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The role of computed tomography and esophageal ultrasonography in the preoperative evaluation of esophageal cancer resection
Get PDFObjectives. Esophageal cancer is one of the most aggressive types of cancer, with a 5-year relative survival rate of only 18%-20.5%. Survival is highly dependent on accurate positive diagnosis and staging, in which the imaging modalities available have a primary role. The study is focused on the analysis of the preoperative T and M staging strategy and the reliability of computed tomography and endoscopic esophageal ultrasound in predicting resectability. A second objective was to evaluate the influence of preoperative imaging modalities on decreasing the number of unnecessary thoracotomies and laparotomies. Material and Methods. This study was conducted on a lot of 97 consecutive esophageal cancers, admitted in the Second General Surgery Clinic of Emergency County Hospital No. 1 of Craiova, between January 2007 to December 2019. We recorded patient data, imaging details and staging, as well as intraoperative aspects and tactics. For statistical analysis we have used chi square test. Conclusions. Computed tomography is not a basic investigation in the T-category evaluation of the TNM stage, the accuracy of the method being extremely variable with the T-stage, the type of CT scan. The maximum utility of CT remains in the identification of invasion of neighboring organs and the operability of the case. Despite the differences in the accuracy, sensitivity and specificity of computed tomography and endoscopic ultrasound in esophageal cancer, the use of these imaging methods is essential in staging esophageal cancer and establishing the therapeutic indication
Giant adrenal myelolipomas: a literature review
Get PDFMyelolipomas are described as small tumors, with some authors referring to sizes less than 4 cm in diameter. However, when greater than 10 cm, myelolipomas are labeled as giant tumors and thus, have a definite indication for surgical resection. Myelolipomas represent a small percentage of adrenal tumors. Giant myelolipomas are usually discovered incidentally during imaging studies performed for other conditions. They are often slow-growing and may reach sizes that significantly distort the anatomy of the affected area. Despite their large size, they are usually benign and do not spread to other parts of the body. Adrenal myelolipoma is a benign tumor with a scarce number of detailed cases reported in literature. It is frequently discovered by chance, covering a variety of differential diagnoses. Imaging techniques and histopathological examinations are of great importance in the differential diagnosis of adrenal gland lesions, including retroperitoneal lipoma and liposarcoma, adrenal myelolipoma, adrenal lymphoma, adrenal adenoma, adrenocortical carcinoma, pheochromocytoma or metastasis. We performed a comprehensive review on PubMed of all cases of giant adrenal myelolipoma reported in literature with more than 10 cm in diameter, in order to estimate the incidence, diagnosis and treatment of giant myelolipoma. So far, only 15 cases of truly giant adrenal myelolipoma have been reported between 1981 and 2023
The role of inflammation in diabetic retinopathy in patients with type II diabetes; potential therapeutic perspectives
Get PDFDiabetic retinopathy is one of the major causes of visual impairment and blindness in adult population. The pathology is complex, the metabolic changes induced by the hyperglycemic environment leading to neurodegeneration, microvascular damage, with secondary ischemic and inflammatory changes in the retina. This review aims to update the literature data related to the role of inflammation in the onset and progression of diabetic retinopathy. Thus, the molecular and biochemical mechanisms triggered by excess glucose increase the expression of genes involved in inflammatory processes, which leads to the synthesis of inflammatory cytokines such as Il1, Il6, TNF alpha as well as complement activation. Furthermore, recent evidence has demonstrated that both systemic and ocular prolonged inflammation are correlated with the progression of diabetic retinopathy. In conclusion, preventing and/or reducing the progression of diabetic retinopathy requires both rigorous glycemic control in diabetic patients and targeted interference of the specific inflammatory pathways involved
The role of radiotherapy in the complex treatment of mycosis fungoides; a case report
Get PDFIntroduction. Mycosis fungoides (MF) is the most common form of primary cutaneous T-cell lymphoma. Radiotherapy induces excellent response rates in the treatment of localized or extensive lesions of MF, both as monotherapy and as part of a multidisciplinary treatment. Total skin irradiation with electrons or protons is available in a limited number of medical centers and is mainly used in patients with extensive MF. Case presentation. It is presented the case of a 47-year-old patient who developed erythematous papules and plaques on the chest, upper limbs, face and scalp, initially diagnosed as chronic eczema and treated with systemic corticotherapy, antihistamines and dupilumab. Under treatment, the lesions progressed with the appearance of tumorous formations on the scalp and face, some of them ulcerated. Thus, additional (histopathological and immunohistochemical) tests were performed and established the diagnosis of MF. As a result, treatment with methotrexate and narrow-band UVB was initiated, subsequently associated with radiotherapy on the scalp and face lesions (right frontal, right parietal, left oral commissure), 30 Gy to each area. During radiotherapy, the patient developed second grade radiodermatitis associated with radiomucositis, but with a significant reduction in the surface area of the lesions until their disappearance. Conclusions. Radiotherapy can be used in all stages of MF, being useful both for alleviating symptoms and eradicating the disease, meaning that the potential of this form of treatment needs to be further exploited and investigated
Advantages of mechanical anastomosis in rectal cancer surgery
Get PDFRectal oncological pathology represents an increased degree of difficulty in terms of surgical approach. Along with the development of minimally invasive surgery, technology has also increased the options for performing digestive anastomoses. A significant increase has been observed among mechanical anastomoses. The evolution of mechanical sutures through the use of the stapler has become a true symbol of technological advancement, as they have led to improvements and effective gains in quality and productivity in suture making. The aim of this paper is to highlight the advantages of the use of staplers in rectal surgery, with their help achieving a lower percentage of postoperative complications, a lower incidence of suppuration, fistula and evisceration, a much faster patient recovery, a lower mortality, an increase in the possibility of performing low anastomosis and a decrease in the performance of colostomies that are difficult to be accepted by patients, most of them requiring a shorter period of hospitalization after major oncological surgery
Management of macrovascular diabetic complications: a single-center case series analysis of consecutively attending patients in primary care
Get PDFIntroduction. The prevalence of diabetes mellitus is increasing, with type 2 diabetes (T2DM) being a major health priority for any public health system. Increased arterial stiffness in patients with diabetes will lead to the appearance of vascular complications. Increased arterial stiffness in patients with diabetes usually leads to vascular complications. Any earlier diagnosis of impaired macrovascular evidence may lead to improved outcomes in patient care. The objective of our study was to assess and evaluate the finger-toe pulse wave velocity (ftPWV), as a measure of arterial stiffness, in order to assist with early detection of macrovascular diabetic complications. Materials and Methods. The observational case series included 140 patients who are registered in a primary care office, of whom 73 were previously diagnosed with diabetes mellitus (study group). The age-matched non-diabetic group included 67 consecutive registered patients who visited the practice for other reasons. Results. The mean age of all patients was 51.42±11.57 years, with DM patients being with 4.5 years older than the non-DM patients (CI 95% and CI 95%). There was a significantly higher mean value of ftPWV in the DM group (p = 0.0039) although the study presented some limitations. Conclusions. The mean value of ftPWV was statistically significant higher in diabetic patients. The assessment of ftPWV is a non-invasive test, and the data can be used as a useful marker of vascular stiffness in primary care, thus providing an early diagnosis of macrovascular complications during the monitoring and care of the diabetic patient
