The impact of Sambucus nigra L. extract on inflammation, oxidative stress and tissue remodeling in a rat model of lipopolysaccharide-induced subacute rhinosinusitis.

Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicines could be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1ß, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1ß. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.

Gold nanoparticles phytoreduced with Cornus mas extract mitigate some of gliadin effects on Caco-2 cells.

Celiac disease (CD) is an autoimmune condition that occurs in genetically predisposed people where the ingestion of gluten produces damage in the small intestine. The treatment accepted until now is a strict gluten free diet. This implies the need for novel or adjuvant treatments, in addition to the standard of care. The present study aimed to assess the effect of gold nanoparticles phytosynthesized with Cornus mas extract (AuCM) compared to Cornus mas extract (CM) and luteolin (LT) on Caco-2 cells, exposed or not to gliadin. Ultraviolet-visible spectroscopy and transmission electron microscopy were used for the characterization of AuCM. Measured cellular outcomes included oxidative stress markers (malondialdehyde level, catalase and superoxide dismutase activities), inflammatory response and cellular signaling and transcription factors involved in apoptosis (NFκB, pNFκB, NOS2, TNF-α, TRAIL, Bax, Bcl-2, p53). The internalization of gold nanoparticles in cells was evidenced by transmission electron microscopy (TEM). The gliadin administration induced oxidative stress, improved the activity of antioxidants enzymes, increased NOS2 and NFκB expressions and reduced pNFκB/NFκB ratio. In addition, gliadin enhanced TRAIL and Bcl-2 levels and reduced p53 expression in Caco-2 cells. The pretreatment with AuCM, CM extract and LT diminished oxidative stress and reduced NOS2 activity. AuCM and CM treatment amplified the expression of p53 and pNFκB/NFκB ratio and diminished Bcl-2, NFκB and pNFκB, especially AuCM. The results obtained confirmed that AuCM mitigate some of gliadin effects on Caco-2 cells through modulation of oxidative stress and inflammation.

Anatomical variations of the obturator veins and their surgical implications.

PURPOSE OF INVESTIGATION: The obturator veins and their network contribute to major bleeding complications during gynaecologic surgery. MATERIALS AND METHODS: The anatomical variations of the obturator veins were studied on 106 patients in which a thorough bilateral pelvic lymphadenectomy was performed. RESULTS: Symmetrical drainage on right and left sides was found in 75 cases: only in internal iliac vein in 32 cases, both in external iliac vein and internal in 41 cases, and only in external in two cases (so called "pubic vein"). In 31 procedures, asymmetric drainage was found between the two sides: one side in internal, the other side both in internal and external in 25 patients; in three patients, in external on one side and in both internal and external on the other; and in external on one side and in internal on the other side in one patient. CONCLUSIONS: Anatomical variations of the obturator veins appear quite often.

Abdominal radical trachelectomy (ART) performed during pregnancy: a case report.

PURPOSE OF INVESTIGATION: Cervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy. MATERIAL AND METHODS: The authors report a pregnancy complicated by cervical cancer treated by abdominal radical trachelectomy (ART) at 16-17 gestational weeks with preservation of the concurrent pregnancy. RESULTS: The pregnancy evolved normally and delivery occurred at 38-39 gestational weeks by elective caesarean section. CONCLUSIONS: Radical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women to avoid the triple losses of a desired pregnancy, fertility, and motherhood.

Multimodal oncosurgery approach to treat peritoneal carcinomatosis in a patient with occlusive ovarian carcinoma.

UNLABELLED: Summary BACKGROUND: This paper aims to present a "pattern" of oncosurgery solution in a case generally considered unrecoverable: intestinal occlusion in case of ovarian carcinoma and carcinomatosis. CASE REPORT: A 62-year-old female patient with ascites, carcinomatosis, unresectable pelvic tumour, and intestinal obstruction suffered a five-step oncosurgery "model": three surgical interventions overlapping chemotherapy administered via the systemic and intraperitoneal route: Step 1: colostomy and partial omentectomy; Step 2: five courses of systemic chemotherapy supported by granulocyte colony-stimulating factor; Step 3: radical surgery--total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, omentectomy, appendectomy, pelvic peritonectomy, and hyperthermic intraperitoneal chemotherapy; Step 4: consolidation systemic chemotherapy consisting of three more similar cycles; Step 5: closure of the colostomy. Nine months after the beginning of treatment, the patient is with no evidence of disease. CONCLUSIONS: The association of surgical and oncologic treatment and the use of hyperthermic intraperitoneal chemotherapy (HIPEC) technology can solve some of these complex cases.

The mandatory role of groin lymphadenectomy in clinical Stages IB and II vulvar cancer.

PURPOSE OF INVESTIGATION: To analyze the prevalence of inguinofemoral lymph nodes metastases in clinical Stages IB-II vulva cancer. MATERIALS AND METHODS: Twenty-two patients with FIGO Stages IB-II FIGO vulva cancer with no clinically and imagistic evidence of nodes metastases were treated in the present clinic. The surgical procedures consisted in radical vulvectomy plus inguinofemoral lym- phadenectomy. RESULTS: The final pathological result was squamous carcinoma in 20 patients, vulva melanoma in one, and carcinosar- coma in one. The prevalence of positive lymph nodes was 45.4%. The median number of harvested lymph nodes was 14.0 per groin (between four and 27). Twelve patients (54.5%) developed some wound complications, but all were resolved. At the present time, 20 patients are alive, but the follow-up period is short for many of them; two patients died of disease. CONCLUSION: The prevalence of groin metastases in Stages IB-II vulvar cancer is high. A thorough inguino-femoral dissection seems necessary, despite the high incidence of wound complications.

Pelvic exenteration--our initial experience in 15 cases.

OBJECTIVE: To analyse the initial experience of pelvic exenteration for gynaecological malignancies in a tertiary referral center. MATERIALS AND METHODS: Between 2011 and 2013, 15 patients underwent a pelvic exenteration for gynaecological malignancies. RESULTS: Out of the 15 exenterations, six were total, four anterior, and five posterior. The indication was cervical (nine patients), advanced vaginal (one patient), and ovarian cancer (in five patients). A Bricker non-continent ileal urinary conduit was performed in all ten anterior and total exenterations. In-hospital complications occurred in six patients (40%) of whom two perioperative deaths (13%). Among the 15 patients, at this moment, eight are alive and six died because of the disease, and one was lost to follow-up. CONCLUSION: Pelvic exenterantion for recurrent or advanced pelvic malignancies can be associated with long-term survival and even cure without high perioperative mortality in properly selected patients. However, postoperative complications are common and can be lethal.

Recurrent left Bockdalek hernia in adult, a rare cause of subocclusive syndrome.

PURPOSE: To present a rare clinical case of a subocclusive syndrome caused by recurrence of a left Bockdalek hernia, with emphasis on the radiological diagnosis and surgical treatment. The current paper presents a 36 year old female with past surgical history of Bockdalek hernia repaired 7 years ago using a diaphragmorrhaphy by thoraco-abdominal approach who presented with a subocclusive syndrome and epigastric pain. Upper endoscopy showed a duodenal ulcer positive for H. pylori. Initial abdominal CT scan was read as negative. On a closer evaluation of the CT images, a small Bockdalek hernia was appreciated, with the elevation of the left colic angle through the diaphragm. Given the occlusive symptoms, the patient underwent surgical treatment with diaphragmorrhaphy and alloplasty with polypropylene mesh, using an open approach. Postoperatively, the patient had a favourable course, being discharged home two days later. To date, there are 173 cases of Bockdalek hernia in the the medical literature, but none with a recurrence. Bockdalek hernia is a rare disease, with non-specific symptoms. It has a broad differential diagnosis that may delay early identification and management. The surgical treatment, either open or laparoscopic, must follow the current recommendations of the surgical societies, including mesh alloplasty to prevent recurrences.

Gastric metastasis of cervix uteri carcinoma, rare cause of lower gastric stenosis.

AIM: the paper presents a rare case of metachronous gastric metastasis of uterine cervix cancer, clinically manifested through severe pyloric stenosis. METHOD: 49-year-old patient, operated on in January 2009, with uterine cervix cancer (Squamous cell carcinoma T2bN1M0), is hospitalized in August 2011 with pyloric stenosis: epigastric pains, abundant, stasis, late postprandial emesis, significant weight loss, stomach form visible upon abdomen inspection. Endoscopy: antral stenosis with intact gastric mucosa, and CT-scan: circumferential intramural gastric tumor, stomach dilated in the upper part, lack of cleavage between the tumor and the liver bed of the gall bladder. CEA increased to 13,78 (below 5), CA 19-9 slightly increased 29.9 (below 27). The case is considered as a second neoplasia and a D2 subtotal gastrectomy was performed, with 1 positive ganglion out of 27 on block with atypical hepatectomy of segments 4-5 for liver invasion, the final mounting being Y Roux. RESULTS: The histopathological examination shows a gastric metastasis of squamous carcinoma, of uterine cervix origin, the invaded perigastric ganglion having the same aspect of uterine cervix carcinoma. The post-surgery evolution was favorable, under chemo radiotherapy the patient being alive without relapse at 9 months post-surgery. CONCLUSION: In the literature there are 2 more cases of gastric metastasis of uterine cervix carcinoma, and 4 of uterine carcinoma without topographic indication, but without the histological documentation of the tumor filiation, without data related to resecability or follow-up, the case at hand being, from this perspective, the first documented resectable metachronous gastric metastasis from a cervix uteri carcinoma.

[Laparoscopic sleeve gastrectomy: the initial experience of the First Surgical Clinic Tg-Mures. Early and late (after 5-10 month follow-up) results]. / Gastrectomia longitudinala laparoscopica--experienta initiala a Clinicii Chirurgie I Tg-Mures. Rezultate precoce si tardive (follow-up între 5-10 luni).

AIM: This paper aims to present the initial experience of the I-st Surgery Clinic Târgu Mures in laparoscopic sleeve gastrectomy, stressing the technical aspects of surgery and postoperative immediate and late results. METHOD: Started in 2008, I Surgery Clinic's experience includes 11 cases of laparoscopic sleeve gastrectomy, pursued between 5 and 10 months postsurgery.The group is structured as follows: 80% female, aged between 13 and 55 years, average BMI 46, with limits between 35 and 72. Surgical technique was unitary, 10 of 11 cases beeing performed by the same team. RESULTS: Surgergical results were excellent: 0 conversions, 0 bleeding, 0 fistulas, 0 missfire. Average hospitalisation was of 48 hours postsurgery. EWL overall 68%, with limits between 50%, in 2 cases (initial BMI 70) and 100%--1 case (initial BMI 35). Life threatening morbidity--0.0 mortality, average BAROS score 6.7. CONCLUSION: GLL is a well standardized, secure, efficient, applicable with good results in all categories of patients with morbid obesity.

[The importance of the I-colic time in colorectal cancer with synchronous hepatic metastases. Specifics of surgical strategy]. / Importanta timpului I-colic în cancerul colo-rectal cu metastaze hepatice sincrone. Particularitati de tactica chirurgicala.

AIM: This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum. MATERIAL AND METHOD: There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention. RESULTS: We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one. CONCLUSION: In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.

[Vascular exclusion of the liver: surgical technique and initial clinical experience]. / Excluzia vasculara a ficatului (EVF): tehnica chirurgicala si experienta clinica initiala.

The intraoperative hemorrhage is the most life threatening complication during a liver resection, reason why the intraoperative vascular control represents one of the key points in the liver resection. This work presents the liver vascular exclusion without caval occlusion technique and also studies the first cases operated in University Surgery Clinic Nr. 1, Targu Mures, Romania. LVE consists of an association between hilum occlusion by Pringle manoeuvre and selective clampage of the three hepatic veins. Once achieved, the technique allows resection without blood lose and no special cautions, a continue clampage of 60-90 minutes being useful for the reconstruction of the possibly harmed or resected structures during the hepatectomy. The indications of the technique are voluminous center located liver tumors, multiple liver tumors, tumors in contact with hepatic veins or with hilum bifurcation. University Surgery Clinic Nr. 1 Targu Mures's experience in this technique began in 2005 consists in 8 cases. Preoperative diagnosis were: 2 right liver voluminous benign tumors (hemangiomas), 5 cases of colo-rectal metastasis and one resection for metastases of gastro-intestinal stromal tumor. Postsurgery evolution was very good with an average hospitalisation of 6 days. Mortality rate and morbidity were zero. We strongly recommend the use of LVE technique for selected cases of difficult liver resection, LVE being one of the most advanced techniques of liver resection.

Periodic structure of spicular magnetic clusters in a magnetic liquid.

The behavior of clusters formed by magnetic particles of magnetic liquid placed into a cylindrical capillary tube in magnetic field is described. Spicular clusters are formed from the sediment at the application of a magnetic field. They arrange themselves along the capillary repeating the direction of external magnetic field. Clusters distribute uniformly in the region of a magnetic field maximum. Such a state remains steady with respect to changes of the magnetic field gradient profile in definite limits. The structure of the uniformly ordered clusters is obtained experimentally. The capability of control of the structure period is shown. It is observed that increasing of magnetic field gradient up to the magnitude higher than a certain threshold value results in rearrangement of the clusters row into a multi-row hexagonal structure.

[Two steps liver resection with right portal vein ligation for two giant hemangiomas of the left and right lobes]. / Rezectie hepatica în doi timpi cu ligatura de ram port drept pentru doua hemangioame gigante de lob drept si stâng hepatic.

The liver failure is one of the most life threatening complication after extensive liver resections. In resections that exceed 70% of liver parenchyma, a two steps approach with portal branch ligation is the best alternative. The aim of the paper is to present the management of a 65-year-old female admitted into hospital for two giant symptomatic liver hemangiomas in the left lobe: segment III-20 cm. and in the right lobe: segments V-VIII-19 cm, which were non-resectable in the same intervention because the small amount of liver parenchyma left, and for these we decided a two steps surgery: left atypical resection with right portal vein ligation in the first step, attending 4 month for atrophy-hypertrophy process, and then right typical hepatectomy for second hemangioma who practically occupied all right liver. The postoperative course, was favorable after both interventions, with 7 days postsurgery hospitalisation, despite some hepatic failure symptoms: coagulation disturbance, increasing of bilirubin and ALAT, ASAT levels, ascites.