Immunohistochemical pattern– a prognostic factor for synchronous gastrointestinal cancer

Recent advancements in medical genetics and molecular biology are reflected in the modern understanding and approach to colorectal carcinoma (CRC). Understanding the cellular mechanisms and mutational patterns that promote carcinogenesis could enhance the predictive accuracy of the TNM classification. Furthermore, this will allow for a much more documented stratification and tailored oncological treatment. This paper presents an illustrative case of a relatively young patient (50 years old) with no family history of cancer who was diagnosed with four synchronous gastrointestinal (GI) adenocarcinomas displaying a wild type P53, negative BRAF testing, and mutated MLH1 and PMS2 proteins. This case report contributes to the relevant literature with a concise review of the role of micro-satellite instability (MSI), chromosomal instability (CIN), and CpG island methylator phenotype (CIMP) in carcinogenesis, hereditary and sporadic gastrointestinal cancers, a discussion over the importance of molecular sub-typing in predicting long term outcomes and choosing the most suitable adjuvant treatment regimen

Ethical aspects in managing patients diagnosed with digestive cancers; a review of literature

Numerous bioethical recommendations are now available in the complex process of communication with cancer patients. In this review, we have focused on the complex process of managing patients with different types of oncologic digestive diseases, immediately after the diagnosis is made. We have analyzed the literature data on the topic. MEDSCAPE and PubMed databases have been studied. Issues such as telling the truth to patients with digestive cancer, the physician\u27s responsibility in the psychological management of patients and their relatives, the nurses’ duties, the consented death, the practice of euthanasia and physician-assisted suicide (PAS) as well as the clinical research have been the main targets of our study

Xanthogranulomatous pyelonephritis: presentation and management

Xanthogranulomatous pyelonephritis (XGP) is characterized by the presence of lipid-laden foamy macrophages with both acute and chronic phase inflammatory cells. The aim of the study is to present our experience about patients with Xanthogranulomatous pyelonephritis. 29 patients were evaluated through a complete anamnesis and the preoperative management included routine blood and biochemical tests, urine culture and renal ultrasound, intravenous urography and computed tomography (CT). All patients underwent open nephrectomy followed by the pathological exam. The main symptoms of these patients were fever and flank pain. Preoperative laboratory tests revealed anemia, leukocytosis and increasing levels of blood urea nitrogen (BUN) and creatinine. Kidney failure was noticed in almost half of the cases. This study succeeded to evaluate the demographic, clinical, biological, surgical and histological characteristics. A pathological diagnosis is mandatory mainly for the evaluation of its coexistence with renal carcinoma

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

Abdominal-pelvic pain in female patients with endometriosis - a review of the literature

Abdominal-pelvic pain is the dominant symptom in endometriosis, one of the most common pathologies that affect women, being also a multifactorial disorder. Exploratory laparoscopy allows the correct assessment of the location as well as severity and extent of the lesions, thus representing the current gold standard in diagnosis. The correlation of pain intensity with the evolutionary stage of endometriosis is inconstant. Surgical treatment, preferably performed laparoscopically, includes the excision of the ectopic endometrium, having as a primary objective the control of persistent pain and the removal of all endometriotic foci. This procedure helps to improve the life quality of the patient, to reduce relapses, to control postoperative pain, and to eliminate the disease. Pre- and post-operative adjuvant medical treatment is used due to its effects on the symptomatology, prolonging the asymptomatic period of the disease. Despite the use of the above procedures, there are cases in which the abdominal-pelvic pain persists even after surgery, which makes endometriosis a significant challenge for both the specialist and the patient, as well as for the medical system itself, as the study of the pathogenic mechanisms is yet the subject of numerous studies. Nutritional education in these patients is essential, given the recommendation to restrict the range of foods and to increase other foods that have an important role in reducing the risk or even leading to regression of the endometrial pathology

Ethical aspects in managing patients diagnosed with digestive cancers; a review of literature

Numerous bioethical recommendations are now available in the complex process of communication with cancer patients. In this review, we have focused on the complex process of managing patients with different types of oncologic digestive diseases, immediately after the diagnosis is made. We have analyzed the literature data on the topic. MEDSCAPE and PubMed databases have been studied. Issues such as telling the truth to patients with digestive cancer, the physician\u27s responsibility in the psychological management of patients and their relatives, the nurses’ duties, the consented death, the practice of euthanasia and physician-assisted suicide (PAS) as well as the clinical research have been the main targets of our study

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

When myocardial infarction is choosing young victims

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a “burnout syndrome” in the last few months. The particularity of the presented case is the severe coronary artery disease in a young patient without discovering the main etiology of the advanced atherosclerotic process

Management options in the sudden hearing loss of a diabetic patient

The aim of our paper is to highlight the main therapeutic principles and the management options in the case of a diabetic patient who has had a sudden hearing loss. Mainly, the aim is to underline the sudden hearing loss treatment adjustment of the diabetic patient compared to the non-diabetic patient. By understanding the mechanism of sudden hearing loss in a diabetic patient, namely the impact of glycemic variations and their implication on the microvascular structures of the inner ear, we try to underline the treatment principles and management options of the previously mentioned combined pathologies. Thus, it is necessary to adapt the classes of drugs used in the case of sudden sensorineural hearing loss of the diabetic patient in comparison with the non-diabetic patient, in order not to aggravate or complicate the patient’s functional status. Therefore, the treatment will need to be adapted both by classes of medication and by the type of administration used. Adequate control of the progression, treatment and complications of diabetes mellitus ensures optimal treatment management in case of a sudden hearing loss and therefore interferes with the favorable functional hearing outcomes. The role of this paper is not only to state the therapeutic principles in the case of sudden hearing loss in a diabetic patient, but also to analyze the impact on the management of potential local and systemic risk factors

Abdominal-pelvic pain in female patients with endometriosis - a review of the literature

Abdominal-pelvic pain is the dominant symptom in endometriosis, one of the most common pathologies that affect women, being also a multifactorial disorder. Exploratory laparoscopy allows the correct assessment of the location as well as severity and extent of the lesions, thus representing the current gold standard in diagnosis. The correlation of pain intensity with the evolutionary stage of endometriosis is inconstant. Surgical treatment, preferably performed laparoscopically, includes the excision of the ectopic endometrium, having as a primary objective the control of persistent pain and the removal of all endometriotic foci. This procedure helps to improve the life quality of the patient, to reduce relapses, to control postoperative pain, and to eliminate the disease. Pre- and post-operative adjuvant medical treatment is used due to its effects on the symptomatology, prolonging the asymptomatic period of the disease. Despite the use of the above procedures, there are cases in which the abdominal-pelvic pain persists even after surgery, which makes endometriosis a significant challenge for both the specialist and the patient, as well as for the medical system itself, as the study of the pathogenic mechanisms is yet the subject of numerous studies. Nutritional education in these patients is essential, given the recommendation to restrict the range of foods and to increase other foods that have an important role in reducing the risk or even leading to regression of the endometrial pathology