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In this prospective, randomized, double blind control trial we aim to investigate which of the most used analgesic techniques after laparoscopic cholecystectomy is the most efficient.

Total duodenopancreatectomy (TDP), performed exclusively by laparoscopic approach is considered one of the most complex abdominal surgical procedures. TDP with preservation of spleen vessels (operation Kimura) is a more technically-demanding procedure, but is beneficial in selected cases. While some high-volume centers have gained experience in minimally-invasive pancreatectomies, laparoscopic approach remains a recommendation for well selected patients with benign or low-grade malignant tumors and should be performed with caution, by experienced HPB surgeons. In this paper, we present a spleen preserving, splenic vessels spearing, pure laparoscopic TDP on a 40-year-old patient diagnosed with diffuse IPMN performed in our center, illustrating the operative steps.

Desmoid tumors (DT) are rare non-metastatic neoplasms that occur through myofibroblast proliferation in musculoaponeurotic or fascial structures of the body, being commonly diagnosed in young women during pregnancy or in the post-partum period. We present the case of a 38-year-old woman, who recently gave birth, manifesting non-specific abdominal symptoms. Computed tomography indicated the presence of a solitary tumor arising from the intestinal wall or from the mesentery. Surgery confirmed the diagnosis, revealing a tumor that was localized at the level of the jejunal mesentery, having about 7 cm in diameter, in tight contact with the duodenum and the mesenteric vessels. ‘‘En bloc’’ resection of the tumor was performed, together with the involved enteral loops followed by end-to-end anastomosis of the jejunum. Histopathological examination of the surgical specimen sustained the diagnosis of desmoid tumor.

Thymus baicalensis is a medicinal plant recognized as a traditional Mongolian therapeutic and health-promoting food supplement. The aim of the study was to check the suitability of the tested plant for supporting the treatment of certain diseases. The following study is the first one to showcase the versatile scope of characteristics of T. baicalensis, including its volatile oil composition, polyphenolic composition, lipid composition, phenolic and flavonoid contents, antioxidant activity, antimicrobial properties and ingestive allergenicity. Myrcene, at 26.15%, was shown to be the most abundant component of the volatile oil. Compounds known as inherent components of the Thymus genus: thymol and carvacrol made up only about 0.24% of the extracted oil. As much as 10.11 g kg−1 of polyphenol compounds were identified as derivatives of luteolin-7-O-glucuronide. The lipid extract was found to be rich in palmitic acid (31.05%), while unsaturated fatty acids were not reported. Spectrophotometric determination of the phenols and flavonoids indicated 7.541 mg of gallic acid g−1 and 4.345 mg of quercitin g−1, respectively. The free radical scavenging activity was determined by the 2,2-difenylo-1-pikrylohydrazyl method at IC50 = 206.97 µg mL−1. The extracts also had a strong inhibitory effect on M. flavus and P. fluorescenes bacteria, as well as S. cerevisiae yeasts. The Bet v 1 and profilin allergens in T. baicalensis were reported at 175.17 ng g−1 and 1.66 ng g−1, respectively.

With all the technological progress registered so far, hepatocellular carcinoma is still a diagnostic and therapeutic challenge, the optimal management being ensured only by a personalized attitude, offered by a multidisciplinary approach. Ultrasound plays an essential role in the guidelines for this neoplasm, the intraoperative application being mandatory to increase the survival of these patients, when the surgical approach is possible and indicated. This paper highlights the main indications for intraoperative ultrasound in the diagnosis and treatment of hepatocellular carcinoma, along with areas that have developmental potential.

Oral administration of nickel is thought to be responsible for type-IV-mediated mechanism of immune response. Alternative type-I IgE-dependent mechanism is occasionally postulated, given relatively...

We report a case of spinal cord injury following an attempted epidural in a conscious woman for pain management in acute pancreatitis. The epidural needle was inserted at the T11-T12 interspace. On the second attempt, dural puncture occurred. The patient did not complain of pain or discomfort during the procedure. Thirty-two hours after the attempted epidural, the patient was found to have motor deficit on her right lower limb. Magnetic resonance imaging showed a spinal haematoma with direct spinal cord injury. Post-laminectomy neurological recovery was slow but progressive. The possible causes for spinal cord injury and spinal haematoma without pain or paraesthesia during the procedure are discussed.

Nanotechnology and its applications in medicine made us live a new era of healthcare, particularly in oncology. The objective of this paper is to review the contribution of nanotechnology in clinical use of contrast agents for gastrointestinal cancer diagnosis and follow-up and to offer an overview of the impact of nanotechnology in the management of cancer.In this regard, we reviewed the main areas of expertise where nanotechnology has contributed to the improvement of diagnostic methods (CE-US, CE-CT, MRI), along with the therapeutic applications that nanoparticles can have. Last but not least, the article highlights the potential that theragnostic molecules can have in the diagnosis and treatment of neoplasia, including those in an advanced stage.Nanomedicine has the ability to improve the specificity and sensitivity of cancer diagnosis, together with the enhancing of the systemic cytostatic effect by developing nano bioconjugates that have a wider effect, higher tumor selectivity and thus, lower systemic toxicity.Ablative treatment, Cancer, Contrast enhanced imaging, Drug delivery, Nanomedicine.La nanotecnologia e le sue applicazioni in medicina ci hanno fatto vivere una nuova era dell’assistenza sanitaria, in particolare in oncologia. L’obiettivo di questo articolo è esaminare il contributo della nanotecnologia nell’uso clinico di agenti di contrasto per la diagnosi e il follow- up del cancro gastrointestinale e per offrire una panoramica dell’impatto della nanotecnologia nella gestione del cancro. A questo proposito, abbiamo esaminato le principali aree di competenza in cui la nanotecnologia ha contribuito al miglioramento dei metodi diagnostici (CE-US, CECT, MRI), insieme alle applicazioni terapeutiche che le nanoparticelle possono avere. Ultimo ma non meno importante, l’articolo evidenzia il potenziale che le molecole teragnostiche possono avere nella diagnosi e nel trattamento delle neoplasie, comprese quelle in stadio avanzato. RISULTATI DELLO STUDIO: la nanomedicina ha la capacità di migliorare la specificità e la sensibilità della diagnosi del cancro, insieme al potenziamento dell’effetto citostatico sistemico sviluppando nano bi-oconiugati che hanno un effetto più ampio, una maggiore selettività tumorale e quindi una minore tossicità sistemica.

The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options���from surgery to immunotherapy trials���it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.

Background and Aims: The fully-covered, lumen apposing metal stents are designed for one step placement, facilitating the direct endoscopic necrosectomy into the walled-off pancreatic necrosis. However, the prediction of the number of necrosectomy sessions in these patients is not known. This study evaluated the association between the proportion of solid necrotic material inside walled-off necrosis, as assessed during the endosonography placement of a lumen apposing metal stent, and the number of necrosectomies subsequently required. Methods: Patients from three tertiary medical centers with symptomatic walled off pancreatic necrosis (pain, infection, gastric/biliary obstruction) at more than 4 weeks after onset of acute pancreatitis were retrospectively analysed. Proportion of solid necrotic debris was estimated during endosonography procedure of lumen apposing metal stents placement. Necrosectomy was performed when obstruction or inflammation occurred subsequently. Lumen apposing metal stents were removed after clearance of necrotic content. Results: In 46 patients with successful lumen apposing metal stents placement, necrosectomy was performed in 39 patients (72.78%). Performance of 3 or more necrosectomies was significantly associated with more than 50% pancreatic necrosis (p=0.032), but not with walled-off pancreatic necrosis size or location. Necrotic infection during lumen apposing metal stents stenting was associated with hypoalbuminemia, but not with necrosectomy requirement. Clinical success after a median follow-up of 13.37 months was 87%. Conclusions: Walled-off pancreatic necrosis with more than 50% solid necrotic content were associated with more necrosectomy procedures, requiering longer endoscopy time, intravenous sedations, and higher costs.

It has been a long time since tumor ablation was first tested in patients with liver cancer, especially hepatocellular carcinoma. Since than it has become a first line treatment modality for hepatocellular carcinoma. Over the years, the indications of thermal ablation have expanded to colorectal cancer liver metastases and intrahepatic cholangiocarcinoma as well. Together with the new indication for ablation, new ablation devices have been developed as well. Among them microwave ablation shows potential in replacing radiofrequency ablation as the preferred method of thermal ablation in liver cancer. The debate whether radiofrequency or microwave ablation should be the preferred method of treatment in patients with liver cancer remains open. The main purpose of this review is to offer some answers to the question: Microwave ablation in liver tumors: a better tool or simply more power? Various clinical scenarios will be analyzed including small, medium, and intermediate size hepatocellular carcinoma, colorectal cancer liver metastases and intrahepatic cholangiocarcinoma. Furthermore, the advantages, limitations, and technical considerations of MWA treatment will be provided also.

Foreign bodies that are ingested and will not pass spontaneously through the gastrointestinal tract, need to be removed either endoscopically or surgically. Surgery will be required when endoscopy alone fails to retrieve the foreign body. In this study, we aimed to present our experience with an combined minimal invasive approach for the removal of a gastric foreign body and to review the medical literature on the complexities related to its management.We report a successful technique represented by a combined laparoscopic and endoscopic approach for the retrieval of a gastric foreign body. A 51 year old male patient, with a longstanding psychiatric history, who ingested a folded bank card with suicidal purpose, had the foreign body removed using this combined minimal invasive approach.The operating time was 150 minutes, there was no blood loss and no perioperative complications. The patient fulfilled the discharge criteria on the 3rd postoperative day DISCUSSION : The approach for ingested foreign bodies should be considered for each patient independently, depending on the characteristics, location and existence of complications of the retained object.This combined minimal invasive technique is safe and feasible, with excellent results for the retrieval of large, non-malleable gastric foreign bodies.Endoscopy, Foreign body, Laparoscopy, Removal.I corpi estranei che vengono ingeriti e non passano spontaneamente attraverso il tratto gastrointestinale, devono essere rimossi endoscopicamente o chirurgicamente. Sarà necessario un intervento chirurgico quando l’endoscopia da sola non riesce a recuperare il corpo estraneo. In questo studio, presentiamo la nostra esperienza con approccio minimamente invasivo combinato per la rimozione di un corpo estraneo gastrico e per rivedere la letteratura medica sulle complessità legate alla sua gestione. Riportiamo una tecnica di successo rappresentata da un approccio laparoscopico ed endoscopico combinato per il recupero di un corpo estraneo gastrico voluminoso. Un paziente maschio di 51 anni, con una storia psichiatrica di lunga data, che ha ingerito una carta di credito piegata a scopo suicidario, e il corpo estraneo è stato rimosso usando un approccio minimamente invasivo combinato. Il tempo di esecuzione è stato di 150 minuti, non si sono verificate perdite ematiche e complicanze perioperatorie. Il paziente ha soddisfatto i criteri di dimissione al 3° giorno postoperatorio. In conclusione il tipo di approccio da adottare per la rimozione di corpi estranei ingeriti deve essere considerato per ciascun paziente in modo indipendente, a seconda delle caratteristiche, posizione ed esistenza delle complicazioni dell’oggetto trattenuto. Questa tecnica minimamente invasiva combinata da noi adottata è sicura e fattibile, con risultati eccellenti per il recupero di corpi estranei gastrici di grandi dimensioni, non malleabili.

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves the prognosis in selected patients with peritoneal surface malignancies but it is an extensive procedure predisposing to major complications. Among them renal toxicity was reported. Severe renal insufficiency is considered a contraindication for this complex procedure. We present a patient with diabetic nephropathy with renal insufficiency KDOQI 3 and peritoneal metastasis from sigmoid adenocarcinoma with a good clinical outcome after CRS with HIPEC, highlighting the anesthetic precautions considered for this particular clinical case.

Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.

Background. Patients undergoing surgery for gastric cancer may be expected to develop a certain range of postoperative complications. This retrospective cohort study determined if gauging the serum value of total proteins and albumins before and especially after surgery can predict an undesired short term outcome in patients with gastric resections for cancer, as we have not found studies debating the link between low postoperative total proteins or albumins and early postoperative morbidity.Methods. A total of 195 patients with gastric cancer who had been subjected to gastric resection (83 patients) or total gastrectomy (111 patients), were subsequently arranged into study group pairs. In each of these group pairs, one group had a complication, while another was without said complication, or total vs. subtotal gastrectomy, etc. Each of these group pairs were compared between them in order to determine if total serum proteins and/or albumins, before and/or after surgery could predict the onset of certain complications or death. In the end, we performed ROC curves to determine the predictability value of variables for certain complications.Results. preoperative serum albumin can predict an early onset of anastomotic leakage (p=0.02) as it can predict the occurrence of general complications (p=0.018) and surgical wound infections (p=0.029) as well as a higher risk of reoperation for the management of complications (p=0.028). Total serum protein may be tied to a higher surgical stress, like albumin, as it was significantly lower in patients undergoing total gastrectomy as compared to those subjected to subtotal gastrectomy (p=0.0001 total proteins, p=0.0001 albumins). Postoperative low total serum proteins and albumins translate in a risk of early postoperative death (p=0.031 total proteins, p=0.001 albumins).Conclusion. We demonstrated the fact that total serum proteins and serum albumins, checked both before and after surgery, are of great value in helping predict a series of postoperative complications in gastric cancer surgery and that they can also be used as surgical stress markers.

The aim of this study was to determine the impact of patient, tumor and surgery-related parameters on 1-year postoperative mortality in a cohort of patients operated in a single tertiary center.The study included 605 patients diagnosed with colon cancer between January 2013 and December 2015 that underwent radical surgery in a tertiary center. Patient demographics, comorbidities, preoperative biological parameters alongside with tumor and surgery-related factors were prospectively recorded and then analyzed in relation 1-year postoperative mortality.One-year mortality rate in the study group was 10.9%. Independent risk factors in relation to 1-year mortality were advanced TNM stage (OR 3.10, 1.10 - 8.75 95% CI ), emergency surgery (OR 1.91, 1.11 - 3.74 95% CI ), location of the tumor in the ascending colon (OR 2.17, 1.32 - 3.57 95% CI ), multiorgan resections (OR 2.07, 1.15 - 3.74 95% CI), age over 63 years (OR 2.05, 1.16 - 3.62 95% CI) and the history of alcohol consumption (OR 2.058, 1.17 - 3.61 95% CI ).Postoperative complications are still being reported in colon cancer surgery, despite technological progress and constant research in the field. So far, factors that influence postoperative mortality have been mostly studied up to 30 days postoperatively. According to some recent papers, reporting 30-day mortality data can underestimate accurate communication of postoperative adverse events. Thus, 1-year mortality in colon cancer surgery could be a better indicator of the impact on surgery on postoperative period of this patients and factors that influence it should be well known.Surveillance, Colon cancer, 1-year mortality.La gestione dei pazienti con cancro del colon rappresenta ancora oggi una sfida. Numerosi studi hanno evidenziato vari fattori che potrebbero avere un ruolo nell’evoluzione di questi pazienti dopo chirurgia radicale, ma è importante essere consapevoli con sufficiente certezza dei fattori che influenzano la mortalità postoperatoria di questa chirurgia. Però secondo alcuni studi recenti, riportare la mortalità postoperatoria a 30 giorni potrebbe offrire una sottostima del loro impatto sull’effettivo risultato postoperatorio. Su questa premessa il presente studio ha analizzato l’impatto di vari fattori correlati a pazienti, tumori e chirurgia radicale in relazione alla mortalità ad 1 anno in pazienti con tumore del colon, facendo un confronto con i risultati ottenuti dallo stesso gruppo di studio in relazione a mortalità postoperatoria di 30 giorni. Mentre nessuna variabile correlata al paziente ha influenzato la mortalità a 30 giorni, l’età oltre i 63 anni e il consumo di alcol hanno dimostrato di avere un impatto negativo sulla mortalità postoperatoria a 1 anno. I risultati di entrambi gli studi confermano che è fondamentale cercare di evitare interventi chirurgici in emergenza perché caratterizzati da un aumento dei tassi di mortalità alla scadenza di 30 giorni e di 1 anno. La posizione del tumore del colon non influenza la mortalità postoperatoria a 30 giorni, ma i tumori del colon retto tendono ad avere una prognosi peggiore di 1 anno, come i tumori localmente avanzati sottoposti a resezione multiorgano. Complicazioni postoperatorie immediate, come emorragie o complicanze respiratorie condizionano maggiori probabilità di influenzare la mortalità precoce. Vari fattori influenzano ancora la mortalità postoperatoria nei pazienti con cancro del colon, anche se l’evoluzione postoperatoria è favorevole. La conoscenza di questi fattori che potrebbero ulteriormente influenzare l’esito postoperatorio è importante per la sorveglianza postoperatoria e per un’accurata informazione sui rischi esistenti. In particolare la riduzione della mortalità postoperatoria nella chirurgia del cancro del colon può essere ottenuta mediante cessazione del fumo, cercando di evitare interventi chirurgici in urgenza con la prevenzione delle fasi avanzate e complicate attraverso il miglioramento dei programmi di screening, con approccio possibilmente non chirurgico dei casi complicati, nel tentativo di preparare il paziente per un intervento chirurgico in elezione e per stadiare correttamente la situazione, ma anche riconoscendo l’importanza della localizzazione del tumore del colon e della loro gestione in base ai risultati noti.

Aim To present the particularities of the intraorbital foreign bodies from a neurosurgical perspective by summarizing the findings of a case series. Material and methods A retrospective study was conducted including a consecutive series of 30 patients with intraorbital foreign bodies treated between 1999 and 2017. Statistical analysis was performed in order to characterize the factors that influence the location of the foreign bodies and the clinical signs. Results The orbital trauma occurred mostly in working accidents. Multiple intraorbital foreign bodies were found in 23.3% of the patients. Metallic foreign bodies were seen in 66.6%, and 30% had wooden foreign bodies. Nonmetallic foreign bodies were significantly associated with displacement of the eyeball, palpebral oedema and upper lid ptosis. Posterior orbit location was associated with displacement of the eyeball and conjunctival hemorrhage. Intraconal location was associated with mydriasis and conjunctival hemorrhage. The posterior orbit was occupied by foreign bodies in 63% of the patients. The foreign bodies were in the extraconal compartment in 55.55% of the cases. Small foreign bodies tend to be retained in the anterior orbit while large ones tend to be retained in the posterior orbit. Conclusion The diagnosis and management of intraorbital foreign bodies must be tailored according to their type and location and to the clinical aspect of the patient.

As laparoscopic surgery has evolved, open cholecystectomy has been replaced with a new minimally invasive approach which is considered nowadays the gold-standard technique. Laparoscopic cholecystectomy has brought multiple advantages in terms of outcomes; however, the incidence of complex biliary injuries has been noticed. The portojejunostomy was first performed for pediatric patients with biliary atresia, involving the attachment of a Roux-en- Y loop to the porta hepatis in order to restore the bilioenteric continuity. In complex cases, with no options of reconstruction after biliary lesions, this technique has become a salvage procedure in adult surgery.

Colorectal cancer is a major public health issue, being the third most common cancer in men and the second in women. It is one of the leading causes of cancer deaths. Nanomedicine is an emerging field of interest, many of its aspects being linked to cancer research. Chemotherapy has a well-established role in colorectal cancer management, unfortunately being limited by inability to have a selective distribution, by multidrug resistance and adverse effects. Researches carried out in recent years about nanotechnologies aimed, among others, to resolve the issues mentioned above. Targeted and localized delivery of the chemotherapeutic drugs, using nanoparticles, with selective destruction of cancerous cells would minimize the toxicity on healthy tissues. Also, the use of nanomaterials as contrast agent could improve sensitivity and specificity of diagnosis. The purpose of this review is to highlight the recent achievements of cancer research by use of nanomaterials, in the idea of finding the ideal composite, capable to simultaneous diagnostic and treat cancer.

We present the case of a 42-year-old woman diagnosed with a cystic pancreatic lesion, suggestive of a serous cystadenoma of 27/13 mm. The diagnosis was established by the examination of abdominal CT and eco-endoscopy. The patient was referred to the surgery department for treatment. The benign etiology suggested by imaging and the desire to preserve the spleen along with as much of the pancreatic parenchyma, indicated a laparoscopic central pancreatectomy with a anastomosis between the distal pancreatic stump and the stomach. The authors reviewed the national and international publications related to the indications of this minimally invasive surgery.

This study analyzes risk factors implicated in postoperative complications and mortality after anterior resection in rectal cancer.A total number of 378 patients with anterior rectal resection, diagnosed with rectal cancer and admitted at the IIIrd Surgery Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Romania, between 2009 and 2016. The inclusion criteria were anterior rectal resections with curative visa for rectal cancer. The complications we assessed are the following: anastomotic fistula, intra-abdominal infections, postoperative bowel obstruction and wound infection.There was statistical significance regarding male gender, emergency hospitalization, hypoproteinemia and the resumption of intestinal transit. Anterior rectal resection of tumors located on the middle rectum was associated with high rate of anastomotic fistula. Patients with manual suture of anastomosis developed intraabdominal abscess more frequently. In the multivariate analysis, hypoproteinemia and a number of lymph nodes1 remained independently associated with the occurrence of wound infection. The 30-day mortality rate was 4.8% with 18 deaths and morbidity rate 20.6% with 78 cases.Major complications after radical resection for rectal cancer are dependent on multiple variables such as male patients, those admitted in emergency and patients with hypoproteinemia. Location of tumor on middle rectum, manual suture of anastomosis, number of lymph nodes1 were associated with high rate of morbidity. Patients with coronary heart disease and diabetes mellitus didn't had statistical significance, but the rate of morbidity and mortality remains high in this groups.Complications, Radical anterior resection, Rectal cancer, Risk factors.Lo studio analizza i fattori di rischio per complicanze postoperatorie e mortalità dopo resezione anteriore del retto su una casistica di 378 pazienti. Si tratta di pazienti ricoverati nella 3a Clinica Chirurgica dell’Istituto Regionale di Gastroenterologia ed Epatologia “Octavian Fodor” di Romania tra il 2009 e il 2016. Il reclutamento ha riguardato cancri del retto proponibili per la resezione anteriore ad intento curativo. Le complicanze accertate sono state la fistola anastomotica, le infezioni intra-addominali, l’occlusione postoperatoria e le infezioni della ferita. Di significato statistico è risultato il genere maschile, il ricovero d’urgenza, l’ipoprotidemia e la ripresa del transito intestinale. I casi di cancro del medio retto sono risultati con alta incidenza di fistula anastomotica. Ascessi intra-addominali si sono verificati più frequentemente nei casi con sutura anastomotica manuale. Nell’analisi multivariata l’ipoprotidemia ed il numero di linfonodi1 si sono dimostrati associati indipendentemente con l’evenienza di suppurazione della ferita. La mortalità a 30 giorni è stata del 4,8% con 18 decessi, e la morbilità ha inciso per il 20,6% con 78 casi. In conclusion le maggiori complicazioni dopo resezione radicale del cancro rettale dipendono da variabili multiple, come il sesso maschile, i ricoveri d’urgenza, e i soggetti malnutriti. Un’alta incidenza di morbilità si è riscontrata nei tumori del medio retto, nelle sutura eseguite manualmente, in caso di linfonodi positivi superiori all’unità. La coronaropatia ed il diabete non hanno mostrato un significato statisticamente rilevante, ma l’incidenza di morbilità e mortalità rimane alta in questi gruppi.

Obtaining negative microscopic resection margins (R0) in cephalic duodenopancreatectomy (CDP) is the gold standard. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. Regarding R1 resections in CDP (data from the literature show rates between 20-80%), we considered it necessary to perform a study in Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor'' Cluj-Napoca.Here we present the results of a retrospective study carried out between January 2012 - December 2013 in our Institute. This study includes 63 patients with pancreatic head resections for pancreatic cancer. The circumferential soft tissue margin, the pancreatic transection margin, the bile duct and duodenum/stomach margins were analyzed. We investigated the incidence of R1 and its impact on the survival rates after oncologic pancreatic resections using a nonstandardized pathologic routine protocol. R1 status was defined as the distance of the tumor from the resection margin of ≤ 1 mm.Pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 93.65 %. The R1 rate was 36.5 % (23 cases). The circumferential margins were most commonly involved as R1 (91,3%). No statistically significant differences were found between patients with R1 to those with R0 (p ≥ 0.1) regarding 3-year survival.Survival for pancreatic head cancer at 3 years is not influenced by the margins of resection (R1/R0). Microscopic resection margin involvement is not an independent marker of survival.Circumferential margins, Nonstandardized pathologic protocol, Pancreatic ductal adenocarcinoma, Positive margins R1 Survival.Il “gold standard” prognostico della duodenocefalppancreasectomia (CDP) è rappresentato dal raggiungimento di margini di resezione microscopicamente esenti da cellule neoplastiche (R0). La presenza di cellule neoplastiche sulla linea di resezione a livello microscopico (R1) può rendere sfavorevole la prognosi. Per quanto concerne le resezioni R1 nella CDP (ed i dati della letteratura mostrano un’incidenza tra il 20 e 80%) ci hanno fatto considerare necessario uno studio presso il Regional Institute of Gastroenterology and Hepatology ‘’ Prof. Dr. O. Fodor’’ Cluj-Napoca. Vengono qui presentati i risultati di uno studio retrospettivo condotto tra Gennaio 2012 e Dicembre 2013 nel nostro istituto. Lo studio ha riguardato 63 azienti sottoposti a resezione pancreatica per cancro, analizzando i margini circostanti dei tessuti, il margine di transezione pancreatica, i margini del dotto biliare, del duodeno e dello stomaco, alla ricerca dell’incidenza di R1 e il relativo impatto sulla sopravvivenza dopo resezione oncologica del pancreas usando un protocollo anatomopatologico non sytandardizzato. La condizione di R1 è stata definita come la distanza del tumore dal margine di resezione ≤1 mm. L’adenocarcinoma duttale del pancreas (PDAC) è stato diagnosticato nel 93,65% dei casi. L’incidenza di R1 è stata dle 36,5% (23 casi). I margini circostanti erano naggiormente coinvolti come R1 (91,3%). Non è stata riscontrata alcuna differenza statisticamente significativa tra pazienti R1 ed R0 (p ≥ 0.1) riguardo una sopravvivenza di 3 anni. Si conclude che la sopravvivenza a 3 anni per un carcinoma della testa pancreatica non è influenzata dai margini di resezione (R1/R0), e dunque il coinvolgimento microscopico dei margini di resezione non è un marker indipendente riguardo alla sopravvivenza.

Aim To correlate the anatomical variants of the circle of Willis with their effects on the hemodynamic and geometrical parameters responsible for the pathogenesis of neurological diseases. Material and methods The circle of Willis and the proximal segments of the main arteries were dissected and measured on ten formalin-fixed human brains. The anatomical variants were systematized using descriptive statistics. The mathematical models for brain perfusion and wall shear stress were developed by optimally approximating resistance to flow, vascular conductance, and branching. Results Eighty percent of the brains presented asymmetries, especially in the posterior communicating (70%) and anterior cerebral (40%) arteries. The posterior circulation had more variations (65.21%). Nine hypoplastic vessels were found in 7 brains. Atypical origins were observed in eight specimens. According to the mathematical models, which integrated each anatomical change in the global circle of Willis anatomy, the circle of Willis' geometry could represent a risk factor for intracranial aneurysms and atherosclerosis, mostly when hypoplastic arteries are present, due to high resistance to flow and imbalanced bifurcation geometry. Accessory vessels are less associated with cerebrovascular risk. Conclusion We described anatomical variants of both the anterior and posterior circulations and their specific effects on the hemodynamic balance of cerebral blood flow.

Alpha-linolenic, docosahexaenoic and eicosapentaenoic acids were shown to cross-link hydrolyzed gluten in digested flour, thus reducing immunoreactivity of flour and bread. Residual immunoreactivity in cross-linked flour samples was determined with human coeliac immunoglobulin G (IgG) at 35–45% and 10–30%, respectively, for subtilisin and collagenase treatment. Analogous transglutaminase-cross-linked flour samples exhibited residual immunoreactivity at 34 and 15%. Chemical cross-linking reagents – polyethylenimine and diethanolamine – decreased it below 20%. Similar results were obtained when rabbit anti-QQQPP (Gln-Gln-Gln-Pro-Pro) IgG were used as detection antibodies. Flour samples underwent fermentation, thermal processing and simulated digestion. Residual immunoreactivity in bread made of flour cross-linked with fatty acids was determined with human IgG at 10–70% and 3–60%, respectively, for subtilisin and collagenase treatment. At the same time, transglutaminase cross-linking yielded residual immunoreactivity of bread at 10–20%. Rabbit antibodies did not indicate significant differences between samples of collagenase-treated bread, whether cross-linked with transglutaminase or fatty acids. Practical Applications Given the popularity of cereal-based products in our diet, gluten intolerance is a significant issue. The antigenicity of flour proteins can, to a great extent, be neutralized through hydrolysis and cross-linking with polyunsaturated omega-3 fatty acids. Antigenic amino acid structures are bound deep into the complex surface of the cross-linked protein and are rendered unrecognizable to the consumer's immune system. Cross-linked proteins in flour and bread provoke milder allergy symptoms, allowing dietary restrictions to be reduced. These natural reagents could potentially be a valuable tool in efforts to produce safer bakery products. We propose that they could be used in combination with other known cross-linkers to improve the overall antigenic effect of food processing.

Foodborne nickel content was determined in six strains of oat in a year-on-year analysis. Results are depicted by relative standard deviation (RSD) values of 17.94 and 31.41%. Wider range of differential is featured in processed foods, with RSD spanning 10–65%. While most studies are confined to analyses in output data only, in this article we dissect the mechanisms that underlie nickel migration in the progress of industrial processing. After-effects attributed to manufacturing are tracked with graphite furnace atomic absorption spectrometer throughout the production cycle. As it starts with raw harvest, nickel content often exceeds 600 ng/g. Most is discarded when middlings are cleaned into grains and after bran is separated. Although there is little discrepancy between checkpoint stages of flour and bread (), it is the intermediate phases where nickel content fluctuations are most pronounced. Procedure involving numerous backslopping steps favors nickel pool enrichment, while thermal processing was found to entail its reduction. Practical Applications Unintentional nickel supplementation during food processing exerts influence on the dietary properties of produced commodities. This is especially significant taken relatively large number of hypersensitive consumers, whose best interest is to limit daily nickel intake. We examined bread production cycles in their thoroughness and gathered data on ever changing nickel content with an inclusion of sequential intermediate phases that are rarely of analytical interest. These phases give an insight into subtle changes reflected in chemical composition of bakery products. If account is taken of presented knowledge, it will allow more aware manufacturing practice and, in consequence, higher quality and nutritional safety of produced foodstuffs.

Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block.Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement.The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected.OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic cholecystectomy when combined with conventional multimodal analgesia regimen.Managementul durerii după intervenţiile laparoscopice pentru colecistectomie poate constitui o provocare, având în vedere efectele secundare ale tehnicilor standard de analgezie post-operatorie. Recent, blocul planului muşchiului transvers abdominal (TAP block) a fost folosit ca parte a analgeziei multimodale, cu rezultate promiţătoare. Abordul oblic subcostal (OSTAP block) este o variantă a TAP block, care produce analgezie supraombilicală unilaterală. În acest studiu am evaluat eficacitatea OSTAP block cu bupivacaină în intervenţiile de colecistectomie laparoscopică prin comparare cu blocul placebo.Şaizeci de pacienţi ASA I/II programaţi pentru intervenţia de colecistectomie laparoscopică au fost alocaţi aleator într-unul din cele două grupuri: grupul A (OSTAP placebo), la care s-a realizat TAP block prin abord oblic subcostal cu ser fiziologic steril, şi grupul B (OSTAP bupivacaină), la care s-a realizat TAP block prin abord oblic subcostal cu bupivacaină 0,25%. Au fost evaluate consumul de opioid per 24 h, doza de opioid necesară în timpul intervenţiei chirurgicale, doza de opioid necesară şi durata staţionării în unitatea de trezire postanestezică (PACU). Calitatea analgeziei a fost evaluată prin Visual Analog Scale (VAS) timp de 24 h în repaus şi în mişcare.Consumul mediu de opioid intraoperator a arătat o diferenţă semnificativă între cele două grupuri (385 ± 72,52 mg grup A vs 173,67 ± 48,60 mg grup B, p0,001). Consumul de opioid per 24 h a fost semnificativ statistic mai scăzut la grupul B (32 ± 26,05 mg vs 79 ± 16,68 mg, p0,001). Durata staţionării în unitatea de trezire postanestezică a fost semnificativ statistic mai scăzută la grupul B comparativ cu grupul A (20,67 ± 11,27 min vs 41,67 ± 12,41 min, p0,001). Grupul B a avut un scor de durere semnificativ statistic mai scăzut decât grupul A la 0 h, 2 h, 4 h, 6 h, 12 h, 24 h atât în repaus, cât şi în mişcare. Nu am înregistrat semne şi simptome de toxicitate sistemică a anestezicelor locale sau alte complicaţii datorate realizării blocului.Blocul planului muşchiului transvers abdominal prin abord oblic subcostal realizat cu bupivacaină 0,25% combinat cu un regim de analgezie multimodală asigură o analgezie eficientă postoperator timp de 24 h, în intervenţiile de colecistectomie laparoscopică.

Neuroendocrine carcinoma of the gallbladder is an uncommon disease. We present the case of a 45-year-old woman with a mass located in the gallbladder, whose diagnosis was based on contrast-enhanced ultrasound and magnetic resonance imaging. The tumor involved the liver and retroperitoneum, and was histopathologically confirmed by liver biopsy as a neuroendocrine tumor grade 3. The patient received chemotherapy with good response, followed by surgery with cholecystectomy and partial hepatectomy.

The average nickel uptake in the group of students aged 20 to 25 was determined at 227 μg/day. The same study conducted among 9 senior researchers aged 40 to 50 brought a mean nickel uptake of 161 μg/day. Trace amounts of nickel are present in the majority of foodstuffs. Absorbed from digested aliment, its ions are directly responsible for the occurrence of allergic symptoms. Assimilation of nutrients varies with individual susceptibility and overall health condition. However, it also has a lot to do with dietary habits and food characteristics. In this manuscript, we delineated main parameters related to nickel accumulation, such as its uptake, release from foodstuffs and assimilability. Each of them, their scale and proportions potentially affect allergic response from hypersensitive organism. We analyzed several nickel-rich commodities of various characteristics for their nickel level with a particular interest in the metal amounts being released from digested matter and their proportions. Quantitatively profiled samples of chocolate (3–5 μg nickel/g), popular plant products (1–4 μg/g), nuts (1–10 μg/g) and herbal spices (0.3–10.8 μg/g) underwent simulated digestion followed by atomic absorption spectrometry measurements to evaluate nickel release ratio. Groups of samples composed of analogous food matrices showed consistent release rates. As opposed to chocolate and nuts (both average 50% release), less homogenous individual herbal spice samples indicated nickel release between 20% and 90%. The release ratio gives an idea of how much metal allergen is available for assimilation out of the total intake of food-borne nickel. Absorption ratio accounts for the amount that ultimately supplies blood serum. We determined mean nickel absorption rate at 16% relative to the daily uptake. Elimination diets should acknowledge release rates specific to individual nutrients as their criterion in designing aware consumption. Apart from crude quantitative approach, specific biochemical food characteristics should be considered in the context of systemic hypersensitivities related to exogenous nickel uptake.

A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival.Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the tumor and the resection margin.The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of the rectum.Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors.Abdomino-perineal resection, Circumferential resection margins, Local recurrence, Rectal cancer, Overall survival.

Aim: Percutaneous radiofrequency (RFA) and microwave ablation (MWA) are currently the best treatment options forpatients with liver metastases (LM) who cannot undergo a liver resection procedure. Presently, few studies have evaluated theefficacy of tumor ablation in beginner’s hands but none at all in hepatic metastasis. Our aim was to report the initial experiencewith ultrasound as a tool to guide tumor ablation in a low volume center with no experience in tumor ablation.Material and methods: We conducted a retrospective cohort study, on a series of 61 patients who had undergone percutaneous US-guided ablations for 82 LM between 2010 and 2015. Long term outcome predictors were assessed using univariate and multivariate analysis.Results: Complete ablation was achieved in 86.9% of cases (53/61). All MWA sessions (20/20) attained ablation margins >5mm, compared to 79% (49/62) for RFA sessions (p=0.031). Ablation time was significantly shorter for MWA, with a median duration of 10 minutes (range: 6-12) vs. 14 minutes (range: 10-19.5, p=0.003). There was no statistically significant difference in local tumor progression (LTP)-free survival rates between MWA and RFA (p=0.154). On univariate analysis, significant predictors for local recurrence were multiple metastases (p=0.013) and ablation margins

Introduction: Peritoneal carcinomatosis represents an advanced stage of tumor dissemination of abdominal cancers in general and colorectal cancer in particular. The only therapeutic methods currently available for the treatment of this pathology are systemic chemotherapy (palliative character) and cytoreductive surgery (CR) with intraperitoneal chemotherapy. After evaluation of evidence-based medical literature and current guide lines we can state that CR + HIPEC procedure is considered to be the treatment of choice in case of patients with peritoneal carcinomatosis of colorectal, ovarian and mucinous appendicular origin. Material and method: In the present study we prospectively analyzed the immediate postoperative results obtained in the first 50 patients that were treated by our team for peritoneal carcinomatosis of different origin. We described the protocol of selection, the patients characteristics that were included in our CR+HIPEC program and analyzed the complications and death rate. Results: From January 2015 till Dec 2018 we evaluated 98 patients with peritoneal carcinomatosis. From them, 51 received radical CR+HIPEC treatment, 33 were not suitable for surgery because of the exclusion criteria's and 15 had only exploratory laparotomies. In regard with the histopathological diagnosis, 30 patients had ovarian cancer and 19 had colorectal cancer or peritoneal pseudomixoma of appendicular origin. There was no 30 days postoperative mortality. The incidence of significant postoperative complications was 15%. Conclusions: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy is a complex technique accompanied by an acceptable rate of complications and postoperative deaths, the results being optimized by a standardized perioperative management and patient selection. The initial results obtained by our team emphasize the feasibility of this procedure, with immediate good results, as a result of a standardization protocol of patient selection and perioperative care.

The immune response to gliadins extracted from 35 wheat cultivars, strains and species was investigated. With the use of a non-competitive ELISA method, we sought to examine if immune reaction occurs between wheat proteins and sera from patients sensitive to gluten, as well as between wheat proteins and rabbit antibodies against pentapeptide QQQPP. Results showed considerable differences among cultivars. Breeding strains STH 183, STH 650, STH 2804, Triticum aethiopicum and Triticum durum showed the lowest immunoreactivity of the native samples. Seventeen of selected wheat flour samples were subjected to enzymatic modifications by subtilisin and transglutaminase. Samples modified by subtilisin exhibited the most extensive change in the level of immunoreactivity of gliadin proteins. The lowest immunoreactivity was reported for the breeding strains STH 1596, STH 2804 and cultivars Tonacja and Zyta. One wheat cultivar (Tonacja), known for its high native gliadin immunoreactivity, was shown to be very...

Leszczynska J., Diowksz A., Łącka A., Wolska K., Bartos A. (2012): Evaluation of immunoreactivity of wheat bread made from fermented wheat flour. Czech J. Food Sci., 30: 336–342. Combined culture of lactic acid bacteria (Lactobacillus brevis, L. plantarum i L. sanfranciscencis) and baker’s yeasts was used in order to reduce immunoreactivity of gluten from wheat. Flour and dough samples were analysed in terms of lactic acid fermentation and thermal processing. Their immunoreactivity was determined with ELISA method using both anti-gliadin antibodies from patients suffering from coeliac disease and rabbit anti-QQQPP peptide (main epitope of flour allergen) antibodies. Also, immunoreactivity was measured in the final products after simulated digestion. The obtained total effectiveness of the fermentation and digestion processes amounted to less than 30% relative to immunoreactivity of human anti-gliadin antibodies and less than 10% relative to immunoreactivity of anti-QQQPP peptide antibodies as compared to the baking made with non-fermented flour.

Background: POSSUM and P-POSSUM are risk scores recommended by ERAS Society for the preoperative evaluation of patients undergoing major surgery. Methods: This study includes 113 consecutive pancreaticoduodenectomy performed in a single centre between July 2013-December 2015. Patients data were prospectively collected using Excel 2009 and retrospectively analysed with R v3.2.4 software. Biological status score, surgical severity score and risk scores for complications and death were calculated using: http://www.riskprediction. org.uk/index-pp.php. Results: Morbidity rate was 61,95%: 19,47% general complications, 14,16% wound infections and 28,32% PD specific complications (11,5% POPF; 8,85% DGE and 6,19% PPH). Comparing the observed and estimated morbidity and mortality, we obtained statistical significant results (p=0,05 and p=0,03, respectivelly). When we considered only specific PD complications and subsequent mortality, there was no longer significant difference between observed and estimated values (p=0,8 and p=0,86).The under ROC curve aria was 0,61 for morbidity and 0,64 for specific PD morbidity, respectively 0,61 for mortality and 0,68 for specific PD complications related mortality. CONCLUSION P-POSSUM represents a useful tool for appreciating the complication and death risk after PD, but better results could be obtain by considering also specific PD risk factors.