The Impact of Cancer Stem Cells in Colorectal Cancer.

Despite incessant research, colorectal cancer (CRC) is still one of the most common causes of fatality in both men and women worldwide. Over time, advancements in medical treatments have notably enhanced the survival rates of patients with colorectal cancer. Managing metastatic CRC involves a complex tradeoff between the potential benefits and adverse effects of treatment, considering factors like disease progression, treatment toxicity, drug resistance, and the overall impact on the patient's quality of life. An increasing body of evidence highlights the significance of the cancer stem cell (CSC) concept, proposing that CSCs occupy a central role in triggering cancer. CSCs have been a focal point of extensive research in a variety of cancer types, including CRC. Colorectal cancer stem cells (CCSCs) play a crucial role in tumor initiation, metastasis, and therapy resistance, making them potential treatment targets. Various methods exist for isolating CCSCs, and understanding the mechanisms of drug resistance associated with them is crucial. This paper offers an overview of the current body of research pertaining to the comprehension of CSCs in colorectal cancer.

Cholecystectomy in Mild and Moderate Acute Pancreatitis: A Retrospective Study.

Background: Cholecystectomy has been a subject of debate regarding its timing and utility in cases of mild and moderately severe acute pancreatitis (AP). We aimed to critically evaluate the role of early cholecystectomy in the management of mild and moderate AP, considering patient's characteristics, associated procedures, and overall impact on patient outcomes. Methods: The study compared the outcomes between patients admitted in a tertiary care surgical center undergoing early ( 96h) versus delayed ( 96h) laparoscopic cholecystectomy (LC) for mild and moderately severe acute gallstone pancreatitis between January 2019 and December 2022. Results: The study included 54 cases [mean (standard deviation) age, 59.4 (16.5) years; 31 (57.4%) years females]. All patients underwent LC, with 29 cases undergoing a two-phase therapeutic regimen for common bile duct (CBD) lithiasis, consisting of endoscopic retrograde cholangiopancreatography followed by sequential LC. The early cholecystectomy group (EC) comprised 17 patients (31.5%), while the delayed cholecystectomy group (DC) included 37 patients (68.5%). EC was significantly correlated with lower length of stay (p-value 0.0001) and significantly lower rate of ERCP usage during perioperative period. Conclusions: EC in the first 4 days after admission provides significant benefits such as prevention of recurrent pancreatitis, reduction in complications, and decreased length of stay for patients with mild and moderately severe AP.

Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

INTRODUCTION: Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. MATERIAL AND METHODS: A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. RESULTS: Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). CONCLUSIONS: DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Clinical and Morphological Characteristics of Gastrointestinal Stromal Tumor.

Introduction: Gastrointestinal stromal tumors (GIST) are a rare form of cancer located within the gastrointestinal (GI) tract, defined as tumors with spindle, epithelioid, or occasionally pleomorphic cells. They originate in the interstitial cells of Cajal, with the function of "pacemaker" of gastrointestinal motility. Their behavior is dictated by changes in the c-kit/PDGFRA gene, which is often highlighted by immunolabeling. Methods: We report the clinical, macroscopic, microscopic, and immunohistochemical characteristics of consecutive patients diagnosed with GIST who underwent surgical removal of the tumor in our department between 2008-2022. Results: We included 20 consecutive patients. The presentation was considered a surgical emergency requiring immediate surgical intervention in most subjects. The most common localization is the small intestine (n=9, 45%), followed by the stomach (n=7, 35%), colon (n=3, 15%), and peritoneum (n=1, n=5%). Histologically, the tumors were predominantly mixed (n=10, 50%) followed by spindle type (n=8, 40%) and epithelioid - 2 cases (10%). Conclusion: The clinical presentation of GISTs remains heterogeneous, and the diagnosis is predominantly postsurgical, using complex immunohistochemistry analysis. The tumor size and number of mitoses are strongly associated with the long-term prognosis.

Comparison of Different Laparoscopic Sacrocolpopexy Procedures: A Retrospective Dual Center Analysis.

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques.

Open and Laparoscopic Surgical Approache in Incisional Hernias: A Descriptive Analysis.

Background: Incisional hernias, occurring in 10-20% of patients post-abdominal surgery, significantly affect patient quality of life and healthcare systems. This study analyses two hernia repair methods: laparoscopic intraperitoneal onlay mesh (IPOM) and open on-lay hernioplasty. Key analysis factors include operative time, postoperative pain, complications, length of hospital stay, recovery speed, and recurrence rates, with the goal of identifying the most effective and beneficial approach for patients. Methods: We conducted a retrospective study on 70 patients with postoperative parietal defects at the Dr Carol Davila Clinical Nephrology Hospital, Bucharest, from January 2018 to December 2021. Patients underwent either laparoscopic IPOM (42 patients) or open hernioplasty (28 patients) for uncomplicated incisional hernia repair. We analyzed demographic data, comorbidities, defect size and location, previous surgeries, and surgical outcomes. Results: The laparoscopic group had a slightly shorter operative time and significantly lower postoperative pain levels, as assessed by the Visual Analog Scale. The laparoscopic approach also resulted in shorter hospital stays and quicker return to routine activities. Complications, such as seroma and hematoma, were more common in the open surgery group, but no wound infections or prosthesis rejections were observed in either group. Notably, the open surgery group showed a higher recurrence rate (11 %) compared to none in the laparoscopic group within a one-year follow-up. Conclusion: Laparoscopic IPOM for incisional hernia repair shows benefits over open hernioplasty, with less pain, shorter hospitalization, faster recovery, and lower recurrence. Its growing preference and potential for further research are highlighted.

Role of a Stoma Nurse in the Management of the Specific Stoma-Related Complications.

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life.

Carcinoembryonic Antigen CEA - Prognostic Value in Immediate Post-Operative Mortality in Colorectal Cancer.

INTRODUCTION: This study investigates the prognostic significance of carcinoembryonic antigen (CEA) levels in predicting early postoperative mortality in patients who have undergone colorectal cancer surgery. METHODS: Between 2017 and 2022, total of 325 patients were enrolled in the study, and their preoperative serum CEA levels were measured. Relevant clinical and operative data were extracted and correlations between CEA levels and postoperative mortality was analysed. RESULTS: Among the surgical cases, 180 patients (55.3%) exhibited elevated CEA levels. Within the early postoperative period of 30 days, 14 patients (4.3%) succumbed, comprising 8 cases (2.4%) of colon cancer and 6 cases (1.8%) of rectal cancer. Notably, only 3 cases (0.9%), consisting of 1 (0.3%) colon cancer and 2 (0.6%) rectal cancer cases, were associated with an elevated CEA level. However, no statistically significant correlations were observed between CEA levels and early postoperative mortality. CONCLUSIONS: Our findings indicate that increased CEA levels may not serve as a reliable non-invasive marker for identifying patients at high risk of early mortality in the context of colo-rectal cancer surgery.