The Role of PET-CT in Gastric Cancer – A Narrative Review

Background: Gastric cancer is one of the most common and leading causes of cancer death worldwide, with an increasing risk and prevalence. Although the usage of 18-FDG PET-CT in gastric cancer evaluation remains a matter of debate and is not consistently recommended by international guidelines, our descriptive review aims to highlight its actual role in the diagnostic accuracy, staging, therapeutic management, and relapse monitoring of this malignancy. Methods: The current research was conducted using scholarly databases including PubMed, Scopus, and Google Scholar by searching useful science journals, references, and abstracts on the topic. The keywords used were “gastric cancer” AND “PET-CT”. Results: 18-FDG PET-CT remains a promising method with increasing clinical utility not only across a wide variety of malignancies, but also among gastric cancer patients. Conclusions: We are certain that with further improvements, this technique could improve the diagnosis and evaluation of gastric cancer, and make it more approachable and accurate. Keywords gastric cancer (GC), PET-CT, 18-FDG PET-CT, 18F-FDG uptake, ceCT (contrast-enhanced CT

The switch from patented medicine to the generic one: an option or a necessity?

This paper assesses the influence of a number of factors taken into account when a brand name drug is replaced by a generic one. It also evaluates responses of health professionals – physicians and pharmacist—and patients regarding the issue of switching. We compared and contrasted their responses in order to identify new points of cooperation for the intended benefit of the patient. Thus, the sample drew from all three groups, consisting of 50 doctors, 50 pharmacists, and 50 patients. We collected information regarding the age, residence, income level, and education level for the patients, and age and experience for the specialists. Based on responses to the survey, replacing the original medication with a generic one raises many issues, such as lack of information for the patient and specialist, lack of collaboration between physician and pharmacist, ineffective communication between specialist and patient, and the influence of the overall profit motive

Insights into mesh placement in contaminated surgical fields for abdominal wall repair – from prohibition to possibility

Surgical field contamination is a critical concern during abdominal wall prosthetic repair, as it significantly affects the risk of postoperative infections. This review paper combines an extensive analysis of relevant literature with personal experience to explore the challenges and advancements in the placement of mesh in contaminated surgical fields for the management of abdominal wall defects. Historically, the presence of any surgical field contamination was considered a contraindication for prosthetic placement due to the high risk of infection. However, with evolving understanding of the physiology and pathophysiology of biologic reaction around the mesh, as well as the development of various mesh types, the landscape has changed. The emerging understanding of hostmesh interaction, biofilm formation, and local tissue response has contributed to the development of innovative mesh designs that improve outcomes in challenging surgical scenarios. With meticulous surgical technique, adherence to infection prevention protocols, and the appropriate choice of mesh, successful abdominal wall prosthetic repair in contaminated fields is now feasible, opening new possibilities for patients with ventral and incisional hernias

Beyond histopathology: integrating inflammation and immune response in neoplasia evaluation

Evaluarea inițială este o componentă esențială în determinarea prognosticului și ghidarea deciziilor de tratament pentru pacienții cu cancer. Abordările tradiționale se bazează pe caracteristicile histopatologice și studiile de imagistică; totuși, există o recunoaștere crescândă a importanței încorporării parametrilor biologici pentru îmbunătățirea înțelegerii comportamentului neoplaziei și a rezultatelor tratamentului. Combinarea raportului neutrofile-limfocite (NLR), raportului trombocite-limfocite (PLR) și a indexului sistemic de inflamație-imunitate (SII) a devenit un posibil marker prognostic în diferite tipuri de tumori maligne. Acest studiu retrospectiv realizat la Clinica de Chirurgie Generală și de Urgență III, Spitalul Universitar de Urgență București, explorează utilitatea NLR, PLR și SII în evaluarea cancerului de sân, cancerului colorectal și cancerului gastric. Prin examinarea efectelor combinate ale inflamației și răspunsului imunitar, NLR, PLR și SII oferă informații valoroase despre microîmprejurimile tumorale și interacțiunile gazdă-tumoră. NLR și PLR ridicate indică o stare proinflamatorie și potențială imunosupresie, în timp ce SII integrează numărul de neutrofile, limfocite și trombocite pentru a evalua cuprinzător inflamația sistemică și starea imunitară. Acest studiu își propune să evalueze potențialul acestor parametri biologici combinați ca markeri prognostici în evaluarea neoplaziei, contribuind la stratificarea riscului, luarea deciziilor terapeutice și managementul pacientului în vederea îmbunătățirii rezultatelor. Mai mult, descoperirile pot contribui la dezvoltarea abordărilor de medicină personalizată prin identificarea pacienților cu risc ridicat care pot beneficia de terapii adaptate. Sunt necesare investigații suplimentare pentru validarea descoperirilor și determinarea semnificației clinice a acestor parametri biologici combinați. Studii viitoare prospective, cu eșantioane mai mari și urmărire pe termen lung, sunt necesare pentru a stabili implicațiile practice și potențiala integrare a NLR, PLR și SII în practica clinică de rutină pentru evaluarea neoplaziei.Neoplasia evaluation is a critical component in determining prognosis and guiding treatment decisions for cancer patients. Traditional approaches rely on histopathological features and imaging studies; however, there is a growing recognition of the importance of incorporating biological parameters to enhance understanding of tumor behavior and patient outcomes. The combination of Neutrophilto-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) has emerged as potential prognostic markers in various malignancies. This retrospective study conducted at the IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital Bucharest, explores the utility of NLR, PLR, and SII in breast cancer, colorectal cancer, and gastric cancer evaluation. By examining the combined effects of inflammation and immune response, NLR, PLR, and SII provide valuable insights into the tumor microenvironment and host-tumor interactions. Elevated NLR and PLR indicate a pro-inflammatory state and potential immunosuppression, while SII integrates neutrophil, lymphocyte, and platelet counts to comprehensively evaluate systemic inflammation and immune status. This study aims to assess the potential of these combined biological parameters as prognostic markers in neoplasia evaluation, contributing to risk stratification, treatment decision-making, and patient management to ultimately improve outcomes. Moreover, the findings may inform the development of personalized medicine approaches by identifying high-risk patients who may benefit from tailored therapies. Further investigations are warranted to validate the findings and determine the clinical significance of these combined biological parameters. Future prospective studies with larger sample sizes and long-term follow-up are necessary to establish the practical implications and potential integration of NLR, PLR, and SII into routine clinical practice for neoplasia evaluation

The switch from patented medicine to the generic one: an option or a necessity?

This paper assesses the influence of a number of factors taken into account when a brand name drug is replaced by a generic one. It also evaluates responses of health professionals – physicians and pharmacist—and patients regarding the issue of switching. We compared and contrasted their responses in order to identify new points of cooperation for the intended benefit of the patient. Thus, the sample drew from all three groups, consisting of 50 doctors, 50 pharmacists, and 50 patients. We collected information regarding the age, residence, income level, and education level for the patients, and age and experience for the specialists. Based on responses to the survey, replacing the original medication with a generic one raises many issues, such as lack of information for the patient and specialist, lack of collaboration between physician and pharmacist, ineffective communication between specialist and patient, and the influence of the overall profit motive

Multidrug resistance in Helicobacter pylori infection

Helicobacter pylori (Hp), a well-known human pathogen, causes one of the most common chronic bacterial infections and plays an important role in the emergence of chronic progressive gastric inflammation and a variety of gastrointestinal diseases. The prevalence of Hp infection varies worldwide and is indirectly proportional to socio-economic status, especially during childhood. The response to the eradication therapy significantly depends on the antibiotic resistance specific to each geographical region; thus, currently, given the increasing prevalence of antimicrobial resistance (especially to clarithromycin, metronidazole, and levofloxacin), successful treatment for Hp eradication has become a real challenge and a critical issue. The most incriminated factors associated with multidrug resistance (MDR) in Hp proved to be the overuse or the improper use of antibiotics, poor medication adherence, and bacterial-related factors including efflux pumps, mutations, and biofilms. Up to 30% of first-line therapy fails due to poor patient compliance, high gastric acidity, or high bacteremia levels. Hence, it is of great importance to consider new eradication regimens such as vonoprazan-containing triple therapies, quintuple therapies, high-dose dual therapies, and standard triple therapies with probiotics, requiring further studies and thorough assessment. Strain susceptibility testing is also necessary for an optimal approach

Hypercholesterolemia, as a Predictor Factor of Severe Acute Pancreatitis

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe)

Gamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures. Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant. Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse

The switch from patented medicine to the generic one: an option or a necessity?

This paper assesses the influence of a number of factors taken into account when a brand name drug is replaced by a generic one. It also evaluates responses of health professionals – physicians and pharmacist—and patients regarding the issue of switching. We compared and contrasted their responses in order to identify new points of cooperation for the intended benefit of the patient. Thus, the sample drew from all three groups, consisting of 50 doctors, 50 pharmacists, and 50 patients. We collected information regarding the age, residence, income level, and education level for the patients, and age and experience for the specialists. Based on responses to the survey, replacing the original medication with a generic one raises many issues, such as lack of information for the patient and specialist, lack of collaboration between physician and pharmacist, ineffective communication between specialist and patient, and the influence of the overall profit motive

Inflammatory Bowel Diseases: the Surgical Perspective

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specific mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fistula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime