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Widely recognized as the most deathful gynecologic malignancy affecting women worldwide, ovarian cancer has reported a significant decline in terms of prevalence and incidence in the last decades. This fact has been especially explained by to the use of menopausal hormonal therapy and of oral contraceptives in association with genetic, oncologic and gynecologic counseling. The aim of the current review is to discuss about actual ovarian cancer prevention and screening tools. For this reason, we reviewed several data related to ovarian cancer, such as: incidence and risk factors, histopathological types (epithelial with high- and low-grade serous carcinomas, clear cell carcinoma, mucinous carcinoma, germ cells ovarian cancer tumors), as well as screening, diagnosis and prevention methods (ovulation disruption, surgical prevention, etc.). Although progress has been reported in the last decades in terms of early diagnosis and treatment of ovarian cancer, this malignancy still represents a significant health problem affecting women worldwide. However, it seems that the golden key for optimizing the long-term outcomes in such patients is represented by a better understanding of the complex pathogenesis of this disease.

Even nowadays the diagnostic of ovarian cancer is difficult to be established preoperatively, and therefore a significant number of patients are submitted to a much too extensive or to an incomplete surgical procedure. Therefore attention was focused on identifying more reliable markers which might help the clinician to distinguish between benign and malignant ovarian lesions. The aim of the current paper is to analyze the differences between benign and malignant ovarian tumors based on the preoperative levels of the mean platelet volume.

Ovarian cancer remains one of the most aggressive malignancies which is frequently diagnosed in advanced stages of the disease, when disseminated lesions are already present. In order to maximize the rates of complete debulking surgery, different prognostic markers have been investigated. The aim of the current paper is to investigate the prognostic value of neutrophil to lymphocyte ratio in advanced stage ovarian cancer patients submitted to debulking surgery.

Several cases reported in the literature have confirmed the link between pulmonary aspergillosis and various malignant diseases. Furthermore, it has been observed that the correlation between carcinoid tumor and lung adenocarcinoma is quite uncommon. The etiopathogenic mechanisms underlying these correlations remain poorly defined. We present the case of a patient with three of these diseases: a lung adenocarcinoma with a lepidic pattern, a typical carcinoid, and pulmonary aspergillosis. An additional noteworthy aspect of this case pertains to the timely detection of both lung malignancies. Thus, the necessity for further investigation to ascertain the pathogenic connection among the three diseases is underscored. The ultimate objective is to enhance the prognosis of individuals diagnosed with lung cancer, which is a prevailing malignant disease on a global scale.

Red cell distribution width [RDW] represents a new prognostic marker which has been widely studied in malignant tumors including ovarian cancer patients. Therefore, it has been stipulated that RDW can be also used as a prognostic marker and a follow up tool for these patients. The aim of the current paper was to analyze the variations of this parameter on a study group of 31 patients diagnosed with advanced stage ovarian cancer and respectively 48 cases with benign ovarian lesions submitted to surgery between 2017-2020 in “Cantacuzino” Clinical Hospital.

Although multiple studies have been conducted so far on the issue of advanced stage ovarian cancer, the overall prognostic of these patients reports a wide variety even in cases in which complete debulking surgery is feasible. Therefore, attention was focused on identifying other prognostic markers which might influence the long term outcomes of these patients. In this paper special attention was focused on studying the impact of mesenteric lymph node involvement in advanced stage ovarian cancer.

Ovarian cancer remains one of the most aggressive gynecological malignancies after cervical and endometrial cancer especially due to the multiple patterns of spread cited so far. Although it has been stated that the peritoneal route is the most dangerous pattern of spread leading to the apparition of disseminated intraabdominal lesions, other pathways such as hematogenous or lymphatic route can be also important, leading to the apparition of abdominal and extra-abdominal metastases. The aim of the current paper is to discuss about the risk of developing axillary metastases from ovarian cancer primaries.

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.

Gallbladder cancer represents the most commonly encountered malignancy of the biliary tract which becomes symptomatic only in advanced stages of the disease when, in most cases, local invasion in unresectable structures is already present. Another significant problem regarding this pathology is related to the fact a positive diagnostic is difficult to be established preoperatively. The aim of the current paper is to discuss about the possible relationship between the preoperative number of circulating platelets and the overall prognosis in gallbladder cancer patients.

Ovarian cancer is recognized for the high capacity of spread which leads to the apparition of distant metastases via multiple pathways such as peritoneal, hematogenous or lymphatic route. If cases presenting peritoneal dissemination usually present extended but limited to the abdominal cavity lesions, patients with hematogenous or lymphatic spread will lead to the apparition of both intra-abdominal and extra-abdominal lesions. Even though, the presence of extra-abdominal lymphatic metastases is rather a rare event; however, contamination of extra-abdominal lymph nodes and is considered as distant metastazation and considered as stage IV of disease. The aim of the current paper is to review the cases presented so far with histopathological documented supraclavicular metastases originating from ovarian cancer.

The presence of thrombocytosis has been widely associated with poor prognostic in patients diagnosed with ovarian cancer at the time of the initial diagnostic. Once this fact has been widely accepted, attention was focused on studying whether this biological parameter could be also a diagnostic tool for identifying patients with poorer outcomes at the time of secondary cytoreduction. Therefore the most commonly encountered questions are whether patients presenting thrombocytosis at the time of primary cytoreduction are expected to have also thrombocytosis at the time of relapse and if thrombocytosis at the time relapse is corelated with lower disease free intervals, with higher rates of incomplete debulking and with poorer rates of overall survival respectively. This is a literature review of the most relevant studies conducted on this issue.

Neutrophil to lymphocyte ratio represents a novel prognostic marker which is usually associated with the presence of proinflammatory conditions such as obesity, metabolic syndrome or certain benign and even malignant diseases. Moreover, in cases in which a malignant condition is present, the value of the neutrophil to lymphocyte ratio also seems to be positively correlated with the biological agressivity of the tumor. The aim of the current paper is to discuss about the most relevant studies which discuss about the role of this parameter as a new biological marker in ovarian cancer patients.

Systemic lupus erythematosus is one of the most common autoimmune disorders affecting young women. Pregnant women with lupus are generally at higher risk for certain pregnancy complications than women without comorbidities. Even so, a pregnancy with lupus can be carried to term in optimal conditions if it is properly managed by a doctor. Monitoring is generally recommended six months after the onset of lupus symptoms, and ideally there should be no active lupus symptoms prior to conception. General screening tests should include the anti-phospholipid, anti-Ro and anti-La antibodies. Women who are positive for these antibodies have an increased risk of congenital heart block in the fetus. In addition, pregnant women with lupus have an increased risk of spontaneous abortion, intrauterine fetal growth restriction, pre-term birth, while neonatal lupus syndrome is a major fetal condition. The maternal risks are faced with disease flares, pre-eclampsia and other complications. Treatment options during pregnancy are limited to a few safe medications. For example, prednisone is unlikely to cause fetal malformations, but it increases the risk of diabetes and high blood pressure in the mother. Consequently, a careful multidisciplinary monitoring is essential for optimal results in pregnancy with lupus.

Defined as the loss of the muscular mass, sarcopenia is a common finding in neoplastic patients, multiple mechanisms such as nutritional deficiency, proinflammatory tumoral related status or physical inactivity being cited. However, the loss of the muscular mass in such cases is associated with significant impact in regard to the type of treatment in such cases; in consequence, as expected the disease-free survival and overall survival might be influenced. The aim of the current paper is to discuss about the most important mechanisms leading to sarcopenia in ovarian cancer patients as well as the impact on the long-term outcomes.

Introduction. Circulating platelets play an essential role in the immune system and furthermore in tumor development and proliferation. Therefore, the correlation ship between different neoplasia and the number of platelets has been widely studied. The aim of the current paper is to investigate the correlation ship between platelet number and tumoral endometrial transformation. Material and methods. Between January 2022 and June 2022 22 patients with endometrial hyperplasia or endometrial cancer were submitted to surgery. The serum levels of platelets were determined and compared to those reported in a similar group of patients in whom the endometrial lining was normal. Results. Patients diagnosed with endometrial cancer presented a significantly higher number of platelets as well as a significantly higher platelet volume when compared to patients diagnosed with endometrial hyperplasia and respectively to those in whom a normal endometrial lining was found. Conclusions. The serum number of platelets and their volume seem to be positively correlated with the aggressivity of the tumoral transformation of the endometrial lining and should be therefore considered as part of the elements which should be analyzed when discussing the best therapeutic option in such patients.

Colorectal cancer is the second leading cause of cancer-related mortality worldwide. Numerous pathophysiological mechanisms, such as abnormal cell proliferation, cell differentiation, resistance to apoptosis, invasion of structures adjacent to colorectal tumor cells, and distant metastasis, are involved in colorectal carcinogenesis. These processes are initiated by the complex interaction of a number of genetic and environmental factors, including sedentary lifestyle, obesity, alcohol consumption, smoking, or gut microbiota. Despite the significant progress achieved in the diagnostic and therapeutic management of patients with colorectal cancer, there has been recently a noteworthy increase in the incidence of colorectal cancer in individuals below the age of 50 years. Early-onset colorectal cancer has a different frequency of oncogenic mutations, a higher prevalence of mucinous histology, a distinct deoxyribonucleic acid (DNA) methylation profile, a more distal location, and lower survival rates. A significant improvement in the prognosis of these patients can be achieved through the detection and removal of modifiable risk factors, along with the implementation of personalized screening strategies for individuals at high risk for this malignancy. Furthermore, gaining comprehension of the pathophysiological mechanisms by which these risk factors contribute to the process of oncogenesis may facilitate the discovery of novel therapeutic targets.

First-trimester screening is focused on both markers of aneuploidies and structural abnormalities detection. In the past ten years, clinicians have been increasingly interested in using Doppler ultrasound in the first trimester of pregnancy. Doppler examination can help estimate the risk of aneuploidy and early diagnose severe fetal malformations. The purpose of this article is to highlight the importance of color Doppler ultrasound examination of the fetus in the first trimester. Color Doppler examination also has a great significance in studying maternal-fetal circulation. According to the ISUOG guidelines, several vascular territories should be covered: uterine arteries, umbilical artery, and ductus venosus. The nowadays first trimester Doppler examination not only identifies specific ultrasonographic markers for aneuploidy but also aids in the identification and analysis of many anatomical structures.

Breast cancer represents the most commonly encountered malignancy in women worldwide. In the last decades, due to the improvement of the imagistic techniques and to the wide implementation of screening tests, a significant number of cases are suitable for conservative surgery therefore improving the quality of life. Although the postoperative morbidity after breast conservative surgery is reduced, the procedure can still be associated with certain complications such as breast lymphedema, or wound difficult healing. The aim of the current paper is to discuss the possibility of prevention and treatment of breast lymphedema by using innovative techniques such as indocyanine green.

Cesarean scar defect, niche or isthmocele represents a poor healing in the anterior uterine wall after performing a cesarean section. The cesarean scar defect can be asymptomatic, or the patient could present abnormal uterine bleeding, chronic pelvic pain, dysmenorrhea, dyspareunia, cesarean scar pregnancy or abnormal placenta. Abnormal uterine bleeding caused by cesarean scar defect presents as a postmenstrual spotting and has become more and more common among women with a history of minimum one cesarean section delivery. The most studied risk factors are: multiple cesarean section deliveries, single layer suture, locked suture, retroflexed uterus and cesarean section delivery performed during active labor with a cervical dilatation of 5 cm. There have been described several surgical approaches: hysteroscopic, laparoscopic or vaginal. From our experience, we have treated successfully symptomatic patients with cesarean scar defect with the levonorgestrel-releasing intrauterine system. Although the therapeutic indications do not include this specific use, we have obtained significant improvement of abnormal uterine bleeding due to cesarean scar defect in our patients. Our results sustain the necessity of extensive interventional studies.

Homeopathic principles have been widely investigated and proposed even from the ancient times in order to treat different wounds, to prevent inflammation and to treat infections. Although initially they have been tested in regard to skin wounds, their use was also tested in regard to different internal viscera with promising results. Therefore, such extracts have been proposed as part of the topical products proposed for treating certain pathologies of the uterine cervix such as infections, cervicitis or even in order to prevent the risk of uterine cervical cancer development. The aim of the current paper is to discuss about the potential protective role of Hydrastasis Canadensis in treating different cervico-vaginal lesions.

The role of intraperitoneal chemotherapy has been widely investigated in locally advanced malignancies which serosal involvement as well as in cases in which disseminated peritoneal nodules are present. However, its benefits have been widely contested by the higher rates of perioperative complications and therefore, the guidelines did not include it as part of standard therapy. Meanwhile, the better control of the intraperitoneal spread which has been demonstrated in certain cases enabled surgeons to propose performing intraperitoneal chemotherapy in particularly aggressive malignancies such as pancreatic cancer. The aim of the current paper is to discuss about the efficacy and the preliminary results of intraperitoneal chemotherapy in pancreatic cancer.

The screening for pre-invasive cervical lesions has significantly decreased the incidence of cervical neoplasm. It is recommended to be performed starting with the age of 21 with a frequency of 3-5 years and it consists of pap smear testing and HPV genotyping, and, if required, it can be continued with colposcopy or biopsy followed by pathological assessment. The importance of the early diagnosis of pre-invasive cervical lesions has led to several studies on this topic. The paper analyzed the modern literature published on the PubMed and Scopus databases. Reference studies have found that most intraepithelial lesions are caused by the presence of HPV. Other commonly associated factors are immunosuppression, multiparity and other viral infections. HPV infection can be prevented by vaccination. It is recommended for people between 11 and 26 years old and also over 27 years old if they associate risk factors. A meta-analysis performed on patients diagnosed with CIN2 revealed a lower recurrence rate in vaccinated women than in unvaccinated women. Other studies have shown the transient nature of HPV infection and spontaneous regression of pre-invasive lesions. The early diagnosis of pre-invasive lesions is necessary for the initiation of therapeutic and follow-up behavior as soon as possible, with the aim of reducing the incidence of cervical cancer. This is possible and easy to access through national health programs.

Vaginal microbiome is submitted to permanent changes accordingly to age, menopausal status or association of different pathological conditions such as inflammation or mucosal atrophy. The presence of these modifications is usually associated with local development of infectious, inflammatory or atrophic vulvovaginitis. These represent the most commonly complaints which affect women at all ages. Therefore, attention was focused on creating a topic product which is able to control the local process and to alleviate the symptoms. The aim of the current paper is to analyze the physiology, physiopathology and therapeutic strategies in such cases with special focus on Cerviron, a product which seems to provide multiple therapeutic benefits in such cases.

The new coronavirus, SARS-CoV-2, first identified in humans in Wuhan Province, China, in December 2019, has spread rapidly throughout the world, causing World Health Organization (WHO) to declare it a pandemic infection. This pathogenic agent belongs to the genus beta-coronavirus, alongside SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The large number of infected patients is mainly due to the modality of transmission, through respiratory droplets. The most common manifestation of the disease/infection COVID-19 is pneumonia, as there are not any specific clinical manifestations that differentiate this disease from other respiratory viral infections. The confirmation of COVID-19 is done by RT-PCR (Real-Time Polymerase Chain Reaction) of respiratory specimens. In most cases, the damage induced by this infection is not severe, and death occurs most frequently among older patients or with significant comorbidities. To control this pandemic infection, measures such as self-isolation at home or quarantine are recommended. Given both the large number of infected patients, as well as the large number of deaths, it is imperative to conduct studies that identify effective therapeutic measures.

Introduction. Pelvic recurrence is not a rare event after resection with curative intent for rectal cancer originating from different segments of the rectum (lower, intermediary and superior part). Material and methods. This retrospective observational study included 106 patients; among these cases there were 79 patients who accepted surgical treatment of rectal cancer (treated in a governmental hospital between 2014 and 2017) and who were submitted to anterior resection with Hartmann’s procedure (6.5% of patients), anterior resection of rectosigmoid with colorectal anastomosis (78% of cases) and abdominoperineal resection (15% of cases). Results. After a 2 year follow-up, pelvic recurrence was reported in 11patients ~ 14% of cases: 33% rate of recurrence after Hartmann procedure, 9% rate of recurrence after abdominoperineal resection, and 10% rate of recurrence after anterior resection of rectosigmoid with colorectal anastomosis. 39 patients (49% of cases) had been submitted to preoperative radiotherapy: the pelvic recurrence rate among these cases was of 11% (9 patients). The rate of recurrence (RR) was also significantly influenced by the stage at diagnostic: stage III had RR = 52% of cases, stage II had RR = 41% of cases and stage I had RR = 0% of cases). The survival rate among surgically treated patients after 1 one year was 86%, and 80% in the first 2 years after treatment. Conclusions. Rectal cancer diagnosed in advanced stages has a high recurrence rate. A low recurrence rate indicates successful curative surgical treatment. The highest recurrence rate was reported after Hartmann procedure (which was usually performed as an emergency operation for locally advanced lesions).

Peritoneal carcinomatosis colorectal cancer unfortunately represents a frequently encountered condition during the natural history of this malignancy which has been considered for a long period of time as a terminal event. However, once new surgical and oncological therapies have been reported significant changes have been reported in the management of these cases. Therefore, cytoreductive surgery to no residual disease as a stand-alone procedure or in association with intraperitoneal hyperthermic chemotherapy has been proposed and significant benefits in terms of survival have been reported; unfortunately not all patients with peritoneal carcinomatosis are candidates for this combined approach, especially if extended, nonresectable lesions are present. In such cases pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed with promising results. The aim of the current paper is to review the most important studies conducted on this issue.

Ovarian cancer represents one of the most aggressive gynecological malignancies affecting women worldwide, associated with significant rates of cancer related death within the first years after the initial diagnostic. The poor survival rates are usually explained by the presence of disseminated lesions even from the beginning. In such situations, the digestive tube is one of the most commonly involved territory, therefore necessitating extended resections in order to achieve complete cytoreduction. The aim of this paper is to report the case of a 53 year old patient who was diagnosed with peritoneal carcinomatosis from ovarian cancer, presenting multiple levels of digestive tract involvement due to the presence of disseminated tumoral masses. Therefore the patients was submitted to multiple digestive resections represented by parcelar gastrectomy, segmental ileal resection and subtotal colectomy. In order to minimize the risks of developing severe postoperative complications – due to the relatively high number of anastomoses – the continuity of the digestive tract was established by a terminal ileostomy, considering that creation of a ileorectal anastomosis would be too dangerous in the context of multiple digestive resections. The postoperative evolution was simple, the patient being further submitted to adjuvant treatment.

Locally advanced and relapsed rectal cancer represent one of the most commonly reported indications for total pelvic exenteration especially in men, while in women the surgical procedure might be limited to a posterior exenteration. This procedure is still associated with high risks of postoperative complications and high rates of perioperative mortality, therefore careful selection of the cases is mandatory. However, in the last decades improvement in the field of oncology treatment leaded to the increase of the lifespan of patients diagnosed with rectal cancer; in this respect, it is easy to be understood the fact that an increased number of cases will develop at a certain moment of their evolution pelvic recurrences which need more extended surgical procedures at a more advanced age. Therefore, extended procedures such as pelvic exenterations are needed in these cases; the aim of this paper is to study whether pelvic exenteration is suitable for elderly patients and which cases could benefit most from this aggressive surgical approach.

Urinary incontinence (UI) is a common condition among women. Approximately 50% of them had an involuntary loss of urine at least once in their lifetime. It can be present during sexual activity, contributing to sexual dysfunction and often associated with anxiety or even depression, thus having a negative impact on the quality of life. The incidence of UI is related to the existence of predisposing factors. The best known are: age, weight, family history, race/ ethnicity, number of pregnancies and mode of birth, history of genitourinary interventions and factors related to ordinary habits: smoking, caffeine consumption, oral contraceptives. Studies on middle-aged women have revealed that BMI, parity, age, hysterectomy, smoking, race/ ethnicity and diabetes are factors often associated with urinary incontinence. Future studies are needed to further explore the risk factors for urinary incontinence.

The increase in the number of births by Caesarean section is a phenomenon whose global expansion is generated by numerous factors and especially by the contemporary perceptions of women regarding childbirth meeting the interests of the professionals in the field. However, the opinion of many women towards the benefits of Caesarean delivery is often not based on the experience or information from reliable sources. This study aimed at sharing the experience of women who gave birth both vaginally and by Caesarean section, focusing on their perception of these events. The study included 26 women and the conclusion of the vast majority (77%) was that natural birth is preferable and they would recommend it as the first option to future mothers. In addition, the analysis of the cases in which, on the contrary, they would recommend birth by Caesarean section (23%) revealed that they objectively had births that had not been optimally managed and hence, the recommendation for careful, professional evaluation of the conditions of birth for each case. Reaching an optimal rate of Caesarean sections is an objective that can be achieved through correct information, health education and the correct management of the cases.

The last decades have brought impressive advances in liver transplantation. As a result, there was a notable rise in the number of liver transplants globally. Advances in surgical techniques, immunosuppressive therapies and radiologically guided treatments have led to an improvement in the prognosis of these patients. However, the risk of complications remains significant, and the management of liver transplant patients requires multidisciplinary teams. The most frequent and severe complications are biliary and vascular complications. Compared to vascular complications, biliary complications have higher incidence rates but a better prognosis. The early diagnosis and selection of the optimal treatment are crucial to avoid the loss of the graft and even the death of the patient. The development of minimally invasive techniques prevents surgical reinterventions with their associated risks. Liver retransplantation remains the last therapeutic solution for graft dysfunction, one of the main problems, in this case, being the low number of donors.

Vaginal atrophy represents a frequently encountered condition which is significantly correlated with decreased amounts of circulating estrogen levels. It is usually characterized by the presence of burning, itching, irritation and dyspareunia. In such cases attention was focused on identifying a topic product which might alleviate these symptoms and stop the deterioration process of the vaginal lining. One product which seems to have an effective role in order to stop this process and to offer a good local control of the disease should contain anti-inflammatory, healing and antiseptic principles. The aim of the current paper is to study the possible benefits of Cerviron a topic product with intravaginal administration which contains seven active principles in order to offer the above mentioned effects.

t has been widely demonstrated so far that lactobacilli represent probably the most important microorganisms which are developed at the level of the vaginal cavity and which are responsible for the maintenance of an adequate environment and pH at this level. Once the number of these microorganisms decrease the pH value increase leading to the apparition of a basic medium, which favors the development of certain microorganisms such as human papilloma virus. Meanwhile it is widely known that the presence of this virus is associated with an increased risk of developing premalignant and even malignant conditions. The aim of the current paper is to investigate the correlation between the vaginal pH, the risk of human papilloma virus infection and, in the meantime, to explore the possible benefits of local application of Cerviron, a topic, vaginal product which seems to significantly influence the risk of cervical lesions development.

Uterine fibroids represent the most commonly encountered uterine tumors in women worldwide which can develop at the level of any segment of the uterus and can pose different problems in regard to the most appropriate therapeutic strategy especially in young women which deserve fertility preservation. Meanwhile in certain cases they can impede the development of a normal pregnancy due to their location or can show significant enlargement in volume during pregnancy due to the increased blow flow at this level. In all cases in which they induce the apparition of symptoms or impede the apparition or development of a normal pregnancy they should be removed. In cases in which the fibroids are located at the level of the uterine cervix attention should be focused on providing a correct and efficient postoperative healing. The aim of this paper is to review the most important aspects related to uterine cervix fibroid symptoms, treatment and postoperative healing, particular attention being given to Cerviron, a topic agent which seems to provide an efficient healing at this level.

Colorectal cancer spreads via multiple pathways, the most commonly encountered ways being represented by the peritoneal and hematogenous ones as well as by direct contiguity. At this time significant benefits in terms of survival have been reported in cases presenting locally advanced lesions and for those presenting extended peritoneal lesions of peritoneal carcinomatosis especially if radical resection is achievable. In this respect, certain authors went further and investigated whether the association of the two surgical strategies – extended pelvic resections and cytoreductive surgery of the peritoneal metastases could improve survival in cases in which both patterns of spread are present. Meanwhile, the possibility of association of hyperthermic intraperitoneal chemotherapy (HIPEC) was also investigated. The aim of the current study is to review and analyze the most relevant studies conducted on this issue.

Pericardial effusion is a common pathology in clinical practice. The etiology of pericardial effusion is diverse, from infectious diseases, malignancies, autoimmune diseases, chronic renal failure, to drug-related or after an invasive cardiac intervention. Clinical presentation of pericardial effusion is variable, depending on the volume of the fluid and the rate of accumulation. Clinical manifestations are dramatic if the pericardial fluid accumulates rapidly. Classical symptoms in pericardial effusion include pleuritic chest pain associated with dyspnea. In case of cardiac tamponade, orthopnea, jugular venous distension, pulsus paradoxus, hypotension, and shock appear. Transthoracic echocardiography is the gold standard investigation for the diagnosis of pericardial effusions. The echocardiographic signs of cardiac tamponade are represented by the collapse of the right atrium and right ventricle, respiratory alteration of mitral and tricuspid flow, and changes of the inferior vena cava. Management of pericardial effusion is guided by several factors, including hemodynamic impact and etiology. Pericardiocentesis guided by echocardiography is a life-saving procedure in cases of large pericardial effusions and cardiac tamponade. This is a review of the diagnosis and treatment of pericardial effusion.

The intestinal microbiota represents an interesting and emergent field of research, with already known implications in metabolic and immunological functions. Recently, there is increasing evidence that specific gut microbial populations are associated with cardiovascular diseases. Numerous completed and ongoing studies aim to evaluate the potential of intestinal microbiota assessment to improve the prevention, diagnosis, and therapeutic arsenal of cardiovascular diseases, considering dysbiosis as a cardiovascular risk factor. There is strong evidence for a correlation between intestinal flora imbalance and metabolic changes secondary to bacterial metabolites. In this minireview, we discuss recent data about the connections between intestinal microbiota and cardiovascular disease.

Myocarditis is an inflammatory disease of the myocardium, that can be produced by a multitude of infectious or noninfectious agents. The incidence rate of the disease is between 10 to 22 per 100,000 individuals. Among the infectious causes, viruses are considered to be the most frequent pathogens. Regarding the clinical presentation, viral myocarditis may have a wide variety of manifestations, ranging from asymptomatic disease to chest pain, myalgia, fatigue, heart failure, arrhythmias and, in some cases, sudden death. A definitive diagnosis of viral myocarditis involves histological evidence for myocarditis associated with positive viral polymerase chain reaction (PCR). Endomyocardial biopsy represents the gold standard for diagnosis; in the absence of histological, immunologic and immunohistochemical criteria, a definitive diagnosis cannot be established.

Inflammatory pseudotumors of the liver are rare entities, only few cases being reported so far, pathogenesis of these lesions being scarcely understood. However since now multiple mechanisms have been proposed in order to explain the development of these lesions, the knowledge of their pathogenesis being mandatory in order to further orientate the therapeutic strategy. The current paper is a literature review of the largest studies which aimed to discuss the etiopathogenesis of the inflammatory pseudotumors of the liver.

Pancreatic cancer remains one of the most aggressive neoplasms affecting people worldwide, with lower than one year rates of survival, especially if metastatic disease is encountered. In such cases palliative chemotherapy has been proposed, but the overall prognostic remains extremely poor. Meanwhile, in certain cases, spectacular response to chemotherapy has been observed, with significant reduction and even disappearance of the liver lesions. In this respect, attention was focused on establishing whether surgery might improve the outcomes in such cases. This is a literature review of the largest studies conducted on this issue.

Hematogenous path remains an important pathway of spread for ovarian cancer; the most commonly reported sites of involvement are represented by liver and lungs. The aim of this paper is to report a rare situation in which adrenal metastasis from ovarian carcinoma was encountered. Case report. The 55-year-old patient with previous history of surgically treated ovarian cancer was diagnosed at 18 months follow-up with an isolated lesion at the level of the right adrenal gland. After completing the biochemical analysis, in order to exclude an endocrine disorder, the final suspicion of diagnostic was of an adrenal metastasis and was submitted to adrenalectomy. The histopathological studies confirmed the presence of an adrenal metastasis of ovarian cancer. Conclusions. Although rare situations, adrenal metastases from ovarian cancer can be encountered and might be successfully treated by surgery with curative intent.

Introduction. Ovarian cancer is characterized by a high capacity of relapse, even in cases in whom cytoreductive surgery with curative intent followed by platinum and taxanes-based chemotherapy were performed. In such cases, attention was focused on determining if iterative cytoreduction might improve the long-term outcomes and how far these boundaries can be pushed. While for secondary cytoreduction multiple studies have been conducted, for tertiary and quaternary cytoreduction data are significantly scarcer. The objective of the study. This paper aims to realize a systematic review of the studies published so far on the theme of quaternary cytoreduction. Methodology. We searched medical journals in English language published from January 2010 to December 2019. Results. Six studies involving 110 patients submitted to quaternary cytoreduction met the inclusion criteria. Data reported in the above mentioned studies demonstrate that quaternary cytoreduction can be safely performed both at the level of the lower and the upper abdomen, in order to maximize the debulking effort. However, a significantly lower number of cases will be considered candidates for this type of procedure, when compared to secondary or even tertiary cytoreduction, an adequate selection process being mandatory in order to minimize the postoperative risks. Conclusions. Although it is less frequently feasible when compared to secondary or tertiary cytoreduction, quaternary cytoreduction might be beneficial in selected cases.

Krukenberg tumors are ovarian metastases from different malignancies, most often originating from the gastrointestinal tract. However, in rare cases, other primary tumors, even with extra-abdominal location, might lead to the development of such lesions. Neither the mechanism of development, prognostic significance or therapeutic strategy are not clearly defined so far. It seems that these lesions are more frequently encountered in patients with BRCA1/2 mutations. Most often, Krukenberg tumors are bilateral lesions associated with ascites and with firm areas at the level of the ovarian surface. This paper aims to review existing data regarding Krukenberg tumors from breast cancer.

Introduction: Ankylosing spondylitis is a chronic inflammatory disorder which primarily affects the axial skeleton, the major characteristic of the disease being the early involvement of the sacroiliac joints. The condition manifests by chronic inflammatory back pain and, as the disease progresses, patients will develop extreme impairment of spinal mobility because of spinal fusion. Case presentation: A 66-year-old man, diagnosed with HLA-B27-positive ankylosing spondylitis, permanent atrial fibrillation, ischemic cardiac disease, arterial hypertension, type 2 diabetes mellitus and stage 3A chronic kidney disease, was admitted for cervicalgia radiated to both shoulders and bilateral mechanical gonalgia. His son was also diagnosed with ankylosing spondylitis at the age of 29 years. Regarding the history of ankylosing spondylitis treatment, initially, the patient was prescribed nonsteroidal antiinflammatory drugs (NSAIDs); because of the inadequate response to NSAIDs, biological therapy with an anti-TNF agent was initiated (Infliximab). Fifteen months after the initiation of Infliximab, the patient presented with worsening symptoms; anti-Infliximab antibodies were detected, therefore he was switched to another anti-TNF agent, Adalimumab. Upon current admission, the clinical examination revealed thoracic kyphosis and marked limitation of cervical and lumbar spine mobility. Blood tests revealed mild anemia, inflammatory syndrome and azotate retention. The pelvic X-ray showed grade 3-4 bilateral sacroiliitis. The continuation of treatment with Adalimumab and Sulfasalazine was decided, with close monitoring of the patient. Conclusions: Ankylosing spondylitis is a multisystem inflammatory disorder, whose natural course includes periods of flares and remission. The peculiarity of this case consists in the early development of anti-Infliximab antibodies (secondary non-responder).

Gastric cancer remains one of the most aggressive malignancies which is frequently diagnosed in advanced stages of the disease. Therefore, the long term prognostic is extremely poor especially if surgery with curative intent is no longer feasible. When it comes to the predilection sites of metastatic disease with gastric origin, it seems that liver has a central role. The aim of this paper is to analyse the largest studies which investigated the potential benefit of gastric cancer liver metastases resection.

The aim of this study is to analyze the feasibility and safety of left upper abdominal resections as part of debulking surgery. Case series presentation. Between January 2015 and August 2019, 32 patients were submitted to left upper abdominal resections. Left upper abdominal resections were performed as part of primary cytoreduction in 22 cases, as part of secondary cytoreduction in eight cases, and respectively as part of tertiary cytoreduction in two cases. The complexity of the resection increased from primary to secondary and tertiary cytoreduction; in the meantime, the rates of postoperative complications also increased with the attempt of cytoreduction. Therefore the postoperative morbidity rate was of 27% at the time of primary cytoreduction, 37.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. However, association of left upper abdominal resections leaded to a complete resection rate of 77% at the time of primary cytoreduction, 62.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. Conclusions. Left upper abdominal resections might increase the rates of complete debulking in the setting of advanced stage or relapsed ovarian cancer. However the complexity of procedures and the risk of postoperative complications increase with the number of attempts of debulking.

Uterine neuroendocrine tumors are extremely rare malignancies which are usually diagnosed in advanced stages of the disease and are associated with poor prognostic. Due to their rarity a standard therapeutic strategy as well as a standard diagnostic protocol is still missing, these patients being rather diagnosed and treated by extrapolation of the present guidelines for other types of neuroendocrine tumors. This is a literature review of the most relevant studies conducted on the issue of diagnostic and management of uterine neuroendocrine tumors.

Diabetes mellitus (DM) and heart failure (HF) are often associated and each disease independently increases the risk for the other. It is well recognized that diabetes is a risk factor for mortality among individuals with heart failure. The risk of incident HF among patients with DM increases with older age, obesity, retinopathy, hypertension, coronary artery disease, peripheral arterial disease, nephropathy, longer duration of DM and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) value. The treatment of each pathology in the presence of the other raise difficulties in the clinical practice. First-line treatment of DM in patients with HF should include metformin and SGLT2 inhibitors; conversely, saxagliptin, pioglitazone and rosiglitazone are not recommended in patients with DM and HF.

Ureteral endometriosis is characterized by the development of deep infiltrating islets of endometrial tissue affecting the ureter, the optimal management in such cases being still poorly defined. Once the techniques of laparoscopic surgery improved, this minimally invasive approach has been proposed with encouraging results in treating such cases. When it comes to the types of surgical procedure which are needed in such cases, they are chosen accordingly to the degree, extent and localization of the endometrial tissue. This is a literature review of the largest studies which were conducted on the theme of the laparoscopic management of ureteral endometriosis; the main analyzed parameters refer to the efficacy and safety of the procedure.

Deep infiltrating endometriosis is a debilitating disease which usually affects young women and significantly impacts on the quality of life. Due to the fact that it remains a benign condition which usually affects patients at the reproductive age, an aggressive, radical surgical procedure might be considered as a too mutilating one by certain cases. In consequence, attention was focused on treating these patients in a less invasive manner, procedures like rectal shaving or full thickness local excision being proposed. In the meantime, once the minimally invasive techniques evolved, laparoscopic surgery has been widely proposed in the last decade in order to treat this pathology. The current paper is a literature review of the largest studies which investigated and compared the outcomes after minimally invasive approach for deep infiltrating colorectal endometriosis.