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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.

Background and Aims: Laparoscopic radio-frequency ablation (L-RFA) for hepatocellular carcinoma (HCC) is used for unresectable tumors, with difficult location, unfitted for a percutaneous ablation technique. L-RFA has a high incidence of local recurrence. Even if intraoperative-ultrasound is standardized for staging and RFA probe guidance, the role of laparoscopic contrast-enhanced ultrasound (L-CEUS) for the real time monitoring of L-RFA efficacy has not been previously reported. We evaluated in a pilot observational study the efficacy of L-CEUS to assess the necrotic post-ablative area in difficult to treat HCC. Methods: Eight consecutive patients diagnosed with HCC (peripherally located) on liver cirrhosis were referred for L-RFA between May 2016 and December 2018. For L-RFA a SturBurst XL (AngioDinamics®) internally cooled electrode was used, being placed under ultrasound guidance. L-CEUS was used to assess the necrotic post-ablative area. The median follow up period was 18 months. Results: L-CEUS real time monitoring of the L-RFA efficacy indicated residual neoplastic tissue in 4 cases (50%). The procedure was repeated by reinserting the needle in the suspected areas indicated by L-CEUS. Complete tumor ablation was achieved in all treated patients. After a median follow-up of 18 months no recurrence of HCC was observed in 7 patients (87.5%). Conclusions: L-CEUS was a reliable procedure for the immediate assessment of L-RFA efficacy; half of the ablated HCC nodules required a second ablation session. This approach might decrease the local recurrences, but its role must be further investigated in larger cohorts.

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.

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.

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.

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.

Recent research suggests that nanotechnologies may lead to the development of novel cancer treatment. Gold nanoparticles with their unique physical and chemical properties hold great hopes for the development of thermal-based therapies against human malignancies. This review will focus on various strategies that have been developed to use gold nanoparticles as photothermal agents against human cancers.

Severe infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) and other bacteria are responsible for millions of deaths each year. One of the main objectives of future antibiotic strategies is to develop new anti-infective agents, which would be highly effective and drug-resistant (antimicrobial resistance being currently exhibited by MRSA), using specific antibodies conjugated to thermally active nanomaterials such as NIR-responsive photothermal contrast agents. Multi-walled carbon nanotubes (MWCNTs) covalently functionalized with immunoglobulin G (IgG, an antagonist of Staphylococcal protein A-SpA, which is a MRSA membrane associated protein) were selectively delivered (at various concentrations and incubation times) into MRSA bacteria. Following treatment, cultures were irradiated using an 808 nm 2 w laser diode. The post irradiation death rate ranged from 39.6% (for 1 mg/L) to 79.2% (for 50 mg/L) at 60 seconds (p < 0.001), while at 30 minutes, the death rate increased from 45.2% (1 mg/L) to 85.72% (50 mg/L), p < 0.001. Irradiated MRSAs treated with MWCNTs alone (control) for 60 seconds and 30 minutes, at concentrations ranging from 1 mg/L to 50 mg/L, resulted in significantly lower death rates (7.1-34.1% for 60 seconds, 11.7-48.8% for 30 minutes). Using IgG molecules bound to MWCNTs, followed by laser irradiation, we obtained a very efficacious nanoshell-mediated laser therapy of individual MRSA agents providing highly localized killing effects for IgG-MWCNTs targeted bacteria.

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.

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.

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.

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.

Pancreatic cancer (PC) is one of the most lethal solid tumor in humans, with an overall 5-year survival rate of less than 5%. Thermally active carbon nanotubes have already brought to light promising results in PC research and treatment. We report here the construct of a nano-biosystem based on multi-walled carbon nanotubes and polyethylene glycol (PEG) molecules validated through AFM, UV-Vis and DLS. We next studied the photothermal effect of these PEG-ylated multi-walled carbon nanotubes (5, 10 and 50 μg/mL, respectively) on pancreatic cancer cells (PANC-1) and further analyzed the molecular and cellular events involved in cell death occurrence. Using cell proliferation, apoptosis, membrane polarization and oxidative stress assays for ELISA, fluorescence microscopy and flow cytometry we show here that hyperthermia following MWCNTs-PEG laser mediated treatment (808 nm, 2W) leads to mitochondrial membrane depolarization that activates the flux of free radicals within the cell and the oxidative state mediate cellular damage in PC cells via apoptotic pathway. Our results are of decisive importance especially in regard with the development of novel nano-biosystems capable to target mitochondria and to synergically act both as cytotoxic drug as well as thermally active agents in order to overcome one of the most common problem met in oncology, that of intrinsic resistance to chemotherapeutics.

Hydatid disease is a severe zoonosis, exerting a high economic and social impact through its numerous complications, leading to disabilities, even death. Because of technical developments, especially the increasing experience of surgeons, laparoscopic surgery has been extended so that it can be successfully applied to abdominal hydatid cysts. We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. The abdominal ultrasonography and computed tomography (CT) showed 2 cyst-like tumors, with hydatid features: one affecting the eighth liver segment and the other located at the upper pole of the spleen. We performed the surgical intervention using a laparoscopic approach, with an uneventful postoperative follow-up and the patient was discharged home on postoperative day 4. The postoperative images at 6 and 12 months showed a decrease in size of the remnant cystic cavities.

Background Selection of the most appropriate treatment to obtain the lowest morbidity, mortality, and recurrence rates is mandatory for hydatid disease of the liver. This study evaluated the results of laparoscopic treatment (compared with the open approach) in the context of a 10-year single-institution experience. Methods Between January 1998 and January 2008, 333 patients with hydatid disease of the liver underwent surgery in the authors’ department. Only the following aspects were considered as selection criteria for laparoscopic surgery: liver cyst not located in segment 1 or 7, with corticalization on the surface and no evidence of intrabiliary rupture. Of 62 patients who underwent laparoscopic treatment, 3 required conversion to open surgery. The remaining 59 patients (group 1) were analyzed. During the same period, 271 patients with hepatic hydatid disease underwent conventional surgery, but only 172 records were compatible with the criteria for the laparoscopic approach and the respective patients were retrospectively reviewed (group 2). Results Conversion to open surgery occurred in three cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2–18 cm) in group 2 (p = 0.699). The mean operative time was 72 min (range, 45–140 min) in group 1 and 65 min (range, 35–120 min) in group 2 (p

Single-walled carbon nanotubes (SWCNTs) were covalently linked to epidermal growth factor (EGF) proteins through an esterification process that was found to be responsible for the docking of SWCNTs on the human pancreatic cancer cells (PANC-1) surface, thus providing a mechanism for the enhanced delivery and internalization of the nanotubes. Micro Raman spectroscopy and enzyme-linked immunosorbent assay were used to evaluate the delivery process and kinetics of the SWCNTs. In vitro studies indicated that the delivery kinetics of SWCNT–EGF conjugates, at a concentration of 85 µg ml−1, to the PANC-1 cell surfaces was significant in the first 30 min of incubation, but reached a plateau with time in accordance with the establishment of equilibrium between the association and the dissociation of EGF with the cell receptors. SWCNT–EGF conjugates could act as strong thermal ablation agents and could induce higher percentages of cellular death compared with the nontargeted SWCNTs alone. Copyright © 2011 John Wiley & Sons, Ltd.

We report the photo-thermal properties of single and double wall carbon nanotubes (CNT) dispersed in various solvents with different concentrations when exposed to near infrared nm laser irradiations. All these studies were correlated to the dispersivity of CNT in various solvents. The observed temperature increase of the various nanotube solutions was found to be determined by the concentration of the optically active nanotubes, as determined from their Raman scattering spectra, which are resonant in the spectral range of the laser excitation. Such findings could significantly improve the understanding of the optically active CNT species, their overall laser induced-heating levels, and thus reducing the amount of the CNT required for bio-medical photothermal applications to limit the possible undesired cytotoxic effects that occur at high nanotube concentrations. Our studies open up the possibility of using selective species of CNT as effective low-toxic photo thermal agents for cancer targeting and ablation.

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.

BACKGROUND. At the current time, the belief that total gastrectomy (TG) offers a better survival benefit compared with distal gastrectomy (DG) in distal gastric cancer still persists among many surgeons. The aim of the study was to determine whether TG in patients with distal stomach cancer offers a benefit in long term survival compared with DG. METHODS. Data on 180 consecutive patients with adenocarcinoma of the distal stomach that underwent surgery during the period 2000-2003 were analyzed. Distal gastrectomy was performed on 91 patients (50.5%), and 89 patients (49.5%) underwent TG. RESULTS. The postoperative morbidity (anastomotic leakage, intraperitoneal hemorrhage and pulmonary complications) was significantly higher in the TG group than in the DG group. The TG group had a significantly higher rate of 30-day postoperative mortality than DG group, and a longer mean postoperative hospital stay. The 5-year survival rate was significantly higher for the DG group than for the TG group. The number of lymph node metastases and TNM stages are significant predictors of poor survival. CONCLUSIONS. Compared with patients undergoing TG, a better long-term survival time, lower postoperative morbidity and mortality rates and a lower hospitalization stay was obtained in patients that underwent DG for distal gastric cancer. This observation justifies the use of this procedure for the surgical therapy of the cancer of distal stomach.

The obstruction of the main bile duct by a foreign body, followed by lithogenesis at that level, is rarely encountered in the literature especially when the foreign body is a plastic biliary stent. We have not found referrals concerning the stone formation as a complication at the level of a biliary stent.A 59-year-old female patient was referred with abdominal pain and jaundice. The patient had had a biliary prosthesis inserted 42 months earlier for treatment of biliary stenosis and fistula, complications that occurred after a laparoscopic cholecystectomy. Imaging investigations evidenced the presence of obstructive jaundice and the biliary stent with gall stones adherent on its surface. After the failure of an endoscopic extraction attempt, surgical intervention ensured the removal of the stent and the gallstones formed on its surface.The particularity of the case consists of the rarity of such a complication after biliary stenting. At the same time, it emphasizes the need for postoperative follow-up, in order to avoid this kind of complication, potentially fatal.

Evidence on the benefits of minimally invasive approach over traditional open procedure in gastrointestinal surgery is continuing to accumulate. This is also the case for esophageal surgery.Although laparoscopic esophageal surgery was initially reserved for benign pathology, the technical development, increasing experience with laparoscopic and thoracoscopic techniques and the theoretical advantages of minimally invasive surgery have widened the scope of minimally invasive approach to esophageal cancer. The surgical treatment of esophageal cancer often requires extensive procedures and is therefore, considered one of the most challenging and invasive procedure of gastrointestinal surgery. While transhiatal and transthoracic esophagectomy are common approaches for esophageal resection, data regarding the combined thoracoscopic and laparoscopic approach to esophagectomy are limited. The minimally invasive technique of esophagectomy to be described consists of three phases: thoracoscopic esophageal mobilization and mediastinal lymphadenectomy followed by laparoscopic gastric mobilization, abdominal lymphadenectomy and gastric conduit formation and finally retrieval of the resection specimen followed by an esophagogastric anastomosis via a left cervical incision.

During the last decade, due to advances in functionalization chemistry, novel nanobiomaterials with applications in tissue engineering and regenerative medicine have been developed. These novel materials with their unique physical and chemical properties are bioactive hierarchical structures that hold great promise for future development of human tissues. Thus, various nanomaterials are currently being intensively explored in the directed differentiation of stem cells, the design of novel bioactive scaffolds, and new research avenues towards tissue regeneration. This paper illustrates the latest achievements in the applications of nanotechnology in tissue engineering in the field of regenerative medicine.