Underactive bladder - an underestimated entity

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology. Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments. Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does not seem to alleviate much of the suffering. This disease remains underrecognized and undertreated. More research is needed to identify less invasive diagnosis tools and treatment for this pathology

The Serine/Threonine Protein Kinase (Akt)/ Protein Kinase B (PkB) Signaling Pathway in Breast Cancer

According to statistical data published in 2019, breast cancer is among the leading causes of death in women worldwide. The serine/threonine kinase (AKT) or protein kinase B (PkB) signaling pathway is activated by phosphorylation processes, which further is associated with cell growth, proliferation, and survival, but also with activation of glucose metabolism. Mutations of the AKT signaling pathway components (especially PI3KCA and PTEN) have been observed in breast cancer patients, which are associated with resistance to hormonal treatment. Many clinical trials are testing the effect of AKT inhibition in order to block the growth and proliferation of breast cancer cells. The purpose of this review is to present the incidence of this neoplastic disease, to describe AKT signaling pathways activation, mutations that occur at its level, and inhibitors that can block this protein kinase

Acute chylous peritonitis due to idiopathic pancreatitis mimicking acute appendicitis

The acute development and the accumulation of chyle into the peritoneal space is a rare condition and one needs to be able to distinguish it from chylous ascites, which is most commonly chronic and associated with related diseases. It is frequently idiopathic and additionally, clinical and imaging findings are nonspecific. In almost all cases, the diagnosis is made intraoperatively during laparoscopy or laparotomy, most diagnostic procedures being indicated by acute complaints pertaining to the abdomen. A 23-year-old man was admitted to the Emergency Department with abdominal pain, with right iliac fossa tenderness and peritonism. Laparoscopy was performed due to acute abdomen findings. Further exploration revealed chylous effusion with milky-like fluid. The peritoneal lavage and the insertion of drains were subsequent to the careful inspection of the cavity. The biochemical analysis of the peritoneal fluid was an important aid which provided the diagnosis of chylous peritonitis due to acute pancreatitis

Miniinvazivitate în chirurgia abdominală

Sfârșitul secolului XX, consfințește un nou concept medical, și anume, miniinvazivitatea, demolând blocajele conceptuale, “chirurg mare-incizie mare”, miniinvazivitatea iși face loc și în chirurgie, sprijinită de un “boom” tehnologic într-o specialitate veche dar nou denumită imagistică medicală: ECHO, CT, RMN, Colangio-RMN, PET-CT, Angiografie. De fapt, acest secol XX lărgește considerabil și explicit orizontul chirurgical. Alături de chirurgia tradițională și desprinsă din ea apar două noi orientări: miniinvazititatea și chirugia de transplant, ambele făcand parte din palmaresul românesc, de pe ambele maluri ale Prutului, datorită unor poli de influență și promovare. Chirurgia de transplant, complexă, dificilă, de excepție, ce presupune echipe multiple, spitale multiple, orașe multiple, țări multiple, costisitoare, energofagă, este posibilă prin „chivernisirea” banului public și în conțiile chirurgiei de zi cu zi. Compensator, această reducere a costurilor este generată de apariția miniinvazivitătii chirurgicale. Mininvazivitatea chirurgicală este un nou concept, departe de a fi unul centimetric, eventual milimetric, și este un concept larg, anatomic, anatomo-patologic, fiziologic, fizio-patologic, topografic, cosmetic, psiho-sociologic, tactic, tehnico-tehnologic, dimensional, financiar, umanist și în primul rând de protecție a pacientului. Obiectul miniinvazivității poate fi definit drept “evitarea sacrificiilor inutile, mai ales a celor parietale, consumatoare plastic, imunitar, temporal, în final energetic având drept consecință diminuarea până aproape la dispariție a complicațiilor căilor de abord și o vindecare mult accelerata”. Efectele pozitive tardive sau imediate sunt: - Vindecare spitalicească rapidă (până la “one day surgery” ) sau alte variante cu costuri directe mici și recuperarea post-spitalicească (convalescență) mult redusă (costuri indirecte mici); - Dispariția cicatricilor mari și a patologiei lor (etalare,cheloid, granuloma de fir); - Dispariția patologiei de plagă extinsă ( serom, hematom, supurație, eviscerație, eventrație); - Dispariția patologiei de secțiune musculară, nervoasă și vasculară extinsă; - Cicatrici inaparente (incizii subcicatriceale - liniile de tensiune tegumantară ale lui Langer); - Consumuri energetice și plastice minime, cee ce presupune accelerarea procesului de vindec-re și aplicarea mai rapidă a terapiei oncologice (dacă e necesar); - Consumuri terapeutice minimale (pierderi sangvine minime/nule, antialgice și antibiotice mult reduse cantitativ și calitativ); - Menajarea psihicului bolnavului prin reluarea mobilițății precoce, absența plăgilor largi, dureroase, cicatrici inaparente, absența firelor extractibile de sutură, părăsirea rapidă a spitalu-lui, elemente ce transferă bolnavul din zona omului suferind în zona omului sanatos

Underactive bladder - an underestimated entity

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology. Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments. Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does not seem to alleviate much of the suffering. This disease remains underrecognized and undertreated. More research is needed to identify less invasive diagnosis tools and treatment for this pathology

The role of inflammation in age-related macular degeneration

Age-related macular degeneration (AMD) is a complex, chronic, and progressive disease which affects the macular area, being one of the leading causes of irreversible vision loss worldwide. Specific alterations of retinal structure occur at the macular level, which regarding its severity can range from the presence of drusen to the development of geographic atrophy or choroidal neovascularization. AMD has long been considered a degenerative disease, but new studies highlight the role of inflammation present both in the atrophic form and in the exudative form. The present review is based on comprehensive research on PubMed and Web of Science databases, and it aims to describe the inflammatory pathways involved in AMD onset and progression. Understanding the molecules involved in AMD pathogenesis, and their mechanism of action, is crucial because they can be both biomarkers with a predictive role in disease management, as well as potential therapeutic targets

CD56dim/CD56bright NK cell subpopulations and CD16/CD57 expression correlated with tumor development stages

BACKGROUND: NK cells are characterized by cytotoxic activity against tumor cells and CD3-CD16+CD56+ phenotype. Two distinct subpopulations of NK cells were characterized in the peripheral blood: NK-CD56dim representing over 95% of NK cells and involved in antitumor cytotoxicity, and NK-CD56bright representing approximately 10% of NK cells and involved in secretion of cytokines.AIM: The aim of the study was to compare the presence of NK-CD56dim/NK-CD56bright subpopulations and their CD16/CD57 expression in peripheral blood NK cells during the particular development stages of malignancy: primary tumor (PT), lymph node invasion (LNI) and distant sites metastases (Mt). MATERIAL AND METHODS: We have analyzed by flow-cytometry peripheral blood samples from total 36 cancer patients: 24 patients with PT, 6 patients with LNI and 6 patients with Mt.RESULTS: The presence of the overall NK cells showed no significant variation between patients in different stages of tumor development. The phenotype analysis showed that CD16+ and/or CD57+ cells were lower in LNI patients compared to PT or Mt patients. Double-positive CD16+CD57+ cells were found decreased in patients with Mt, compared to patients with PT. During the stages of tumor development, NK-CD56bright subpopulation increased progressively (7% in PT patients, 13% in LNI patients, 65% in Mt patients), whereas NK-CD56dim subpopulation gradually decreased (92%, 86%, and 35% respectively). CD16/CD57 expression decreased in NK-CD56dim and increased in NK-CD56bright cells over the three studied stages.CONCLUSION: Our results show changes in NK cells characteristics during tumor development: reversal of NK-CD56dim/NK-CD56brightdistribution and modification of CD16/CD57 expression. Both types of changes can concur in reducing the efficiency of NK cell activity in patients with progressive tumors.Â

Is open surgery still part of the current treatment of inguinal hernias?

Inguinal hernia repair represents one of the most frequent pathologies with surgical addressability. From the multitude of surgical procedures, a limited number still keep their indication in the current treatment of hernias. Open surgery, the exclusive repair method until recently, is associated with laparoscopic techniques with benefits that are at least superposable on those in open repair. We conducted a study, analyzing several types of procedures in open surgery and comparing them to each other, but also with the TAPP approach, which is still at the beginning in our service. The non-mesh procedures scored poorly in terms of recurrence, the duration of the surgical intervention, and complications of the pain type, the Lichtenstein procedure was frequently associated with non-infectious inflammatory complications, and the TAPP, which is still in the learning curve, presented a prolonged duration of the surgical intervention. The Lichtenstein procedure maintains its usefulness and represents the most frequent technique for sanctioning inguinal hernia, the non-mesh processes, less used lately, are more frequently preferred in situations where hernia strangulation is associated with a septic complication. Open surgery hernia repair remains a feasible option in the era of minimal invasiveness, especially under the conditions of performing a tension-free technique, for specific categories of patients or surgical services remaining the first intention solution