21 research outputs found
Acute lithiasis cholecystitis; particularities of diagnosis and treatment in the elderly
Objectives. The incidence of acute cholecystitis increases with age, when patients usually associate additional comorbidities. Such comorbidities and the late presentation to the doctor make the treatment more complex, associating higher rates of complications. The present study aims to evaluate the methods of diagnosis and treatment applied to a group of older patients with acute cholecystitis. Materials and Methods. 585 patients were enrolled in the study between 2019 and 2023. The inclusion criteria in the study were represented by the presence of the diagnosis of acute cholecystitis in patients over 65 years of age, while patients who presented complex locoregional pathologies (trauma, cancer, etc.) were excluded. Results. In about 91% of cases, acute cholecystitis was determined by gallstones. 61.19% of cases benefited from laparoscopic cholecystectomy, the rest of the patients requiring additional procedures or open surgery. Morbidity and mortality were not significantly influenced, but some of the patients required complex interventions and longer hospital stay. Conclusions. The clinical manifestations of acute cholecystitis can be diminished in some of the elderly patients (neurological disorders, diabetes, immunosenescence, etc.), being initially appreciated as mild forms. Later it is found (by imaging or intraoperatively) that these are much more severe forms, which often require a customized therapeutic approach
Diagnosis and management of colon cancer patients presenting in advanced stages of complications
Colorectal cancer is an important health problem with a significant impact on the individual and society. Malignancy (including colorectal cancer) is usually slightly symptomatic in its initial stages. This causes cancer to be discovered in some patients accidentally (either through screening tests in predisposed individuals or during routine investigations for other diseases), while in other patients the colorectal cancer is discovered in late stages, when the symptoms are much more intense due to complications. Unfortunately, such advanced cases of the disease have high rates of morbidity and mortality even with treatment. Current treatment methods are usually complex, interdisciplinary, causing significant suffering (physical, mental) to the individual, while the cost of treatment per patient seems to be extremely high. Until finding therapeutic methods that are effective and accessible to most patients with advanced colorectal cancer, several methods of prophylaxis and early diagnosis should be considered, to reduce as much as possible the devastating impact of this disease. The purpose of this review is to present literature data regarding the current methods of diagnosis and treatment of patients presenting to the doctor with colorectal cancer in advanced stages of complications
A systematic review of sinus floor augmentation complications. Does graft type influence the complications rate?
Background. Sinus floor elevation is considered a safe procedure to properly augment the height of the edentulous crest. Often, complications may arise due to multiple causes and can lead to a poor outcome of the graft and implant’s osseointegration. A careful surgical approach, a good knowledge of possible obstacles, and careful treatment planning can reduce the risks of complications, as well as their impact on the surgical outcome. This study aims to make a literature review of 40 articles, analyzing the incidence and type of complications related to maxillary sinus graft surgeries and graft materials. Material and methods. A total of 40 articles published between 2015 and 2021 were selected for a systematic literature review on maxillary sinus floor complications. The studies were selected from 2 different internet databases: PubMed and Science Direct. The sinus lift complications were counted and their incidence was organized upon the surgical technique and the timing of occurrence (intraoperative, postoperative). It was also analyzed if the graft material influences the complication rate. Results. In a group of 1757 sinus augmentation surgeries performed on 1605 patients, 363 complications were found. Sinus membrane perforation occurred in 242 cases, 29 procedures resulted in partial or total graft loss, there were 26 postoperative cases of sinusitis, 24 sinus infections, 16 wound dehiscence, 6 bleeding complications, 5 lost implants, and 2 oro-antral fistulas. Conclusion. Sinus lift complications are sometimes inherent circumstances of the procedures, but they can also be prevented through an accurate technique and preoperative plan. The type of bone graft does not influence the incidence of surgical complications
Genetic and serological markers in colorectal cancer surgery
Colon cancer is relatively asymptomatic in the early stages, the manifestations appearing and intensifying with the evolution of the disease, especially when associated with local and/or systemic complications. In such cases, surgical interventions are often emergency and involve more extensive operations (on metabolically and immune-stressed organisms), so that an early diagnosis (endoscopy, tumor markers, etc.) remains not only desirable but even a priority, especially in predisposed patients (genetic factors, lifestyle, etc.). As a consequence, the involvement of tumor markers in colon neoplasms has become more and more investigated in recent times. This review investigates the roles of serological and genetic markers in the management of patients with colon cancer, focusing on carcinoembryonic antigen, mismatch repair deficiency (dMMR), as well as KRAS and BRAF mutations. As a preliminary conclusion, tumor biomarkers seem to have a significant contribution to the diagnosis, decisions related to operative management, prognosis and postoperative follow-up of colon cancer, both in the categories of patients from high-risk groups and those without a clear predisposition to this condition
Limb amputations; etiopathogenesis, diagnosis and the multidisciplinary therapeutic approach
Despite remarkable advances in medicine, limb amputations remain a therapeutic measure that saves the lives of many patients. Given the varied etiopathogenesis, such operations are performed both as an emergency and as an elective procedure. Such interventions address either only the distal segments of a limb, or even the entire limb, having a great psychological, functional and social impact on the patient. Due to these multiple implications, limb amputations must be performed by specialized teams, in order to achieve the best possible functional and aesthetic results to be compatible with the correction of the remaining deficit with a prosthesis. The main causes leading to amputations and the corresponding preventive measures are presented, as well as the general principles of amputations as a therapeutic solution of last resort. In conclusion, reducing the number of traffic/workplace accidents and effective treatment of chronic diseases affecting the vascular system can contribute to decreasing the need for amputations, a life-saving therapeutic solution, but with a devastating impact on the patient and society
Barrett\u27s esophagus as a premalignant condition; medical and surgical therapeutic management
Barrett\u27s esophagus (BE) represents a special clinical entity, which may have reduced symptoms, but an increased potential for malignant degeneration. The factors that lead to the appearance of Barrett\u27s esophagus are multiple, the most important being gastro-esophageal reflux, as well as smoking and obesity. BE occurs as a result of damage of the esophageal mucosa, caused by acid/basic gastroesophageal reflux and resulting in the transformation of the epithelium from squamous to intestinal type. The diagnosis of BE is primarily based on endoscopic examination. This method has not only a diagnostic role, but also a therapeutic one through the minimally invasive resection of the mucosa with suspicious dysplastic lesions, thus reducing the risk of esophageal adenocarcinoma. Conservative therapeutic methods by administering chemoprotective agents (proton pump inhibitors, statins, etc.) are also useful. Surgical treatment of Barrett\u27s esophagus aims to both resect areas of high-grade esophageal dysplasia/adenocarcinoma and reduce the degree of gastroesophageal reflux through various surgical procedures. As a conclusion, the potential for malignant degeneration of BE should not be neglected, the form of treatment largely depending on the patient\u27s age and comorbidities
Diabetes mellitus and associated complications in the digestive tract
Diabetes mellitus presents an increasing prevalence and severe multisystemic complications, with notable personal, professional and social implications. Diabetes is generally known by hyperglycemia and subsequent metabolic disorders. In addition to hyperglycemia, it appears that other factors (related to anthropometric-pathophysiology and genome-based subphenotyping) are involved not only in the clinical course but also in the occurrence of diabetes complications. This review presents several diabetes-induced complications on the digestive tract (periodontal disease, xerostomia, oral infections, dental caries, taste disturbances, gastroesophageal reflux disease, gastroparesis, gastric ulcer and cancer, diabetic enteropathy, inflammatory bowel diseases, colorectal cancer, etc.), many of them with major implications and unfavorable long-term prognosis. Consequently, prompt recognition and treatment of diabetes and its complications, as well as strict follow-up education, still remain essential for the effective management of this complex metabolic disease
Diabetic patients and postoperative complications in colorectal surgery
Diabetes mellitus is one of the most common comorbidities of patients undergoing surgery. Colorectal surgery is frequently associated with postoperative complications, and diabetic patients represent a population that presents a high risk of developing such complications. Understanding the interrelationships between neoplastic disease and diabetes, as well as the pathophysiological mechanisms underlying postoperative complications, are essential for effective therapeutic management. Genetic predispositions, alterations in the gut microbiota, inflammatory response, ischemic, thrombotic and infectious processes contribute significantly to the development of severe surgical complications, such as anastomotic fistulas. Postoperative ileus, characterized by gastrointestinal dysmotility, is common in diabetic patients due to neuropathic dysfunction and altered intestinal metabolism. In addition, diabetic patients are at increased risk of intestinal ischemia, requiring specific perioperative care. The strategies to avoid these complications assume an adequate surgical technique, a personalized anesthesia management, and last but not least, the best possible glycemic control. This article highlights the importance of a better understanding of the interaction between diabetes and postoperative complications, in order to obtain good results with an important impact on the patient\u27s health and well-being.
This article highlights the importance of a better understanding of the interplay between diabetes and postoperative complications informs targeted interventions aimed at reducing morbidity and improving patient well-being
Gastric cancer; actualities and perspectives of early diagnosis and targeted therapy
Gastric cancer is an extremely aggressive form of malignancy that, if left untreated, is life-threatening. Improved survival rates depend on early detection of the disease, as well as on the combination of different forms of treatment (surgery, chemotherapy, radiotherapy, immunotherapy, etc.). Screening methods have brought real benefit in early detection of malignancies, but many cases are still diagnosed at advanced stages. The current study is a review related to actualities and perspectives of early diagnosis and targeted therapy of gastric cancer. After an extensive review of the literature, epidemiological, diagnostic and treatment data are presented. The open surgical approach is used in emergency centers or with a low surgical activity, while the minimally invasive approach (laparoscopic, robotic) is possible in large centers dedicated to the treatment of gastric cancer. In the near future, new diagnostic and therapeutic tools are expected to appear, not only to cure cancer definitively, but also to be able to prevent it, if possible, without radically changing the lifestyle of the population
Pancreatic cancer; from effective prevention and early diagnosis to personalized therapy
Despite substantial improvements in survival rates for most cancers, pancreatic cancer still remains a leading cause of death from malignancy. The disease has no symptoms in the initial stages, it can early invade the surrounding organs, and treatment methods have poor long-term prognosis. In addition, this neoplasia is starting to be diagnosed more and more frequently in young people. High incidences have been found in developed regions such as Europe, North America, Australia, but recent data show that this condition is increasing in other regions as well. Pancreatic cancer involves multiple factors such as cigarette smoking, obesity, diabetes, alcohol consumption, inherited genetic factors, recent studies also correlating pancreatic cancer with abnormal metabolism of human microorganisms, blood type, as well as glucose and lipid levels. This review aims to update knowledge on the epidemiology, pathophysiology, diagnosis and treatment of pancreatic cancer. The goal is to encourage screening and early diagnosis methods, as well as to stimulate further research on this oncological topic, insufficiently studied to date