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The Covid-19 pandemic has had a massive impact on global health, social and economic well-being worldwide. In addition to the direct effects of the disease on patients infected with the virus, this pandemic has severely affected the activity of surgical clinics around the world. One of the significant issues was an important decrease in the number of surgeries performed even in countries with highly performant medical systems. This study aimed to analyze the effects of the pandemic on the 1st General Surgery Clinic in Timisoara County Hospital, compared to 2018–2019. In order to conduct this study, data regarding the activity of the clinic in the pandemic period and 2018–2019 was collected and analyzed from a statistical point of view, considering a p

Gastro-intestinal stromal tumors (GIST) represent a type of mesenchymal tumors, located in the digestive tract wall, with the possibility of alternate locations such as the caul or the mesentery. The relapse prognosis is closely corelated with the dimensions of the tumor, the rate at which tumor cells divide, the cellularity of the tumor and the nuclear pleomorphism. The definitive treatment for these types of tumors is surgical resection, associated with tyrosine- kinase inhibitors.The largest gastro-intestinal stromal tumor ever recorded in medical literature measured 42/31/23 cm and weighed in at 18.5 kg. The following case presentation is of a patient aged 65 at his first admission, who received tyrosine-kinase inhibitors of different generations, associated with multiple surgical interventions for tumor cytoreduction. The case presented, according to specialty literature, is the second one as far as volume and weight of the tumor go, the tumor invading the peritoneal cavity and weighing in at approximatively 15 kg. KEY WORDS: Gist, Second largest tumor, Tyrosine-kinase inhibitors, Nuclear pleomorphism.

This study presents the impact of the Covid-19 pandemic on elective surgical treatment of patients diagnosed with colon cancer, in a University Clinic of Surgery.The data from patients who underwent an elective surgery procedure for colon cancer during the pandemic period (26.02.2020-01.10.2021) was analyzed. This period was compared with the same interval for the years 2016-2017 and 2018-2019.There was a significant decrease in the number of patients that underwent an elective surgery for colon cancer during the pandemic. The Covid-19 generated pandemic has influenced the number of days from diagnosis to treatment, preoperative and postoperative hospitalization. There was an increase in the number of patients with severe symptoms, with complete or incomplete ileus. The number of lymphatic nodes harvested increased during the last period of study, being correlated with the advanced cancer stage.The Covid-19 pandemic had an influence on the management of the patients with colon cancer undergoing an elective surgery procedure. Firstly, their number decreased compared to the other periods, and they presented more severe symptoms. The duration of the surgical act was extended, but the postoperative stay was shortened.Colon cancer, Covid-19 Pandemic, Duration of surgery, Elective surgery.La pandemia Covid-19 ha influenzato la gestione e il trattamento in chirurgia elettiva dei pazienti con cancro al colon. Questo periodo ha generato un decremento del numero dei pazienti sottoposti a trattamento chirurgico e, al tempo stesso, un incremento degli stessi con sintomatologia più severa. Anche la durata stessa dell’atto chirurgico ha sofferto, il numero di giorni dalla diagnosi al trattamento, dal ricovero all’operazione, la degenza postoperatoria ne hanno risentito. Il cancro al terzo stadio è stato il più comune durante la pandemia e si è assistiti ad un importante incremento dell’uso delle anastomosi meccaniche. Ci si aspetta, in futuro, che il numero dei pazienti con cancro al colon aumenterà, per il semplice fatto che essi non sono stati diagnosticati durante la pandemia a causa delle restrizioni imposte dalle autorità e della loro paura e riluttanza a venire in contatto con presidi ospedalieri per evitare il contagio con il virus SARS-CoV-2.

Chronic venous disease (CVD) is a frequently encountered disease that progresses with age. Although the principal method of evaluation and diagnosis is Doppler ultrasound, routine laboratory tests may be an easier and more accessible way to evaluate CVD progression. The present retrospective study evaluated the laboratory results of 256 patients diagnosed with CVD. According to the Clinical, Etiological, Anatomical and Pathophysiological classification, depending on the CVD stage, patients were stratified into three groups: Group 1 (C2-C3; mild disease), Group 2 (C4; moderate to severe disease) and Group 3 (C5-C6; severe disease). The considered parameters were age, red blood cell count (RBC), white blood cell count (WBC) and platelet count (PLT), percentage of neutrophils and lymphocytes, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, prothrombin time (in percentages and seconds), internal normalized ratio, activated partial thromboplastin time, creatine kinase (CK), CK myocardial band, alanine transaminase, aspartate transaminase, total bilirubin and urea. No significant differences among the groups were noted in RBC, WBC, PLT and coagulation factors; on the other hand, inflammatory markers exhibited differences among the groups. Several differences were observed in hepatic, metabolic and muscle tissue markers. Intraluminal thrombus formation in the case of varicose veins (thrombophlebitis) may be due to conditions of turbulent flow, stasis and endothelial inflammation, rather than hypercoagulability. The results of the present study confirmed the implication of inflammatory factors in pathophysiological modifications, including thickening of venous walls and valvular modification, as well as the appearance of intraluminal thrombi and trophic lesions. NLR, ESR, CRP and fibrinogen were increased with CVD progression and may be considered useful markers in evaluating CVD progression. Simple blood tests may provide phlebologists with additional insight for the management of those patients.

The aim of this study is to analyze the impact of the COVID-19 pandemic on the emergency treatment of patients with colorectal cancer in a university surgery clinic. Data from patients undergoing emergency surgery during the pandemic period (2020–2021) was taken into consideration and the results were analyzed and compared with the periods 2016–2017 and 2018–2019. A significant decrease in the number of patients undergoing emergency surgery was reported (p = 0.028). The proportion of patients who presented more severe symptoms at the hospital was significantly higher (p = 0.007). There was an increase in the average duration of surgical interventions compared to pre-pandemic periods (p = 0.021). An increase in the percentage of stomas performed during the pandemic was reported. The average duration of postoperative hospitalization was shorter during the pandemic. A postoperative mortality of 25.7% was highlighted. Conclusions: The pandemic generated by COVID-19 had significant consequences on the emergency treatment of patients with colon cancer. A smaller number of patients showed up at the hospital, and with more severe symptoms. In order to reduce the risk of infection with SARS-CoV-2 virus, the postoperative hospitalization period was shortened and a higher number of protective stomas were performed.

Objectives The study evaluates the potential morphological changes that may occur in the venous wall in the case of the patients with chronic venous disease which associates treatment with statins for at least 2 years. Methods Operated patients with chronic venous disease in the CEAP C2-C3 stage were included in the study. 215 venous fragments, collected from 50 patients within the study group and 179 venous fragments collected from 52 patients within the control group were microscopically analysed, evaluating a series of morpho-anatomical parameters. Results In the study group, it was found that, venous reflux predominantly affects small veins, and also, a significant increase in collagen deposits in the adventitia and media tunics, proportional to the thickening of the venous wall. Conclusion Our results indicate possible effects of statins upon the venous morphology. Further studies are needed to determine the impact of these results on daily practice.

Objective: The presentation of cryostripping as an alternative procedure useful in venous insufficiency treatment. Methods: This retrospective study presents the results of 1087 operated patients, including follow-ups. Cryostripping was practised in all mentioned cases. Patient follow-up was performed at one week, one month, and six months postoperatively by clinical examination, Doppler ultrasonography, CIVIQ-20 and r-VCSS questionnaires. Outcomes, complications, surgery and hospitalisation period, and benefits of the method were analysed. Results: Generally, good functional and aesthetic outcomes defined by clinical symptom remission, absence of insufficient veins on Doppler ultrasonography, QoL and r-VCSS improvement (p < 0.001) were obtained. Complications included bruising ⌀ < 2 cm (32.38%), haematoma (8.92%), saphenous nerve injury (3.49%), deep vein thrombosis (0.18%). Recurrence was noted in 2.94% cases. Mean duration of procedure was 42 ± 12.5 min, mean duration of hospitalisation was 1.05 ± 0.36 days. Compared to high ligation and conventional stripping, the postoperative complications were reduced; compared to other minimally invasive procedures, the costs were reduced. Conclusions: Cryostripping seems to combine the radicality and efficacy of the stripping technique with the cosmetic advantage of the endothermal procedures, being an effective therapeutic method perfectly adapted to the economic conditions of middle-income countries health system. It is also suitable as day-case surgery.

Obesity is an important preventable risk factor for morbidity and mortality from cardiometabolic disease. Oxidative stress (including in visceral adipose tissue) and chronic low-grade inflammation are the major underlying pathomechanisms. Monoamine oxidase (MAO) has recently emerged as an important source of cardiovascular oxidative stress. The present study was conducted to evaluate the role of MAO as contributor to reactive oxygen species (ROS) production in white adipose tissue and vessels harvested from patients undergoing elective abdominal surgery. To this aim, visceral adipose tissue and mesenteric artery branches were isolated from obese patients with chronic inflammation and used for organ bath, ROS production, quantitative real-time PCR, and immunohistology studies. The human visceral adipose tissue and mesenteric artery branches contain mainly the MAO-A isoform, as shown by the quantitative real-time PCR and immunohistology experiments. A significant upregulation of MAO-A, the impairment in vascular reactivity, and increase in ROS production were found in obese vs. non-obese patients. Incubation of the adipose tissue samples and vascular rings with the MAO-A inhibitor (clorgyline, 30 min) improved vascular reactivity and decreased ROS generation. In conclusion, MAO-A is the predominant isoform in human abdominal adipose and vascular tissues, is overexpressed in the setting of inflammation, and contributes to the endothelial dysfunction.

BackgroundThe purpose of the guideline was to achieve consensus in the care and treatment of patients with chronic venous disease, based on current evidence.MethodA systematic literature search was performed in PubMed, Embase, Cinahl, and the Cochrane library up until 1 February 2019. Additional relevant literature were added through checking of references. Level of evidence was graded through the GRADE scale and recommendations were concluded.ResultsFor the treatment of great and small saphenous vein reflux, endovenous ablation with laser or radiofrequency was recommended in preference to surgery or foam sclerotherapy. If tributaries are to be treated it should be done in the same procedure. Treatment with mecanicochemical ablation and glue can be used but we still need long term follow up results.ConclusionFor the treatment of truncal varicosities, endovenous ablation with laser or radiofrequency combined with phlebectomies is recommended before surgery or foam.

(1) Aim of the study: Our study aims to analyze the influence of biological parameters such as hemoglobin, albumin, total protein, on the management and duration of treatment of colon cancer patients who have undergone elective surgery. (2) Material and methods: Data of 147 patients from the Surgery Clinic 1 of the County Clinical Hospital of Timisoara who underwent an elective surgery for colon cancer treatment were statistically analyzed using statistical tests such as Anova or Chi square with a p < 0.05 considered to be statistically significant. (3) Results: Differences between preoperative and postoperative parameters were correlated with the duration of surgery (hemoglobin, p = 0.014). The average length of hospital stay was correlated with the difference between the preoperative and postoperative level of hemoglobin (p = 0.043). There was a direct correlation between the length of postoperative hospital stay and the difference between the plasmatic levels of albumin (p = 0.033). There were differences in the average Charlson index value of patients who required albumin, with no statistical significance. (4) Conclusions: The difference between preoperative and postoperative levels of biological parameters (hemoglobin, albumin, total protein) has an influence on the management of patients with colon cancer undergoing elective surgery, affecting the number of days the patients spend in the hospital after the surgical procedure, as well as the total number of days spent in the hospital (from day one to discharge). The greater the variation of those differences, the longer recovery period needed, showing that an early correction of those parameters can lead to a shorter hospital stay, a faster postoperative recovery and a shorter postoperative hospital stay.

The influence of excipients on the stability of sodium levothyroxine pentahydrate (LTSS) under ambient conditions and thermal stress was evaluated. Since LTSS is a synthetic hormone with a narrow therapeutic index, the interactions of LTSS with excipients can lead to a drastic diminution of therapeutic activity. Ten commonly used pharmaceutical excipients with different roles in solid formulations were chosen as components for binary mixtures containing LTSS, namely, starch, anhydrous lactose, D-mannitol, D-sorbitol, gelatin, calcium lactate pentahydrate, magnesium stearate, methyl 2-hydroxyethyl cellulose (Tylose), colloidal SiO2 (Aerosil) and talc. As investigational tools, universal attenuated total reflectance- Fourier transform infrared spectroscopy UATR-FTIR spectroscopy and thermal analysis were chosen and used as follows: UATR-FTIR spectra were drawn up for samples kept under ambient conditions, while thermoanalytical tools (TG/DTG/HF data) were chosen to evaluate the inducing of interactions during thermal stress. The corroboration of instrumental results led to the conclusion that LTSS is incompatible with lactose, mannitol and sorbitol, and these excipients should not be considered in the development of new generic solid formulations.

In this paper, we present the spectroscopic description (by the means of UATR-FTIR spectroscopy) for four naturally occurring bile acids, namely lithocholic acid (LC), taurocholic acid sodium salt hydrate (TC), taurodeoxycholic acid sodium salt hydrate (TDC) and chenodeoxycholic acid (CDC), as well as their thermal behaviour in dynamic oxidative atmosphere, by TG/DTG/HF means. It was shown that all samples have a good thermal stability, favourized by the presence of cholan-24-oic structural moiety in all samples, as well as the solid-state structure (intermolecular H-bondings for the carboxylic acids CDC and LC and saline structures for TDC and TC, respectively). These data are simple, but of great interest in identifying the presence of these compounds by fast, reproducible and precise instrumental techniques in complex mixtures, such as biliary stones.

Obesity is an age-independent, lifestyle-triggered, pandemic disease associated with both endothelial and visceral adipose tissue (VAT) dysfunction leading to cardiometabolic complications mediated via increased oxidative stress and persistent chronic inflammation. The purpose of the present study was to assess the oxidative stress in VAT and vascular samples and the effect of in vitro administration of vitamin D. VAT and mesenteric artery branches were harvested during abdominal surgery performed on patients referred for general surgery (n = 30) that were randomized into two subgroups: nonobese and obese. Serum levels of C-reactive protein (CRP) and vitamin D were measured. Tissue samples were treated or not with the active form of vitamin D: 1,25(OH)2D3 (100 nmol/L, 12 h). The main findings are that in obese patients, (i) a low vitamin D status was associated with increased inflammatory markers and reactive oxygen species generation in VAT and vascular samples and (ii) in vitro incubation with vitamin D alleviated oxidative stress in VAT and vascular preparations and also improved the vascular function. We report here that the serum level of vitamin D is inversely correlated with the magnitude of oxidative stress in the adipose tissue. Ex vivo treatment with active vitamin D mitigated obesity-related oxidative stress.

Monoamine oxidases (MAO) with 2 isoforms, A and B, located at the outer mitochondrial membrane are flavoenzyme membranes with a major role in the metabolism of monoaminergic neurotransmitters and biogenic amines in the central nervous system and peripheral tissues, respectively. In the process of oxidative deamination, aldehydes, hydrogen peroxide, and ammonia are constantly generated as potential deleterious by-products. While being systematically studied for decades as sources of reactive oxygen species in brain diseases, compelling evidence nowadays supports the role of MAO-related oxidative stress in cardiovascular and metabolic pathologies. Indeed, oxidative stress and chronic inflammation are the most common pathomechanisms of the main noncommunicable diseases of our century. MAO inhibition with the new generation of reversible and selective drugs has recently emerged as a pharmacological strategy aimed at mitigating both processes. The aim of this minireview is to summarize available information regarding the contribution of MAO to the vascular oxidative stress and endothelial dysfunction in hypertension, metabolic disorders, and chronic kidney disease, all conditions associated with increased inflammatory burden.

(1) Background: Infection with Echinococcus granulosus is the cause of hydatid cysts located frequently in the liver and lungs, but also in the kidneys, bones, spleen, brain and muscles. Cystic echinococcosis is sometimes complicated to treat, requiring radical surgery and prolonged medication. The hydatid cyst in the retroperitoneal space is frequently asymptomatic, unless it grows and produces symptoms caused by high intracystic pressure, secondary infection, wall breaking and allergy. (2) Case Report: We present the case of a 47-year old male patient, admitted for a giant bilobed retroperitoneal hydatid cyst. Following diagnosis, the patient was operated on using an anterior midline abdominal approach. The cyst was inactivated, the contents were evacuated and the cavity was drained and cleaned by opening the cyst in the middle area and at its lower pole, respectively. Subsequently, the cyst required re-installation of the drain. The evolution of the case was finally favorable but confirmed that the postoperative evolution of large hydatid cysts can be unexpected and even followed by complications. (3) Conclusions: For the presented case, the classic surgical method was the appropriate choice, considering the large size of the hydatid cyst. Bilobed cysts and those with calcified walls may cause problems with the spontaneous closing of the remaining cavity. For complicated cysts, the treatment is radical or conservative surgery, while for uncomplicated cysts, minimally invasive treatment is an appropriate choice.

The active form of vitamin D, 1,25-dihydroxycholecalciferol (1,25(OH)2D3), was reported to improve vascular function in patients with diabetes, yet the underlying mechanisms remain to be fully elucidated. Monoamine oxidase (MAO), a mitochondrial enzyme, with two isoforms (A and B) that generates hydrogen peroxide (H2O2) as by-product, has been recently reported to contribute to the pathogenesis of endothelial dysfunction in diabetes. The present study assessed the interaction between vitamin D and MAO in the vascular wall in the setting of type 1 experimental diabetes. To this aim, diabetes was induced in male Wistar rats via a single injection of streptozotocin (STZ, 50 mg/kg, IP) and 1 month later thoracic aortas were harvested and used for organ bath studies and H2O2 measurements. MAO expression was assessed by immunohistochemistry and RT-PCR. Endothelial function was evaluated in isolated aortic rings in the absence vs. presence of 1,25(OH)2D3 (100 nM, 24 h incubation). In diabetic animals, we found a significant reduction in the endothelial-dependent relaxation to acetylcholine and an increased expression of the MAO-A isoform, respectively. Vitamin D significantly improved vascular function, mitigated oxidative stress and decreased MAO-A expression in diabetic vascular preparations. In conclusion, MAO-A is induced in diabetic aortas and vitamin D can improve diabetes-induced endothelial dysfunction by modulating the MAO-A expression.

Oxidative stress and vascular inflammation are the two major pathomechanisms that contribute to the progression of both cardiovascular and metabolic diseases. We have previously demonstrated that monoamine oxidases (MAOs), mitochondrial enzymes with two isoforms (A and B), are contributors to the endothelial dysfunction associated with inflammation in mice. The present study was purported to assess the effects of MAOs on endothelial dysfunction in rats with lipopolysaccharide (LPS)-induced acute inflammation. To this aim, aortas harvested from rats treated or not with a single dose of LPS were used for organ-bath studies of vascular reactivity and H2O2 production assessment in the presence vs. absence of MAO inhibitors. Our results demonstrate that MAO-A and B isoforms are induced in the rat vascular system after LPS administration. Both reversible and irreversible MAOs inhibition improved vascular function and reduced oxidative stress. In conclusion, MAOs are contributors to the occurrence of endothelial dysfunction in the rat model of LPS-induced acute inflammation. MAO inhibition may become a viable therapeutic strategy for the treatment of cardiometabolic disease.

The functional materials based on natural zeolite (clinoptilolite), TiO2-zeolite and Ag-TiO2-zeolite have been successfully synthesized by solid-state reaction in fast-hydrothermal conditions. The obtained functional materials were investigated by X-ray diffraction (XRD), FT-IR (Fourier transform infrared) spectroscopy, DRUV-VIS (diffuse reflectance ultraviolet-visible) spectroscopy, BET (Brunauer-Emmett-Teller) and SEM/EDX (scanning electron microscope/energy dispersive X-ray spectrometer) analyses. The XRD results indicated that the clinoptilolite structure has a good thermal stabilization after the fast-hydrothermal treatment. Also, the high specific surface area about 92.55 m2·g−1 was noticed for Ag-TiO2-zeolite functional material. The presence of dopants was evidenced from EDX spectra. The enhanced bactericidal activity of Ag-TiO2-zeolite catalyst is proved through damaging of Enterococcus faecalis colonies under visible irradiation, at different material doses and irradiation times.

The colo-cutaneous fistula is an extremely rare post-operative complication of hernias. This type of complication, besides the surgical aspects, raises also a medical-legal problem regarding the production of the fistula and its consequences.The authors present the clinical case of a 65 years old man, J.N., from a rural background, who presented himself in the ambulatory with a colo-cutaneous fistula as a complication which debuted a few weeks after a surgical intervention for an irreducible left inguinal hernia. He was submitted to a surgical reintervention with good results.The main particularity of the present case is the association of the colo-cutaneous fistula with the presence of the oxyuris helmintiasis in the fistulos secretions.Even though it was rather difficult to obtain the patient's consent for the surgical treatment, the intervention had very good results leading to the healing of the patient.Colo-cutaneous fistula, Enterobius vermicularis (oxyuris helmintiasis), Post-operative complications of hernia.La fistola colo-cutanea rappresenta una complicazione estremamente rara dopo una erniorrafia. A parte gli aspetti chirurgici di questo tipo di complicazione, essa dà origine a problemi di tipo medico-legale per la ptoduzione della fistola e delle sue conseguenze. Viene presentato il caso di un uomo di 65 anni di estrazione rurale, giunto al nostro ambulatorio per la presenza di una fistola colo-cutanea come complicanza insorta poche settimane dopo un intervento chirurgico per il trattamento di un’ernia inguinale non riducibile. Egli è stato rioperato con risultato favorevole. La principale particolarità di questo caso è stata l’associazione della fistola colo-cutanea con una elmintiasi da ossiuri nella secrezione della fistola. Nonostante la difficoltà di ottenere dal paziente il suo consenso al trattamento chirurgico, è stato ottenuto un ottimo risultato con la sua guarigione.

The liver segmentation is mainly determined by the intraparenchymatous distribution of the vascular and ductal hepatic elements; from this, the hepatic portal vein (HPV), is the most important afferent element. The lateral branches (LBrs) are serving left lateral division (LLD) of the liver and present a moderate morphological variability. On a total of 160 pieces of liver corrosion casts, one examined the intraparenchymal distribution of portal LBrs and the segmentation of LLD. Regarding the intraparenchymal distribution of the portal branches in the LLD of the liver, we showed two distinct morphological types: Type I (89.375% of cases) in which from the ombilical part of the left branch arise two LBrs; Type II (10.25% of cases) in which from the ombilical part of the left branch arise three LBrs. Knowledge of these morphological types of portal LBrs is important for clinical and surgical practice.

There are several reports of multiple ectopic renal arteries (RA) in the literature. However, the ectopic origin of a single RA with a normal kidney position is rare. Knowledge of this variant is extremely important in clinical, surgical and radiological practice. Using MDCT angiography examination, we describe a rare case of a right kidney located in a normal lumbal position with a single ectopic thoracic renal artery originating in the thorax, above the diaphragmatic dome, at the level of the upper one-third of the T12 vertebral body. With an "S"-shaped course and a total length of 103 mm, this artery had an intratoracic portion of 38 mm. It crossed the diaphragm at 23 mm lateral to the right side of the TA, through a hiatus located on the lateral side of the right crus of the diaphragm. The right inferior phrenic artery arose from the left lateral wall of the right RA, 5 mm below the level of CT (45 mm distal to the right RA origin). Remarkably, this variant was associated with an area of proximal arterial stenosis, which produced signs and symptoms of hypertension secondary to renal arterial stenosis. To the authors' knowledge, this is the first reported case of a stenotic single ectopic thoracic renal artery associated with a normal kidney position.

The analysis of the progress in the gallbladder laparoscopic surgery by comparing the cases operated after the implementation of this procedure in General Surgery Clinic I of Emergency County Hospital Timisoara, Romania to the current period.Two groups of 1000 patients undergoing laparoscopic cholecystectomies have been studied. The first group has been operated between 1994 and 1998, the second group between 2008 and 2011. Analyzed data: surgical indications, the rate of conversions to conventional surgery, intraoperative accidents, postoperative complications and the death rate.The indications for a laparoscopic approach have been extended from 53 % (530 cases) of the total number of cholecystectomies to 78%(780 cases). The rate of conversions has decreased from 4.9% (26 cases) to 3% (23 cases). The number of patients with acute cholecystitis operated with laparoscopic approach has risen from 48.30 % (256 cases) to 73.07 % (570 cases). The intraoperative accidents and the postoperative complications rate remained unchanged. There were no registered deathsThe comparative study has demonstrated the positive evolution of the laparoscopic method due to surgical technique improvement and technological progress. The laparoscopic cholecystectomy is "the gold standard" as an ablation procedure of the gallbladder.Lo studio riguarda l’analisi dei progressi nella chirurgia laparoscopica della colecisti paragonando i casi operati dall’adozione di questa procedura nella General Surgery Clinic I of Emergency County Hospital Timisoara, Romania, fino all’attualità. Per questo sono stati studiati due gruppi di 1000 pazienti ciascuno, sottoposti a colecistectomia laparoscopica. Il primo gruppo è quello degli operati tra il 1994 e il 1998, ed il secondo degli operati tra il 2008 e il 2011, analizzando i seguenti dati: indicazione chirurgica, tasso di conversione a chirurgia laparotomica, incidenti operatori, complicanze postoperatorie e numero di decessi. L’indicazione per l’approccio laparoscopico si è ampliato dal 53 % (530 casi) del numero totale di colecistectomia al 78%(780 casi). Il tasso di conversione è diminuito dal 4.9% (26 casi) al 3% (23 casi). Il numero di pazienti affetti da colecistite acuta operati con la procedura laparoscopica si è accresciuto dal 48.30 % (256 casi) al 73.07 % (570 casi). Gli incidenti intraoperatori ed il tasso di complicanze postoperatorie è rimasto invariato, e non sono state registrati decessi. In conclusione lo studio comparative ha dimostrato l’evoluzione positiva del metodo laparoscopico grazie ai miglioramenti della tecnica chirurgica ed ai progressi dei mezzi tecnoclogici, e la colecistectomia laparoscopica si è dimostrata essere il “gold standard” per l’asportazione della colecisti.

PROX1 is involved in cancer development and progression as both a tumor suppressor and oncogene. Immunohistochemical (IHC) PROX1 nuclear expression is a widely accepted pattern. Scattered data reported PROX1 IHC cytoplasmic expression in different tumors, including gastric cancer but it is not clear if this holds true.Evaluation of the cytoplasmic expression of PROX1 in normal gastric mucosa and gastric cancer was performed by IHC followed by RNAscope, an in situ hybridization-based method for detecting PROX1 mRNA amplification on paraffin-embedded samples and to evaluate its clinical impact.Twenty five out of 48 cases of gastric cancer showed PROX1 nuclear and cytoplasmic immunohistochemical expression. Twelve out of these 20 cases positive for PROX1 on IHC (54.5%) had PROX1 mRNA gene amplification. The overlapping of PROX1 cytoplasmic expression assessed by immunohistochemistry and cytoplasmic RNAscope amplification was statistically significant (p=0.031). PROX1 mRNA gene amplification correlated with tumor grade (p=0.05) and regional lymph node metastasis as well (p=0.033). No significant correlation was obtained between PROX1 and histopathology, tumor size or distal metastasis.A significant correlation was found between IHC and RNAscope PROX1 expression in the cytoplasm of normal and gastric cancer cells. This strongly supports its validation as a true expression on immunohistochemistry. A strong correlation between PROX1 mRNA amplification and regional lymph node metastasis supports its implications in cancer spreading and metastasis and sustains its utility, not only as a lymphatic marker, but also as a potential tumor marker in various tumor types, including gastric cancer.