Current principles for the surgical treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma is one of the most aggressive forms of cancer. It is usually diagnosed in advanced stages of the disease, mainly because it is asymptomatic for a long time after the onset. Consequently, intrahepatic cholangiocarcinoma still represents an important problem of diagnosis and treatment. In the multidisciplinary treatment of these patients, oncological surgery is essential, as the accuracy of resection is one of the most important prognostic factors for the long-term results of these patients. Therefore, there has been a continuing concern to improve surgical techniques, with the aim of maximizing the chances of achieving the best possible long-term survival. The purpose of this paper is to discuss the surgical standard of care in intrahepatic cholangiocarcinoma, with particular attention being paid to resection margins and lymph node dissection. For unresectable cholangiocarcinoma, locoregional therapy can be used such as transarterial chemoembolization, transarterial radioembolization, thermal ablation, radiotherapy and hepatic artery infusion pump chemotherapy

Ovarian cancer prevention and screening – where do we stand today?

Widely recognized as the most deathful gynecologic malignancy affecting women worldwide, ovarian cancer has reported a significant decline in terms of prevalence and incidence in the last decades. This fact has been especially explained by to the use of menopausal hormonal therapy and of oral contraceptives in association with genetic, oncologic and gynecologic counseling. The aim of the current review is to discuss about actual ovarian cancer prevention and screening tools. For this reason, we reviewed several data related to ovarian cancer, such as: incidence and risk factors, histopathological types (epithelial with high- and low-grade serous carcinomas, clear cell carcinoma, mucinous carcinoma, germ cells ovarian cancer tumors), as well as screening, diagnosis and prevention methods (ovulation disruption, surgical prevention, etc.). Although progress has been reported in the last decades in terms of early diagnosis and treatment of ovarian cancer, this malignancy still represents a significant health problem affecting women worldwide. However, it seems that the golden key for optimizing the long-term outcomes in such patients is represented by a better understanding of the complex pathogenesis of this disease

NONMUSCLE INVASIVE TRANSITIONAL CELL CARCINOMA OF URINARY BLADDER – ADJUVANT INTRAVESICAL THERAPIES AFTER TRANSURETHRAL TUMOR RESECTION

Introduction. More than 70% of all bladder cancers are nonmuscle invasive involving only the mucosa and the submucosa. A large percentage of patients present local recurrence after endoscopic surgery, and many of them progress to muscle invasive disease necessitating radical cystectomy. The high recurrence and progression rate is the reason to use intravesical therapy to prevent recurrences. The aim of this study is to compare the efficacity and safety of intravesical immunotherapy with Bacillus Calmette Guerin (BCG) vs. chemotherapy (Pharmoribicin) after TUR-B for NMIBC. Material and methods. Following TURB and pathological analysis, NMIBC was stratified into low, intermediate and high-risk groups depending on the probability of recurrence and progression to muscle-invasive disease. Patients were treated with adjuvant intravesical therapies, BCG or Pharmorubicin. Results. Between 2008 and 2012, a total of 125 patients with NMIBC were diagnosed in the Urology Department Sibiu. Histopathological data show: pT1 G1 – 48 patients (38.4%), pT1 G2 – 69 patients (55.2%), pT1G3 and or Tis – 8 patients (6.4%). Adjuvant intravesical therapies with Pharmorubicin was administered to 83 patients (66.4%) and with BCG 42 patients (33.6%). Pharmorubicin, the recurrence rate was 22.8% in the first year and at 5 years there was a recurrence of 36.1%. For the group of patients treated with BCG recurrent rate was 14.2% in the first year and 33,3% at 5 years. For the whole group of patients tumor progression was 2.4% in the first year and 9.6% at 5 years. For the Pharmorubicin group, in the first year, the progression was 2.4% compared with 2.3% tumor progression in the BCG-treated group. Conclusions. Intravesical instillation treatment after TURB reduce the recurrence rate and tumor progresion. In our series there are no major differences between efficacity of intravesical immunotherapy (BCG) vs. chemotherapy (Pharmoribicin). Disease-free survival and progression-free survival are comparable to the two studied lots

SUBOPTIMAL VITAMIN D STATUS IN INFANTS BETWEEN 1 AND 24 MONTHS OF AGE

Introduction. Vitamin D is well known for its role in calcium absorption and maintenance of healthy bones and its deficiency results in rickets. Serum 25-hydroxyVitamin D (25(OH) D) is the most abundant Vitamin D metabolite and its concentration reflects Vitamin D status in humans. The aim of this study was to analyse the level of 25(OH) D in children between 1 month and 24 months of age, admitted in Sibiu Children’s Hospital, with various pathologies, and to give scientific evidence for the prevention and treatment of rickets. Materials and methods. We made a retrospective study on 200 children, aged between 1 month and 24 months, hospitalized in different Pediatric Departments of Sibiu Children’s Hospital between 01.09.2015 and 01.11.2016, in whom we determined the level of serum 25(OH)D. The optimal level of 25(OH)D was considered to be ≥30 ng/ml; values of 25(OH) D between 20-29 ng/mL define insufficient Vitamin D and Vitamin D deficiency is characterized by levels < 20 ng/ml. Results. Overall, 111 children (55.5%), aged between 1 month and 24 months, had levels of 25 (OH) Vitamin D below 30 ng/ml, with a mean value of 28.68 ng/ml. Of these 111 patients, 87 (78%) had 25(OH)D values between 20-29 ng/ml, with a mean value of 22.61 ng/ml and only 24 children (22%) had values less 20 ng/ml, with a mean value of 17.2 ng/ml. Conclusions. Low serum 25(OH) D levels affect more than half of infants and children, aged 1 month to 24 months, suggesting that there are many children in our area who have suboptimal levels of Vitamin D and this should be a matter of concern for families with children, for medical professionals and public health authorities. Determination of 25(OH) Vitamin D is an important test for children between 1 month and 24 months of age, to be used as a starting point in efficiently preventing rickets at this age

Controversies Regarding Mesh Utilisation and the Attitude towards the Appendix in Amyand’s Hernia—A Systematic Review

Inguinal hernia containing the vermiform appendix is a rare entity. It is more common in children than in adults. It can be discovered incidentally during the surgical intervention performed for the cure of the inguinal hernia or when the appendix shows inflammatory changes, a situation that can lead to diagnostic confusion with a number of other diseases. Imaging can guide the diagnosis, which often comes as an intraoperative surprise. The therapeutic approach is controversial both in terms of whether or not to perform an appendectomy in the case of an appendix without inflammatory changes and especially in terms of using a mesh during the hernia repair process. Since the pathology is not very frequent, there are no standardized stages in terms of surgical ethics that can guarantee good surgical practice. The study aimed to carry out a review of the specialized literature to obtain some conclusions or trends regarding the management of this pathology. The low frequency of this type of hernia did not allow the consultation of large-scale studies or extensive reviews focusing on case reports or case series communications. The obtained results were statistically analyzed and integrated in relation to the surgical attitude depending on the particularities of the condition

Exploring the Potential of Fecal Microbiota Transplantation as a Therapy in Tuberculosis and Inflammatory Bowel Disease

This review explores the potential benefits of fecal microbiota transplantation (FMT) as an adjunct treatment in tuberculosis (TB), drawing parallels from its efficacy in inflammatory bowel disease (IBD). FMT has shown promise in restoring the gut microbial balance and modulating immune responses in IBD patients. Considering the similarities in immunomodulation and dysbiosis between IBD and TB, this review hypothesizes that FMT may offer therapeutic benefits as an adjunct therapy in TB. Methods: We conducted a systematic review of the existing literature on FMT in IBD and TB, highlighting the mechanisms and potential implications of FMT in the therapeutic management of both conditions. The findings contribute to understanding FMT’s potential role in TB treatment and underscore the necessity for future research in this direction to fully leverage its clinical applications. Conclusion: The integration of FMT into the comprehensive management of TB could potentially enhance treatment outcomes, reduce drug resistance, and mitigate the side effects of conventional therapies. Future research endeavors should focus on well-designed clinical trials to develop guidelines concerning the safety and short- and long-term benefits of FMT in TB patients, as well as to assess potential risks

Meniscal Tear Management Associated with ACL Reconstruction

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases

Meniscal Tear Management Associated with ACL Reconstruction

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. &ldquo;Masterly neglect&rdquo; is a valuable option in selected cases