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Industrial areas affected by high and long-term heavy metal pollution have a great impact on health of the resident population. Children represent a group at high-risk with an increased susceptibility to chronic heavy metal intoxication. Our work included the assessment of attention particularities through a case-control study in pre-school and school-aged children (4-6 years and 8-11 years) from two study areas, Copsa Mica and Zlatna, compared to a non-polluted locality with no history of heavy metal pollution. Copsa Mica and Zlatna are two of the most polluted heavy metals regions in Romania due to non-ferrous metallurgy for a long period of time. Recruitment of participants was made by a random selection of an entire class for each age within the schools and kindergartens from the study areas (Copsa Mica and Zlatna) and from the non-polluted region. Interpretation of data was performed using statistical analysis (ANOVA and Student's t-test). Preschool children (4-6 years) were tested using Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests, Animal House and labyrinth samples. The results of the attention tests applied to pre-school children were lower in the study areas compared to the control group, but no statistical differences were found. The results of the attention tests applied to children aged between 8 and 11 years (Toulouse-Pieron test and Traffic light test) indicate lower average scores within the study groups from polluted areas, compared to the control group. Differences with statistically significance were registered for the 8 years age group (p = 0.037). In these areas efficient strategies and precise intervention measures are needed in order to limit or remove the heavy metal exposure and protect the human health, especially the groups exposed to a high level of risk.
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Monitoreo del Ambiente , Metales Pesados , Estudios de Casos y Controles , Niño , Preescolar , Contaminación Ambiental/análisis , Humanos , Metales Pesados/análisis , Rumanía/epidemiologíaRESUMEN
Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies-thoracic computed tomography (CT) scan with or without contrast-but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.
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Tumor Fibroso Solitario Pleural/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Distribución por Sexo , Tumor Fibroso Solitario Pleural/fisiopatología , Tumor Fibroso Solitario Pleural/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Introduction: The abdominal wall hernias in patients with liver cirrhosis have a significant higher prevalence than those in non- cirrhotic patients. The best surgical treatment option and the optimal operative time still represent a subject of debate. Material and method: We have retrospectively analyzed the cases of abdominal wall hernias in patients with liver cirrhosis admitted in the Surgical Department of the Sfantul Pantelimon Clinical Emergency Hospital from Bucharest, undergoing surgical treatment between January 2012 and December 2016. Data regarding the laboratory results (the serum albumin and bilirubin levels, the Prothrombin Time) and the clinical aspects (the presence of ascites or encephalopathy) that helped establish the grade of the disease according to Child classification system, and, also, the information regarding the type of hernia, the character of the surgical indication (emergency or elective), the surgical technique and the postoperative evolution have been collected from the medical documents of the patients included in the present study. The statistical analysis has been made using the chi- square test. Results: 32 cases out of the total 65 patients included in the study, that underwent surgical intervention for the treatment of the abdominal wall defects, had umbilical hernia (49,23%), 18 cases presented with inguinal hernia (27.69%), 11 with incisional hernia (16.92%) and 4 with epigastric hernia (6.15%). 29 patients were subjected to elective surgery (44.6%) and 36 to emergency surgery (55,4%). Regarding the Child classification system used in the present study, 24 patients presented with Child A grade of cirrhosis (36.92%), 30 with Child B (46.15%) and 11 with Child C (16.92%). The postoperative morbidity rate was 45,83% in Child A group, 56,66% in Child B group and 81,8% in Child C group. The mortality rate was 4,16% in the Child A group (one death), 13.33% in the Child B group (4 deaths) and 72.72% in Child C group (8 cases). The highest mortality rates have been registered in patients that underwent emergency surgical intervention. Conclusions: The parietal defects in patients with liver cirrhosis can be surgically treated with satisfactory outcomes. The best results have been registered in patients with compensated form of the cirrhosis or in cases undergoing elective surgery. The methods used for the surgical treatment of the abdominal wall defects vary from herniorrhaphy to alloplastic techniques. For patients with ascites, a good control of this complication represents an important factor for the favourable postoperative evolution. The emergency surgical interventions are associated with greater risks of morbidity and mortality.
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Hernia Abdominal/cirugía , Herniorrafia/mortalidad , Cirrosis Hepática/complicaciones , Adulto , Anciano , Femenino , Hernia Abdominal/complicaciones , Herniorrafia/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Peritoneo/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Finasteride has proved to be relatively safe and effective in the therapeutic management of male androgenic alopecia. However, literature data report several endocrine imbalances inducing various adverse effects, which often persist after treatment cessation in the form of post-finasteride syndrome. Here we present the case of a 52-year-old man receiving finasteride (1 mg/day) who developed an uncommon adverse effect represented by generalized vitiligo 2 months after finasteride discontinuation. Associated adverse effects encountered were represented by mild sexual dysfunction (as determined by the International Index of Erectile Function, IIEF) and moderate depressive symptoms (according to DSM-V criteria), all of these manifestations aggregating within/as a possible post-finasteride syndrome. Further studies should develop and compare several therapeutic approaches, taking into account not only compounds that decrease the circulating dihydrotestosterone level but also those that could block the dihydrotestosterone receptors (if possible, compounds with selective tropism towards the skin). In addition, the possibility of predicting adverse effects of finasteride (according to hand preference and sexual orientation) should be taken into account.
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Finasterida/efectos adversos , Vitíligo/inducido químicamente , Alopecia/tratamiento farmacológico , Finasterida/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Symptomatic hemorhoidal disease is a serious issue affecting the quality of life. The multiplicity of current interventional procedures reflects the failure of covering all pathological aspects, thus justifying the quest for other operative solutions. Any new operative procedure is challenged by the need for broad applicability and less invasive attributes and should fit inside the frame of reasonable costs, fair efficacy, low morbidity and recurrence rate based on a procedural technique that is simple enough, reproducible and easy-tolearn. Aiming to achieve these goals we conceived a procedural variant of hemohrhoidopexy fit for outpatient surgery, a technique that does not require sophisticated/costly medical equipment or disposables and is less invasive. The operative indication concerned 2nd, 3rd and 4th grade hemorrhoids. The surgical indication was represented by 2nd, 3rd and 4th grade hemorrhoids. The needed anesthesia is regional (caudal spinal anesthesia), which qualifies this procedure for private medical services. Prolapse reduction is followed by transmucosal suturing using two rows of slowly absorbable half-step staggered en-X stitches placed just above the dentate line. Preliminary results are encouraging both as therapeutic success rate and legerity of postoperative consequences. This hemorrhoidopexy is a simple and broadly applicable technique, causing mild pain, low morbidity and good efficacy, preferable to other techniques used to treat 3rd grade and selected 4th grade hemorrhoids.
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Hemorreoidectomía/métodos , Hemorroides/cirugía , Técnicas de Sutura/instrumentación , Procedimientos Quirúrgicos Ambulatorios , Estudios de Factibilidad , Hemorroides/patología , Humanos , Calidad de Vida , Recurrencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Recent clinical and imaging studies suggest that sex hormones modulate sexuality according to a psychophysiologic process of lateralization of the brain, with androgens playing a greater role in sexual functioning of left hemibrain/right handedness and estrogens possibly for right hemibrain/left handedness. Based on this perspective, the current study attempted to specify the relationship between hand preference, estrogens, and sexual function in subjects with male breast cancer, taking into account the sexual side effects of tamoxifen as the agent for inhibiting estrogen action. Twenty-eight Romanian men-17 right-handed and 11 left-handed-undergoing treatment with tamoxifen for male breast cancer participated in this study. These men were assessed both prior to and during tamoxifen treatment using the International Index of Erectile Function, a standardized instrument used for the evaluation of various aspects of sexual functioning, including erectile function (EF), orgasmic function (OF), sexual desire (SD), and overall functioning (OF). A main effect for handedness was found on EF, OF, SD, and OS scales, with right-handed men showing higher functioning than left-handed men. Regarding interaction effects, the left-handed group of men showed greater decreased sexual functioning during tamoxifen (on three subscales: OF, SD, OS) compared to right-handed men. Further research should be conducted in order to support and refine this potential lateralized process of sexual neuromodulation within the brain.
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Antineoplásicos Hormonales/administración & dosificación , Neoplasias de la Mama Masculina/tratamiento farmacológico , Lateralidad Funcional , Tamoxifeno/administración & dosificación , Adulto , Antineoplásicos Hormonales/efectos adversos , Encéfalo/fisiología , Humanos , Masculino , Erección Peniana/fisiología , Proyectos Piloto , Rumanía , Encuestas y Cuestionarios , Tamoxifeno/efectos adversosRESUMEN
OBJECTIVE: To investigate the relationships between pharmacologically induced deprivation of dihydrotestosterone, sexual arousal, libido and hand preference, by comparing the self-reported sexual response prior to and during reception of the anti-androgen finasteride in men undergoing treatment for male pattern baldness. PATIENTS AND METHOD: In total, 33 sexually healthy Romanian men participated in this study. Patients prospectively provided information regarding their sexual functioning (over 4 weeks), as measured by the International Index of Erectile Function (IIEF) prior to and after commencing treatment with 1 mg finasteride for male pattern baldness. RESULTS: Overall IIEF scores as well as the erectile function, orgasmic function, sexual desire and overall satisfaction subscales showed group, treatment and group by treatment effects. The intercourse satisfaction subscale showed group and group by treatment effects. On most subscales, right-handed men showed no effect or lower sexual function whereas left-handed men reported no effect or improved sexual function, primarily. CONCLUSIONS: These results suggest that the sexual effects of dihydrotestosterone deprivation may depend on handedness--a proxy variable that may represent cognitive style--which lends further support to the idea of two distinct neuroendocrine psychosexual axes. They further suggest that detection of such sexual effects may be enhanced by using research methodologies and communication strategies that increase patients' sensitization to such effects.
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Alopecia/tratamiento farmacológico , Disfunción Eréctil/inducido químicamente , Finasterida/uso terapéutico , Salud del Hombre , Satisfacción del Paciente , Erección Peniana/efectos de los fármacos , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Adulto , Alopecia/complicaciones , Alopecia/psicología , Disfunción Eréctil/fisiopatología , Disfunción Eréctil/psicología , Finasterida/efectos adversos , Estudios de Seguimiento , Humanos , Masculino , Proyectos Piloto , Conducta Sexual/efectos de los fármacos , Encuestas y CuestionariosRESUMEN
Pancreatic cancer is one of the most lethal malignancies affecting people worldwide. As it is frequently diagnosed in advanced stages of the disease, the 5-year overall survival rate is <10%. Advanced stages are usually characterized by the local invasion of the superior mesenteric axis, celiac axis and portal vein and are considered a sign of unresectable cancer. The association between venous resections and survival outcomes has been widely reported. The effect of arterial invasion remains unclear as only isolated cases have been reported thus far. The present study investigated the preliminary experience in the field of arterial resection for locally advanced pancreatic cancer. Between January 2018 and January 2020 arterial resection was successfully associated with pancreatoduodenectomy in four cases. The mean age at the time of surgery was 48 years, and in all cases the indication of resection was represented by pancreatic head adenocarcinoma. Different types of venous resections were required in all cases. Postoperative reoperation was required in one case, while histopathological studies confirmed microscopic negative resection margins in all but one case. In selected cases, combined pancreatoduodenectomy with venous and arterial resection may be required to increase the chances of radical surgery.
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BACKGROUND: pancreatic cancer is one of the most lethal malignancies and a leading cause of cancer-related death worldwide. The only chance to improve the long-term outcomes of patients with pancreatic cancer is surgery with radical intent. METHODS: in the present paper, we aim to describe a case series of 9 patients submitted to radical surgery for borderline resectable pancreatic cancer. RESULTS: in all cases, negative resection margins were achieved. The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. CONCLUSIONS: extended venous resections can be a safe and efficient way to maximize the benefits of radical surgery in locally advanced, borderline resectable pancreatic cancer.
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BACKGROUND/AIM: Pancreatic cancer represents the most lethal abdominal malignancy, the only chance for achieving an improvement in terms of survival being represented by radical surgery. Although it has been considered that venous invasion represents a contraindication for resection, recently it has been demonstrated that in regards to overall survival after radical resection, it is similar to the one reported after standard pancreatoduodenectomy. CASE REPORT: A 53-year-old patient with no significant medical past was diagnosed with a borderline resectable pancreatic adenocarcinoma invading the superior mesenteric vein. The patient was submitted to pancreatoduodenectomy en bloc with superior mesenteric vein resection; the two jejunal veins were further anastomosed to the remnant portal vein. The postoperative outcome was favorable; the patient was discharged in the 10th postoperative day. CONCLUSION: Although technically more demanding, pancreatoduodenectomy en bloc with superior mesenteric vein resection and jejunal portal anastomosis is feasible and might offer a chance for long-term survival in borderline pancreatic head carcinoma invading the superior mesenteric vein.
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Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/cirugía , Anastomosis Quirúrgica , Humanos , Venas Mesentéricas/cirugía , Persona de Mediana Edad , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Vena Porta/cirugíaRESUMEN
BACKGROUND: Locally advanced pancreatic cancer invading the surrounding vascular structures has long been considered as unresectable and, therefore, patients were usually submitted to palliative chemotherapy. CASE REPORT: We present the case of a 44-year-old male investigated for weight loss and abdominal pain and diagnosed with a locally advanced pancreatic tumor invading the celiac axis. An endoscopic ultrasound was performed and a biopsy was retrieved demonstrating the presence of a moderately differentiated pancreatic adenocarcinoma. After discussing with the patient the risks and the benefits of performing an extended surgical procedure, the patient consented to distal pancreatectomy en bloc with celiac axis resection. Postoperatively, the patient was submitted to low-molecular-weight heparin therapy for 3 weeks followed by oral anticoagulant for 2 months. Histopathological studies confirmed the presence of a moderately differentiated pancreatic adenocarcinoma invading the celiac axis and described negative resection margins. CONCLUSION: Although celiac axis invasion has been considered for a long period of time as a sign of unresectable disease due to the high rates of perioperative complications, it seems that in selected cases, surgery can be safely performed with curative intent, especially if negative resection margins are achieved.
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Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Adulto , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/cirugía , Humanos , Masculino , Páncreas , Pancreatectomía , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugíaRESUMEN
The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities. Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.
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BACKGROUND/AIM: Association between cervical cancer and uterine prolapse represents a scarce eventuality. This is a case series of 11 patients diagnosed with different stages of cervical cancer in association with uterine prolapse. PATIENTS AND METHODS: Between 2014 and 2020, 11 patients were diagnosed with cervical cancer on prolapsed uterine cervix. RESULTS: The mean age of patients at the time of uterine cervix diagnosis was 68 years. In six cases, the first intent treatment was surgery, while in the remaining five cases it consisted of radio-chemotherapy, followed by radical surgery. The perioperative and postoperative outcomes were compared to those reported in a similar series of patients diagnosed in similar stages of the disease, but in the absence of uterine prolapse, no significant differences being encountered. CONCLUSION: Although it represents an unusual situation, malignant transformation of the uterine cervix might be encountered even in cases presenting uterine prolapse. In such cases, the therapeutic strategy should be tailored according to the stage of the disease.
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Neoplasias del Cuello Uterino , Prolapso Uterino , Anciano , Femenino , Humanos , Histerectomía , Neoplasias del Cuello Uterino/cirugía , Prolapso Uterino/complicaciones , Prolapso Uterino/diagnóstico , Prolapso Uterino/cirugíaRESUMEN
BACKGROUND/AIM: Malignant transformation of mature cystic ovarian teratoma is a scarce eventuality, only rare cases being reported so far. Furthermore, development of this transformation in the setting of an abscessed tumor is even scarcer. The aim of this study was to report the case of a 47-year-old patient submitted to surgery for such a lesion. CASE REPORT: The patient was investigated for diffuse pelvic pain and diagnosed with a 10×7×8 cm mass at the level of the left adnexa with imaging findings suggesting the presence of an ovarian teratoma. The patient was submitted to surgery involving a total hysterectomy with bilateral adnexectomy, lymphadenectomy and peritoneal biopsies. The histopathological examination demonstrated the presence of squamous cell carcinoma areas transformation in association with areas of abscess. Postoperatively the patient was submitted to six cycles of platinum-based chemotherapy and concurrent external radiotherapy. At one-year follow-up she is free of recurrent disease. CONCLUSION: Although malignisation of mature cystic ovarian teratoma is a rare event, it should not be omitted when mature ovarian teratoma is suspected; however, association between malignant transformation and abscess is a scarcer eventuality.
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Carcinoma de Células Escamosas , Neoplasias Ováricas , Teratoma , Absceso/diagnóstico , Absceso/cirugía , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Transformación Celular Neoplásica , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Teratoma/diagnóstico , Teratoma/cirugíaRESUMEN
BACKGROUND/AIM: Gastroenteropancreatic neuro-endocrine carcinomas represent poorly differentiated neoplasms with a high capacity of spreading inducing the development of distant metastases. In such cases debulking surgery seems to offer a good chance for survival especially in well and moderately differentiated lesions. The aim of this study was to report the case of a 48-year-old patient submitted to surgery for moderately differentiated neuroendocrine gastric carcinoma with distant metastases. CASE REPORT: The patient was initially investigated for hematemesis and weight loss and was diagnosed with a lesser curvature gastric tumor in association with liver and peritoneal metastases. Due to the extent of the disease, the patient was initially submitted to neoadjuvant chemotherapy followed by surgery with radical intent. At the time of surgery subtotal gastrectomy en bloc with total omentectomy, peritonectomy, cholecystectomy and atypical liver resection were performed. Moreover, the two ovaries presented large tumoral masses so total hysterectomy with bilateral adnexectomy was performed. The histopathological studies confirmed the presence of a moderately differentiated neuroendocrine gastric carcinoma with negative resection margins. CONCLUSION: Multiple visceral resections might be needed in order to maximize the debulking effort in metastatic gastric neuroendocrine carcinomas.
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Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/cirugía , Procedimientos Quirúrgicos de Citorreducción , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción/métodos , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Endometrial cancer is one of the most commonly encountered malignancies among obese women worldwide, a strong causality relationship being established between the two entities. Furthermore, obesity is also associated with metabolic syndrome; the aim of this study was to investigate the effect of metabolic syndrome on the postoperative outcomes of patients with endometrial cancer. PATIENTS AND METHODS: Data of 23 patients diagnosed with endometrial cancer and metabolic syndrome were retrospectively reviewed and compared to the those of a control group of patients diagnosed with endometrial cancer in the absence of metabolic syndrome. RESULTS: Patients in the first group presented significantly higher values of body mass index when compared to the control group. There were no significant differences in terms of stage, histopathological subtype or degree of differentiation between the two groups. The completeness of cytoreduction was lower among patients with metabolic syndrome, however, this did not reach statistical significance (p=0.08). Although the rate of complete debulking was lower among those with metabolic syndrome, the rates of postoperative complications were significantly higher. CONCLUSION: The association of metabolic syndrome significantly influences the risk of postoperative complications in patients with endometrial cancer; moreover, in certain cases, it might preclude the achievement of freedom from residual disease.
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Neoplasias Endometriales , Síndrome Metabólico , Índice de Masa Corporal , Neoplasias Endometriales/complicaciones , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/cirugía , Femenino , Humanos , Síndrome Metabólico/complicaciones , Síndrome Metabólico/epidemiología , Obesidad/complicaciones , Obesidad/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND/AIM: The presence of "omental cake" has been considered since long as a negative prognostic factor in patients diagnosed with advanced-stage ovarian cancer. The aim of this paper was to study the impact of "omental cake" presence on the perioperative outcomes in advanced-stage ovarian cancer. PATIENTS AND METHODS: Between 2015 and 2020, 85 patients were submitted to surgery for advanced-stage ovarian cancer. RESULTS: Among cases diagnosed with "omental cake" the rate of complete cytoreduction was significantly diminished when compared to cases in which this entity was not revealed. In the meantime, the presence of omental cake among cases in which complete debulking was achievable was significantly associated with a higher number of digestive resections when compared to the other cases submitted to surgery and in which tumoral transformation of the omentum was encountered. CONCLUSION: The presence of "omental cake" is associated with a higher rate of incomplete resections. However, in cases in which complete debulking was achieved, the presence of omental cake was associated with a significantly higher number of digestive tract resections.
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Procedimientos Quirúrgicos de Citorreducción , Neoplasias Ováricas , Carcinoma Epitelial de Ovario , Femenino , Humanos , Estadificación de Neoplasias , Epiplón/patología , Epiplón/cirugía , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Estudios RetrospectivosRESUMEN
Due to the wide introduction of screening tests, patients with neoplastic diseases of the uterine cervix trend to be diagnosed in early stages of the disease, and less invasive surgical procedures are needed in certain cases. In this respect, the technique of sentinel lymph node dissection has been widely implemented as part of the therapeutic strategy, indocyanine green (ICG) being one of the most reliable markers for sentinel lymph node detection. However, it seems that this agent is extremely useful in order to achieve better short-term and long-term results after cervical cancer surgery, due to its capacity to determine the uterine vascular perfusion in cases in which conservative treatment, such as trachelectomy, is performed, as well as to prevent and treat lower limb lymphedema. A literature review was conducted of the studies which focused on the role of ICG utility in cervical cancer patients besides sentinel lymph node detection, special focus was given to vascularization preservation and lower limb lymphedema prevention and treatment.
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Inguinal lymph node mass as the first sign in patients with ovarian cancer represents a rare situation, with only few cases being reported so far. We present the case of a 46-year-old patient who presented for the apparition of bilateral inguinal tumoral masses in the absence of any other pathological signs. The biopsy revealed the presence of an adenocarcinoma with probable genital origin; however, neither the gynaecological examination nor the computed tomography demonstrated the presence of any suspect lesion. The patient was submitted to a positron emission computed tomography which revealed a high capitation in both adnexal areas as well as at the level of the inguinal lymph nodes. The patient was submitted to surgery, the frozen section of the adnexas confirming the ovarian origin of the tumor. Complete cytoreduction to no residual disease was successfully performed. At one-year follow-up the patient is free of any recurrent disease.
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Conducto Inguinal/patología , Ganglios Linfáticos/patología , Neoplasias Ováricas/diagnóstico , Ovario/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor , Biopsia , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Diaphragmatic surgery in advanced-stage ovarian cancer has been considered since long time to increase the rates of postoperative complications. However, improvement of surgical techniques and perioperative management of these patients has lead in the last decade to a safe association of such procedures as part of debulking process. The aim of the current paper was to report our experience regarding the role of diaphragmatic resections as part of debulking surgery for advanced stage ovarian cancer. MATERIALS AND METHODS: Between 2014 and 2016 diaphragmatic surgery was performed in 22 cases with advanced stage ovarian cancer. RESULTS: Diaphragmatic surgery consisted of diaphragmatic peritoneal resection in 10 cases, full thickness diaphragmatic resections in four cases and coagulation of peritoneal nodules in eight cases. In all but two cases debulking surgery to no residual disease was achieved. Other upper abdominal resections consisted of splenectomy - in four cases, liver resections - in three cases, glissonian capsule resections - in eight cases, distal pancreatectomy - in one case and partial gastrectomies in two cases. The postoperative outcomes were similar irrespective of type of diaphragmatic surgical procedure. CONCLUSION: Diaphragmatic surgery is a crucial procedure which can be safely associated as part of debulking surgery for advanced stage ovarian cancer.