11 research outputs found
Sentinel node biopsy for personalized breast cancer management; advances and controversies
Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary lymph node staging, providing valuable prognostic information while minimizing complications compared to axillary lymph node dissection. However, there are ongoing debates and controversies surrounding SLNB in specific cases. Studies have explored the use of SLNB in neoadjuvant chemotherapy, emphasizing the need for customized therapy decisions. Factors such as age, tumor characteristics, and treatment response influence the selection of SLNB or axillary lymph node dissection. Additionally, the presence of extranodal extension, micrometastases, and isolated tumor cells has been evaluated to determine the need for lymphadenectomy. The importance of accurate oncological staging by thorough pathological evaluation has been highlighted, particularly with regards to invasion depth and lympho-vascular invasion. The significance of biological tumor status, such as hormone receptor and HER2 status, in axillary management decisions has been emphasized. Moreover, discussions have emerged regarding SLNB in the context of local recurrence, with differing perspectives on its utility. Future extensive studies are needed to refine protocols and incorporate these concepts related to SLNB into breast cancer management guidelines
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
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
Hepatitis C virus: host, environmental and viral factors promoting spontaneous clearance
Hepatitis C virus (HCV) is a pathogenic entity which determines inflammation and liver damage through complex immune mechanisms. Although progress has been made in managing the disease course, chronic infection still remains a significant cause of morbidity and mortality to this day. Because both acute and chronic infection are often asymptomatic, chronic infection is frequently diagnosed when its complications have developed. In a small proportion of cases, the chronic infection does not develop, the immune system managing to cleanse the body from this silent pathogen in the absence of specific treatment, a process called spontaneous viral clearance, which occurs rarely, in about 20-30 % of cases. A competent immune response that manages to eliminate the virus from the organism was associated with IL-28B genetic polymorphism, female gender, young age, which often lead to clinical manifestations of acute hepatitis after initial exposure. Environmental factors such as limited viral exposure also play an important role. These factors and the mechanisms underlying spontaneous clearance are not fully understood but their action is complementary. In this paper, we review the concept of spontaneous clearance of HCV and assess the factors that have been associated with this clinical outcome of the infection
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
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
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
Regenerative medicine options in treating premature ovarian failure
Infertility is generally defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. premature ovarian failure (POF) is a cause of female infertility, being estimated to affect 1% of the general population. This condition represents a loss of hormonal and germinative activity of the ovaries due to a lack in the number of active follicles in women under 40 years old. Regenerative medicine represents a complex therapeutic option and it consists of technologies such as the use of stem cells, tissue engineering, and gene therapy alone or in different combinations. Although the boundaries of regenerative medicine are not clearly outlined at present, this paper is aiming to review its possibility of treatment in the future in what concerns POF, focusing more on the use of stem cell therapy. Stem
cell therapy could be a feasible therapeutic approach for POF as the cells can be easily obtained. However, additional clinical studies are needed because until now the majority of the literature focuses on animal models for the evaluation
of the role of stem cells on treating POF. Additionally, the platelet-rich plasma (PRP) approach for POF should be kept in mind as it was shown to be useful in the regeneration of multiple types of tissue
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