-Hodgkin lymphoma (DLBCL). CHOP (Cyclophosphamide, Hydroxydaunorubicin (also called doxorubicin or adriamycin), Oncovin (vincristine), Prednisone or Prednisolone) polychemotherapy and radiotherapy were e...
We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with ... more We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with haemorrhage- or perforation-induced complications. This category of ulcers, i.e., giant (over 2–3 cm) and multiple ulcers, is rarely encountered. We discuss the circumstances determining the occurrence of such lesions, their diverse aetiology and pathogenesis, their common manifestations, and the severity of their evolution. Some of the lesions are benign (chronic or acute ulcers), whereas others are neoplastic: carcinoma, stromal tumours, and lymphomas. In gastric ulcers, the characteristics of this particular and rare category of lesions strictly places them in the surgical field, requiring primary surgical intention. Conservative treatments are not effective in such cases, and preoperative biopsies are not appropriate for emergency interventions. Whether these unusual ulcers are benign or malign, they need to be surgically removed.
Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed an... more Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed annually with this disease, of which 2000 will die. The incidence is three times higher than UE average. A total of 9629 women are diagnosed with breast cancer annually, and deaths reaches 3209. Approximately 90% of these patients are diagnosed in stages II, III or IV. The high rate of cancer cases diagnosed in advanced stages is caused by the lack of an organised screening, Romania being one of the few European countries which doesn’t have implemented yet a screening program for breast cancer. Another causes are represented by the low level of health education and the difficult access to some medical services and adequate treatments. Materials and method. World Health Organization and European Cancer Leagues recommend, among the preventing measures for cervical cancer scientifically proven to be effective, the screening for active early detection, along with HPV vaccination. The Min...
According to a study realized at Johns Hopkins University, up to 50% of the patients have nutriti... more According to a study realized at Johns Hopkins University, up to 50% of the patients have nutritional deficiences when they are hospitalized, and only 20% of the patients benefit from a nutritional consult at the admission. This situation is seen in patients of all ages, but older people are very vulnerable. The nutritional deficit significantly increases the risk of postoperative complications and, consequently, the risk of death after surgery, being the main reason for hospital readmission. This is due to the lack of sufficient biological resources to deal with the catabolism determined by the systemic inflammatory response. Cancer, other chronic diseases and the surgical intervention trigger a systemic inflammatory reaction. This inflammatory response, whose intensity is determined by the extent of the surgical act, leads to the intensification of glycogen and lipid catabolism, with the release of glucose, free fatty acids and amino acids in the circulation. The routine nut...
Objective. Anastomotic fistulas in digestive surgery is a serious complication that can lead to p... more Objective. Anastomotic fistulas in digestive surgery is a serious complication that can lead to patient’s death. The identification of paraclinical laboratory samples to allow early diagnosis of fistulas would allow an optimal patient’s management. Materials and method. We conducted a prospective study on 41 cancer patients operated for gastric tumors between 2016 and 2017 in the First Clinic of General Surgery and Oncology of the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest. All patients were subjected to gastric resections or gastrojejunal anastomoses. Therefore, digestive sutures were performed. Postoperative follow-up included the determination of C-reactive protein (CRP), monitoring of leukocyte counts in the peritoneal cavity (from a biological product harvested from the chest tube), associated with the number of leukocytes in the blood. Depending on the values of these biological samples and the clinical evolution, other paraclinical investi...
Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics ... more Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics which can make the diagnosis and treatment questionable, and, which in general, have a good prognosis. In recent decades, the incidence of rectal neuroendocrine tumors has increased due to the accessibility of colonoscopy and the introduction of screening programs for colorectal tumors. We present the case of a 55-year-old patient who presented for rectal bleeding started 6 months before. At the moment of the hospital admission, the general state of the patient was good, and the clinical and paraclinical examination confirmed the diagnosis of stage IV rectal tumor. The pathology examination could not distinguish between a non-differentiated carcinoma and a neuroendocrine tumor. The diagnosis of Rectal neuroendocrine tumor with an aggressive behaviour was established via immunohistochemistry (ki 67 index of 75-80%, G3 grading). Due to the high aggressiveness of the tumor, the patient had ...
Preoperative radiotherapy is standard procedure in rectal cancer treatment protocols. Experience ... more Preoperative radiotherapy is standard procedure in rectal cancer treatment protocols. Experience and analysis of clinical and laboratory features of the results of this procedure have established that the response to radiotherapy, in order to reduce the volume of tumor and adenopathies of stations I and II is highly variable, from complete disappearance of the tumor mass, to the lack of response. The response to radiotherapy in conjunction with pathological and immunohistochemical data could allow assessment of prognosis in the rectal cancer. For this purpose we have proposed conducting a clinical trial to examine the tumor grading, immunohistochemical markers, and possible genetic changes that allow assessment of the degree of post-radic regression and the postterapeutic prognosis. Based on these criteria would be possible to establish a group of regression in which the patient stands still from the pretherapeutic phase. In this way the type of the presurgical radiation would shade...
Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed an... more Introduction. In Romania, cervical cancer is a public health issue, 4000 women being diagnosed annually with this disease, of which 2000 will die. The incidence is three times higher than UE average. A total of 9629 women are diagnosed with breast cancer annually, and deaths reaches 3209. Approximately 90% of these patients are diagnosed in stages II, III or IV. The high rate of cancer cases diagnosed in advanced stages is caused by the lack of an organised screening, Romania being one of the few European countries which doesn’t have implemented yet a screening program for breast cancer. Another causes are represented by the low level of health education and the difficult access to some medical services and adequate treatments. Materials and method. World Health Organization and European Cancer Leagues recommend, among the preventing measures for cervical cancer scientifically proven to be effective, the screening for active early detection, along with HPV vaccination. The Min...
Objective . Anastomotic fistulas in digestive surgery is a serious complication that can lead to ... more Objective . Anastomotic fistulas in digestive surgery is a serious complication that can lead to patient’s death. The identification of paraclinical laboratory samples to allow early diagnosis of fistulas would allow an optimal patient’s management. Materials and method . We conducted a prospective study on 41 cancer patients operated for gastric tumors between 2016 and 2017 in the First Clinic of General Surgery and Oncology of the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest. All patients were subjected to gastric resections or gastrojejunal anastomoses. Therefore, digestive sutures were performed. Postoperative follow-up included the determination of C-reactive protein (CRP), monitoring of leukocyte counts in the peritoneal cavity (from a biological product harvested from the chest tube), associated with the number of leukocytes in the blood. Depending on the values of these biological samples and the clinical evolution, other paraclinical inves...
According to a study realized at Johns Hopkins University, up to 50% of the patients have nutriti... more According to a study realized at Johns Hopkins University, up to 50% of the patients have nutritional deficiences when they are hospitalized, and only 20% of the patients benefit from a nutritional consult at the admission. This situation is seen in patients of all ages, but older people are very vulnerable. The nutritional deficit significantly increases the risk of postoperative complications and, consequently, the risk of death after surgery, being the main reason for hospital readmission. This is due to the lack of sufficient biological resources to deal with the catabolism determined by the systemic inflammatory response. Cancer, other chronic diseases and the surgical intervention trigger a systemic inflammatory reaction. This inflammatory response, whose intensity is determined by the extent of the surgical act, leads to the intensification of glycogen and lipid catabolism, with the release of glucose, free fatty acids and amino acids in the circulation. The routine nut...
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