Laparoscopic approach of inguinal hernia associated with adult cryptorchidism: case series and literature review.

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management.

Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

AIM: Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. METHOD: A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Double J Stents and Reno-Ureteral Lithiasis: Dynamic Changes in Management during the COVID-19 Pandemic.

PURPOSE: To provide an evidence-based review of the use of ureteral stents in managing reno-ureteral lithiasis during the COVID-19 pandemic. MATERIALS AND METHODS: A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the search query, we entered "ureteral stents" OR "double J stent" AND "renal colic" OR "ureteral obstruction" OR "reno-ureteral lithiasis" AND "COVID-19 Pandemic" OR "SARS-CoV-2 infection". RESULTS: Patients with lithiasis should be categorized into low priority, intermediate priority, high priority, and emergency under the COVID-19 pandemic scenario to manage their delay and save resources, including healthcare professionals, beds, and ventilators. However, immediate interventions are necessary for individuals at risk of life-threatening septic complications. During the COVID-19 pandemic, the feasibility of conducting or resuming elective activity depended on local circumstances, the accessibility of beds and ventilators, and the execution of screening protocols. If lithiasis surgery is delayed, consequences and increased effort will be inevitable. It is possible that teleconsultation could help guide these patients and cut down on unnecessary visits and exposure. CONCLUSIONS: COVID-19 has shifted treatment options for urinary stones, with ureteral stents being a safe, efficient, and cost-effective option for managing urolithiasis. Decompression is essential in emergency situations, while ureteral stents reduce the risk of infection and hospital visits.

A prospective, real-world, multinational study of febrile neutropenia (FN) occurrence in oncology patients receiving chemotherapy with intermediate risk of FN: a MASCC Neutropenia, Infection, and Myelosuppression Study Group initiative.

PURPOSE: Limited knowledge is available on the incidence of febrile neutropenia (FN) in intermediate-risk patients and the rationale for use of granulocyte colony-stimulating factor (G-CSF) in these patients. We aimed to estimate the rate at which patients associated with intermediate risk (10-20%) of FN would develop ≥ 1 episode of FN with a commonly used chemotherapy regimen in clinical practice. METHODS: This prospective, real-world, observational, multinational, multicenter study (December 2016-October 2019) recruited patients with solid tumors or Hodgkin's/non-Hodgkin's lymphoma. Patients receiving chemotherapy with intermediate risk of FN, but not G-CSF as primary prophylaxis were included and observed for the duration of the chemotherapy (≤ 6 cycles and ≤ 30 days after the last chemotherapy administration). RESULTS: In total, 364 patients (median age, 56 years) with 1601 cycles of chemotherapy were included in the analysis. The incidence of FN was 5% in cycle 1, 3% in cycles 2-3, and 1% in cycles 4-6. The rate of patients with ≥ 1 episode of FN was 9%, and 59% of FN events were reported during cycle 1. The rate of grade 4 neutropenia in cycle 1 was 11%, and 15% of patients experienced ≥ 1 episode of grade 4 neutropenia. CONCLUSIONS: Overall, the incidence of FN was low, with a high incidence in cycle 1 and a decrease in the subsequent cycles. These results provide the real FN risk for common chemotherapy regimens in patients generally excluded from clinical trials. Prophylactic G-CSF in intermediate-risk patients could be considered as per clinician's judgement.

Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial.

BACKGROUND: Delayed gastric emptying sometimes occurs after right colectomy with extended lymphadenectomy. The aim of this randomized controlled trial is to evaluate the effect on delayed gastric emptying after performing a fixation of the stomach to the retrogastric tissue to return the stomach to a physiological position after right colectomy with lymphadenectomy, including gastrocolic lymph nodes dissection for proximal transverse colon cancer. METHODS: From January 2015 to December 2020, patients undergoing right colectomy with extensive lymphadenectomy for proximal transverse colon cancer were randomly assigned to either the gastropexy group or the conventional group. In the gastropexy group, the posterior wall of the stomach, at the level of the antrum, was sutured to the retrogastric tissue to prevent the abnormal shape that the gastric antrum acquires together with the duodeno-pancreatic complex, the shape that leads to an obstruction of the antrum region and to the delay in emptying the gastric contents. RESULTS: Mean age, sex, comorbidities, and right colectomy procedures were similar in the 2 groups. Delayed gastric emptying developed in twelve patients in the conventional group (38.7%) versus 4 patients (12.1%) in the gastropexy group (P = .014). The total number of complications was higher in the conventional group (14 complications) than in the gastropexy group (7 complications). According to univariate analysis, gastropexy significantly lowered the risk of delayed gastric emptying (P = .014). Overall morbidity was 9.7% in the conventional group versus none in the gastropexy group. Postoperative hospitalization was longer in the conventional group (7.61 ±â€…3.26 days) than in the gastropexy group (6.24 ±â€…1.3 days; P = .006). CONCLUSION: Gastropexy decreases the occurrence of delayed gastric emptying after right colectomy with extended lymphadenectomy for proximal transverse colon cancer.

Flexible Ureteroscopy Without Radiation Exposure.

Introduction:Renal stones are a common pathology in daily practice with a continuously increasing incidence. Using flexible ureteroscopy (fURS), urologists can treat difficult renal stones through the natural orifice and maintain a satisfactory stone-free rate. Even though advancing technologies offer the opportunity for minimally invasive surgery, the surgeon is still exposed to a considerable amount of ionizing radiation during several procedures. In this study, the aim is to determine the efficacy of flexible ureteroscopy without fluoroscopy in terms of stone-free rates and complications. Materials and methods:In the Urology Department of Saint John Clinical Emergency Hospital in Bucharest, Romania, a retrospective study was conducted on 98 patients diagnosed with renal calculi between September 2020 and December 2021. Using two different groups, the demographic characteristics of patients, characteristics of stones (size, number, location), the use of fluoroscopy, the operative time (in minutes) and postoperative complications, and the stone-free rate were compared. In one of the groups, fluoroscopy was used during fURS (Group I), while in the second group (Group II), no ionizing radiation was used during fURS. Results:Twenty-four males and 23 females were enrolled in Group I, whereas 31 males and 20 females were enrolled in Group II. The mean age of subjects was 63.2 years old in the fluoroscopy group and 61.6 years old in the group without fluoroscopy. While the stone characteristics revealed some variations in stone location between the compared groups, there were no statistical differences in mean stone diameter (1.489 mm - Group I vs. 1.588 mm - Group II). Stone-free rates and complications classified using Clavien-Dindo modified system for urological surgeries were used to analyze the main results. Group II had a slightly higher stone-free rate, but statistical studies found no significant differences; therefore, both methods are deemed equal in this field. Identified complications were classified as Clavien I and II and were successfully treated for both groups. Conclusion:This study reveals that by adhering to additional intraoperative measurements for guiding the access sheath, fURS without fluoroscopy can be performed safely and with a high success rate.

Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS).

Flexible ureteroscopy (fURS) is a well-established procedure for treating multiple upper-urinary tract pathologies, particularly renoureteral lithiasis. Endoscopes have undergone significant advancements, including miniaturization, improved optics, and increased maneuverability. In addition, advancements in accessory instruments, such as the performance of laser fibers, guidewires, and extraction probes, have played a significant role in improving the overall performance of flexible ureteroscopy procedures. However, despite these advancements, unique circumstances can make achieving optimum results during flexible ureteroscopy challenging. These include congenital renal anomalies (horseshoe kidneys, ectopic kidneys, rotation anomalies), as well as the unique intrarenal anatomy (infundibulopelvic angle, infundibular length) or the specifications of the endoscope in terms of maneuverability (active and passive deflection). This review explored challenging scenarios during flexible ureteroscopy procedures in the pyelocaliceal system.

Tissue and Circulating MicroRNA-31, MicroRNA-200b, and MicroRNA-200c Reflects Disease Activity in Crohn's Disease Patients: Results from the BIOMIR Study.

BACKGROUND AND AIMS: MicroRNAs (miR) have altered expression in multiple autoimmune disorders including inflammatory bowel disease. The aim of the study was to assess the tissue and circulating miR-31, miR-200b, and miR-200c expression levels as potential biomarkers for intestinal disease activity in patients with Crohn's disease (CD). METHODS: The study included 45 patients with histopathological confirmed CD and active disease (defined as fecal calprotectin >50 µg/g and Simple Endoscopic Score (SES) of CD >3), and 21 subjects as controls for the validation cohort. Demographic and clinical data, biomarkers (fecal calprotectin), endoscopy data, the expression levels of miR-31, miR-200b, and miR-200c in tissue and serum were assessed (by RT-PCR). Receiver operating characteristic analysis was performed to assess the miR-31, miR-200b, and miR-200c expression levels as potential biomarkers for active CD. RESULTS: Mean fecal calprotectin was 1540±890 µg/g. Mean SES-CD was 8.9±4.2. Tissue and circulating miR- 31 were significantly correlated with fecal calprotectin (r=0.81, r=0.83, p<0.01) and with SES-CD (r=0.82, r=0.79, p<0.01). The expression level of miR-31 was significantly upregulated in CD tissue cases compared to the control tissue samples (6.24±1.57 vs. 3.70±1.44; p <0.01). Similarly, serum miR-31 expression levels in CD patients were significantly upregulated compared to the control serum samples (0.78±0.42 vs. -2.07±1.00; p<0.01). The expression levels of tissue miR-200b and miR-200c were significantly upregulated in CD tissue cases compared to the control tissue samples (-5.25±0.93 vs. -4.69±0.80, p=0.03 for miR-200b, and -0.86±0.96 vs. 0.39±0.66, p<0.01 for miR-200c). Similarly, serum miR-200b and miR-200c expression levels in CD patients were significantly upregulated compared to the control serum samples (p < 0.05). Receiver operating characteristic analysis revealed that the expression levels of the selected miRNAs could help to discriminate active CD patients from healthy controls with very good specificity and sensitivity. CONCLUSIONS: Tissue and circulating miR-31, miR-200b, and miR-200c reflect disease activity in CD patients and can be used as biomarkers for active disease.

TCF7L2, CASC8, and GREM1 polymorphism and colorectal cancer in south-eastern Romanian population.

Colorectal cancer (CRC) is a heterogeneous disease with an increasing trend and with multiple epigenetic alterations and different molecular features, a major cause of mortality and morbidity. The Wnt/ß-Catenin pathway is involved in multiple aspects of cell dynamics, architecture of developing gastrointestinal tissues, and intestinal tissue homeostasis in adults, but its aberrant activity plays an important role in every aspect of colorectal carcinogenesis. The aim of our study was to investigate the association of the TCF7L2 rs7903146, CASC8 rs6983267, and Gremlin1 (GREM1) rs16969681 polymorphism in patients with CRC without other pathologies. A case-control study conducted on 31 patients diagnosed with CRC and 30 healthy controls age and sex-matched with the patients. Real time PCR was used to determine the genotypes of rs7903146, rs698267, rs1696981. We observed no association between rs6983267 and rs16969681 polymorphism and risk of CRC and low association between TCF7L2, rs7903146, polymorphism and risk of CRC. The recessive model of the TCF7L2 rs7903146 had an OR of 1.6 (95% CI 0.058-4.414, P < .05) which means that TT genotype increased the risk and possibility of development of CRC. Our study did not confirm a significant association between TCF7L2 rs7903146, CASC8 rs6983267, and GREM1 rs16969681 with CRC, but emphasizes the possibility of existence of a high risk of CRC development in patients with TT genotype of rs7903146.

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2-4 cm.

Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.

The Clinicopathological Differences of Colon Cancer in Young Adults Versus Older Adults.

Purpose: Colon cancer is the third-most common and fatal cancer, with a mean age of onset >65 years. In recent years, there has been an increase in the number of cases of colon cancer in young (CCY) patients. This study investigates the biological behavior and epidemiological features of CCY and older adults in our area. Methods: Eighty-one patients (19 young adults <40 years old and 62 older adults ≥40 years old) were admitted to the General Surgery Clinic of the Constanta Emergency Hospital for colon cancer between January and December 2018. The biological behavior and epidemiological characteristics of the two groups were compared. Results: The group of young patients was characterized by finding the diagnosis on an average of 6-9 months after the onset of the first symptom, in a more advanced stage of the disease (73.69%); the onset of symptoms being nonspecific (diarrhea 26.32%, weight loss 21.05%, constipation 21.05%, and bloating 21.05%) and initially treated in a benign context, without the recommendation of additional specific explorations. The time between the onset of symptoms and the diagnosis established in the category of patients ≥40 years of age was on an average of 3-6 months, with most patients being diagnosed in the early stages of the disease (62.9%). Conclusions: Improving health education through colon cancer information programs should be implemented with information on alert symptoms and indications on the steps that a symptomatic patient should follow and no longer ignore his or her symptoms, because health is not necessarily the prerogative of youth.

New Insights into Lynch Syndrome: A Narrative Review.

Lynch syndrome, characterized by DNA mismatch repair deficiency, represents a significant paradigm among cancer predisposition syndromes and is notably associated with heightened susceptibility to various cancers, particularly colorectal and endometrial malignancies. The primary aim of this research paper is to scrutinize specific associations and delve into the underlying molecular mechanisms of Lynch syndrome. Genetic alterations in MMR genes, including MLH1, MSH2, MSH6, PMS2, and EPCAM, compromise DNA repair mechanisms, predisposing affected individuals to a spectrum of malignancies. This paper comprehensively investigates current screening methodologies and preventive measures tailored for individuals identified or at risk of Lynch syndrome. The integration of advanced sequencing technologies and refined bioinformatics tools has significantly improved mutation detection accuracy, facilitating precise identification of mutation carriers and their at-risk relatives. Moreover, this review emphasizes the evolving diagnostic landscape, which have revolutionized the identification of potential mutation carriers. The structured diagnostic algorithm, incorporating clinical criteria, tumor testing, and genetic analysis, plays a pivotal role in systematically identifying and managing individuals with Lynch syndrome. While the well-established association of Lynch syndrome with colorectal and endometrial cancers is recognized, emerging evidence suggests an increased risk for other types of malignancies. A crucial aspect of this literature review is to extensively analyze the less commonly acknowledged correlation between Lynch syndrome and prostate or testicular malignancies. Understanding these correlations holds significant importance in guiding tailored screening protocols and preventive strategies for individuals carrying Lynch syndrome-associated genetic mutations. The comprehensive assessment of this diverse spectrum of cancers underscores the necessity for tailored surveillance strategies and multidisciplinary approaches to effectively manage and mitigate risks in individuals harboring Lynch syndrome-associated genetic alterations.

Surgical Outcome in Bilateral Inguinal Hernia Repair: Laparoscopic Total Extraperitoneal Approach (TEP) as Best Approach?

Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods:We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair - TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results:Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic pain were seen in 1.20% of patients. No wound infections were observed. The average operative time was 97.77 minutes (SD=17.08); when associated surgery was present, it prolonged the operative time, and we found statistical significance (p=0.002). Similarly, the presence of recurrent hernia extended the operative time, which was found to be statistically significant (p=0.003). The conversion rate in our data was 2.41%. Drainage, which was performed in 13 patients (15.66%), decreased the incidence of complications, especially seroma (p=0.026). The mean length of hospital stay was 2.93 days (SD=1.81), with most of the patients having been discharged on the second postoperative day (37.35%). Only one recurrence was identified (1.20%). Conclusion:The laparoscopic approach for bilateral inguinal hernia treatment is feasible and has been proven to be advantageous. Our study emphasizes that the TEP procedure has low rates of complications, conversion and recurrence; hence, we recommend bilateral hernia repair.

Indoor Particle's Pollution in Bucharest, Romania.

Air pollution risk factor on human health was surpassed only by high blood pressure, tobacco use and poor diet. Total number of deaths due to air pollution worldwide was estimated to 6.67 million people in 2019. In the European Union, 97% of the urban population is exposed to levels of fine particulate matter above the latest guideline levels set by the World Health Organization. Air pollution accounts for 20% of newborn deaths worldwide, most related to complications of low birth weight and preterm birth. Low birth weight and preterm birth are responsible for 1.8 million deaths worldwide. Bucharest is the capital city of Romania and one of the most polluted cities in Europe, ranking in the 9th position out of 96 of the top cities from Europe and in the 4th position out of 32 of the top cities in Eastern Europe, data from June 2022. The aim of this study was to measure the real time level of indoor particulate pollution levels in different indoor environments from Bucharest, during the pandemic period. The PM2.5/PM10 ratio and its rate of change were also determined for the measured data. The PM2.5/PM10 ratio and its rate of change were also calculated based on the measurement data. The PM2.5/PM10 ratio showed an upward trend on weekends compared to weekdays, suggesting a relationship with outdoor PM where leisure activities and traffic infiltrated the indoors. The fluctuation range of the PM2.5/PM10 ratio was 0.44~0.95, and low measured values were detected on weekdays. Of the seasons, the proportion of particulate in autumn and its rate of change tended to be higher than in summer. It was suggested that outdoor air may have permeated the room. In addition, the relationship was considered, such as it is a holiday period, there are few rainy days, the concentration of coarse particles is high, and the number of residents in the city decreases. When it comes to indoor air quality, the higher this ratio, the more serious the air pollution. PM10 concentrations decreased by 29.1% in the absence of human activity and increased by 35.1% in the presence of humans. PM2.5 concentration decreased by 30.3% without human activity and increased by 3.1% with the presence of humans. Certain trends were suggested for the resumption of human activity and an increase in PM2.5 concentrations. The average relative difference between October 2021, a pandemic period, and October 2022, a post pandemic period, was 64% for PM10 and 47% for PM2.5. The pandemic period brought a significantly better indoor air quality from the particulate pollution point of view.

Detection of Urinary Molecular Marker Test in Urothelial Cell Carcinoma: A Review of Methods and Accuracy.

Early detection of bladder cancer has a positive impact on prognosis. A variety of biomarkers have been developed to detect bladder tumors in urine early and reduce the need for cystoscopy. To detect bladder cancer, several methods are available, but their accuracy varies according to the sensitivity and specificity of each method. This review aims to highlight the established detection methods for bladder cancer based on the available literature. In addition, we aim to identify the combination of different effective detection methods that provides the highest degree of accuracy. In our study, a keyword retrieval method was used to search for appropriate English-language references. This bibliography has been indexed in PubMed and Scopus or has been found through systematic searches from 2015 to 2022. Based on an analysis of international guidelines, it has been revealed that there are numerous discrepancies and unresolved issues. The discovery of an ideal detection method for urothelial cell carcinoma biomarkers has been the subject of numerous efforts. In recent years, a wide range of off-label, experimental, novel, and combined approaches have been published on this topic. This review can contribute to the identification of accurate methods of detecting bladder cancer and highlight areas for future research that can be improved.

Influence of type II diabetes mellitus on postoperative complications following colorectal cancer surgery.

Diabetes mellitus (DM) promotes colorectal cancer (CRC) carcinogenesis through complex processes and is considered as an independent risk factor for cancer in general and for CRC in particular. Diabetic patients have complications in the postoperative period following CRC surgery. The aim of the present study was to explore the effect of type II DM (T2DM) on postoperative outcomes for CRC compared with non-diabetic patients. The present study analyzed the data from patients admitted to the General Surgery Department, Emergency Hospital of Constanța (Romania) diagnosed with CRC and DM compared with a control group (patients with CRC, without DM, recruited in the same period and frequency matched to cases by number, sex and age) analyzing patient comorbidities and postoperative complications. A total of 61 patients had undergone surgery for CRC and met the inclusion criteria in the present study conducted during September 2020-2021. A total of 30 patients associated T2DM. Diabetic patients have been associated with more comorbidities than non-diabetics; the age-adjusted Charlson comorbidity index score ≥6 was identified in 90% of diabetic patients compared with 45.2% of controls. Grade III Clavien-Dindo classification was observed in 13.3% diabetic patients compared with 3.2% of non-diabetic patients. Additionally, a higher rate of urinary and pulmonary complications (6.7 vs. 3.2% in controls respectively) in patients with diabetes was found. Postoperative hospitalization was prolonged in diabetic patients (P=0.042). Univariate and multivariate analyses revealed that the laparoscopic approach for diabetic patients was found to be associated with

Half abdomen tumor - giant retroperitoneal lipoma: a case report and review of the literature.

The pure retroperitoneal lipoma is a sporadic benign tumor originating from the mesenchymal tissue. There are only a few data in the literature. The technique available at this moment cannot establish a clear distinction between a benign adipose mass and a low-grade liposarcoma. This study presents the case of a 53-year-old man presenting computed tomography (CT) and magnetic resonance imaging (MRI) findings that revealed a giant retroperitoneal fatty tumor of 365∕210∕165 mm dimensions, suspected of malignancy. The patient's medical history, clinical data, and blood tests are more likely inclined to a benign condition. Liposarcoma couldn't be excluded preoperatively. The patient underwent an open surgical procedure respecting the oncological principles, with complete resection of 6400 g of retroperitoneal adipose tumor that also affected the surrounding organs' normal abdominal anatomy. The tumor was relatively well delimited without any signs of local invasion or infiltration. Three solid masses described on the MRI were identified upon dissection and sent separately for histological examination. The result indicated a giant retroperitoneal lipoma with benign characteristics. Facing imagistic difficulties to distinguish lipoma from liposarcoma clearly, and the inconclusiveness of fine-needle biopsies, oncological resection remains the only option as a diagnostic method and curative treatment.

Association of TCF7L2, CASC8 and GREM1 Polymorphisms in Patients with Colorectal Cancer and Type II Diabetes Mellitus.

BACKGROUND: The aim of the study is to explore the association between the TCF7L2 rs7903146, CASC8 rs6983267 and GREM1 rs16969681 polymorphisms in patients diagnosed with type 2 diabetes mellitus (T2DM) and colorectal cancer. METHODS: Sixty individuals were enrolled in this case-control study: thirty with colorectal cancer and type II diabetes mellitus (T2DM) and thirty healthy control individuals. Real-time PCR was used to determine the genotypes of TCF7L2 rs7903146, CASC8 rs 6983267 and GREM1 rs16969681 in patients with CRC and T2DM and in patients without T2DM and CRC. The Hardy-Weinberg equilibrium was determined in the control group for the genotype distribution of every polymorphism. RESULTS: People carrying the TT genotype of rs7903146, rs6983267 and rs1696981 had a significant association with T2DM and CRC. Moreover, the people with the TT genotype of rs1696981 had a greater risk for T2DM and CRC (OR = 7, CI 0.397-23.347). CONCLUSIONS: TCF7L2 rs7903146, CASC8 rs6983267 and GREM1 rs16969681 could be risk factors for the association of T2DM with CRC.

Middle Pulmonary Lobe Abscess: A Delayed Complication of Laparoscopic Cholecystectomy.

Background: Laparoscopic cholecystectomy has become a routine procedure in abdominal surgery, a "gold standard" in the treatment of gallstones. Iatrogenic perforation of the gallbladder during a cholecystectomy is a possible incident, with numerous complications due to unidentified intraperitoneal gallstones during surgery. Pulmonary complications of laparoscopic cholecystectomy are extremely rare. Case report: This report presents the case of a 62-year-old female with post cholecystectomy subphrenic abscess and trans-diaphragmatic fistula in the middle pulmonary lobe. In this case, the pulmonary symptoms dominated the clinical picture and the initial complementary explorations indicated a strictly pulmonary condition. The initial evolution of the patient was towards worsening, and the subsequent explorations established the real diagnosis. Conclusion: Gallbladder perforations with accidental loss of gallstones should be recognized immediately and managed. In the development of a pulmonary abscess, we can take into account an intra-peritoneal condition as well.

Extended Lymphadenectomy for Proximal Transverse Colon Cancer: Is There a Place for Standardization?

Background and Objectives: Complete mesocolon excision and high vascular ligation have become a standard procedure in the treatment of colon cancer. The transverse colon has certain embryological and anatomical particularities which require special attention in case of oncological surgeries. Proximal transverse colon cancer (TCC) can metastasize to the lymph nodes in the gastrocolic ligament. The aim of this study is to assess the tumor involvement of these lymph nodes and to determine the applicability of gastrocolic ligament lymph nodes dissection as the standard approach for proximal transverse colon cancer. Materials and Methods: this study analyzes the cases of patients admitted to the Surgery Department, diagnosed with proximal transverse colon cancer, with tumor invasion ≥ T2 and for which complete mesocolon excision with high vascular ligation and lymphadenectomy of the gastrocolic ligament (No. 204, 206, 214v) were performed. Results: A total of 43 cases operated during 2015−2020 were included in the study. The median total number of retrieved central lymph nodes was 23 (range, 12−38), that had tumor involvement in 22 cases (51.2%). Gastrocolic ligament tumor involvement was found in 5 cases (11.6%). The median operation time was 180 min, while the median blood loss was 115 mL (range 0−210). The median time of hospitalization was 6 days (range, 5−11). Grade IIIA in the Clavien-Dindo classification was noticed in 3 patients, with no mortality. Upon Kaplan−Meier analysis, tumors > T3 (p < 0.016) and lymph node ratio < 0.05 (p < 0.025) were statistically significant. Conclusions: lymph node dissection of the gastrocolic ligament in patients with advanced proximal transverse colon cancer may improve the oncological outcome in T3/T4 tumors, and therefore standardization could be feasible