Pelvic floor disorders in gynecological malignancies. An overlooked problem?

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors

Determination of pyrrolizidine alkaloids in dietary sources using a spectrophotometric method

Pyrrolizidine alkaloids (PAs) are a class of toxic compounds found in the composition of more than 6000 plants. People can be exposed to PAs by consuming phytotherapeutic products, food from crops contaminated with seeds of some species with high content of PAs, and/ or contaminated animal products like bee products. For this reason we developed and validated a method for quantitative determination of PAs, from the most frequently contaminated food sources, honey and flour. Colorimetric Ehrlich reagent method was used with standard addition (1mg/kg senecionine). The extraction solvent was methanol 50% acidified with citric acid to pH 2-3, as this solvent can be used for alkaloids and N-oxides. We found that, in extracting the alkaloid only once from the dietary sources, the percent of recovery is low (52.5% for honey, and 45.75% for flour). Using successive extractions, three times with the same solvent, the senecionine retrieval percentage increased to 86.0% for honey and 76.0% for flour. The method was validated using the following parameters: selectivity, linearity (0,25- 20 mg/ mL senecionine), accuracy (average recovery 93.5 - 107.93%) and precision (RSD 3,26-4.55%.). The calculated limit of quantification (0.174 mg/ mL) makes this method applicable for determining Pas occurring at toxic levels for consumers

Pelvic floor disorders in gynecological malignancies. An overlooked problem?

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors

The evaluation of oxidative stress in patients with essential thrombocythemia treated with risk-adapted therapy

Introduction. Essential thrombocythemia (ET) is a clonal disorder of the hematopoietic stem cells characterized by persistent thrombocytosis in the peripheral blood, excessive proliferation of megakaryocytes and minor reticulin fibrosis in the bone marrow. It seems that oxidative stress is involved in the development and progression of ET. Objective. To evaluate oxidative stress levels in ET patients treated with risk-adapted therapy. Material and methods. 62 ET patients and 20 controls (informed consent obtained) were enrolled. ET diagnosis was based on WHO criteria (2016 revised). Reactive oxygen species (ROS) levels and the total antioxidant capacity (TAC) were evaluated at time of diagnosis and after 6 months of risk-adapted therapy. ET patients were divided into 3 groups and treated with risk–adapted therapy: a low risk group, treated with low doses of aspirin 75 mg/day or watch-and-wait; an intermediate risk group treated with low doses of aspirin 100 mg/day or low-dose aspirin + cytoreductive treatment; a high-risk group, treated with low doses of aspirin and cytoreductive treatment (hydroxyurea) or platelet-lowering agents (anagrelide). Results. ET patients had at diagnosis higher ROS levels and a lower TAC vs. controls. After 6 months of risk-adapted therapy, ROS levels decreased and TAC increased. No significant differences were seen between the effect of hydroxyurea and the effect of anagrelide on oxidative stress levels. Conclusions. ROS levels are increased and TAC is decreased in ET patients vs. controls. These values depend on the risk group assigned to the patient. Risk-adapted therapy was useful to reduce ROS levels and increase TAC

Skin metastases: three-year study of 50 cases in a university center

Introduction. Skin metastases are rare metastases of internal or cutaneous tumors, commonly diagnosed after the primary cancer. Sometimes, they can be the first manifestation of a malignancy. Cutaneous metastases associate a poor prognosis for the patient and the survival rate decreases considerably. The objective of the study was to analyze the clinico-epidemiological and histological characteristics of skin metastases, in order to better understand different types of malignancies and their prognosis, as well as to highlight the particularities of this rare localization of the metastases. Material and methods. We conducted a retrospective study, in which we included 50 cases of skin metastases diagnosed in the Pathology Department of the University Emergency Hospital Bucharest, Romania, over a period of three years. We analyzed the cases from all epidemiological, clinical, gross and histological data, based on the records of the hospital. Results. The patients’ ages ranged from 16 to 92 years old, with a mean age of 60.1 years. Almost half of the patients were females (26 cases). Most of the patients were diagnosed with primary melanoma (17 cases), followed by primary tumors of the gastrointestinal tract (9 cases) and breast carcinomas (8 cases). 29 cases presented with complications, such as ulceration, infection or necrosis. Conclusions. Most of the skin metastases were of malignant melanoma, but any kind of primary tumor can, eventually, disseminate to the skin, conferring a poor prognosis on the patient. Also, any site can be involved, but some malignancies do have preferred areas for dissemination

The importance of early arthritis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies