Adenocarcinoma versus pancreatic neuroendocrine tumor - case report.

Pancreatic cancer represents one of the most aggressive types of cancer, resulting in a late diagnosis and rapid death (poor overall survival). After adenocarcinoma (counting almost 80% of cases of pancreatic cancer), the second category, as frequency, is represented by the family of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Pancreatic cancer is characterized by genetic heterogeneity and may results in different evolution among metastases, which may acquire driver mutations with the ability to transform under the action of several cancer treatments. Here we report a case of a 64-year-old patient diagnosed with pancreatic tumor localized on the body and tail, invasive in the splenic and portal vein, pT3pN0M0 (adenocarcinoma pancreatic cancer), treated with a multimodal approach: surgery (splenectomy and distal pancreatectomy, with suture of the portal vein), chemotherapy, in 2010, that relapsed in 2015, with local recurrence that was resected and distant liver metastases. Immunohistochemistry of the recurrence tumor showed a neuroendocrine transformation of the tumor, with major implications in treatment and prognosis. Computed tomography examination, as well as histopathological and immunohistochemically testing, sustained positive and differential diagnosis.

Cutaneous Toxicities of Molecular Targeted Therapies.

Antineoplastic targeted therapies, such as EGFR inhibitors, tyrosine kinase inhibitors and BRAF inhibitors, frequently lead to systemic and cutaneous side effects, significantly affecting patient's quality of life. Patients with new targeted therapies have an increased risk of developing skin reactions. The new molecular target therapies developed in the last decades can induce severe skin reactions, which may require dose reduction or discontinuation of treatment and consequently, a decrease in patient's quality of life. The present paper describes toxic cutaneous reactions associated with the most frequently used molecular therapies (epidermal growth factor receptor inhibitors, tyrosine kinase inhibitors, BRAF-inhibitors), frequency of occurrence and methods of diagnosis and treatment, in order to offer a clinically efficient management for maintaining a good quality of life, with compliance to treatment and good therapeutic efficacy. Knowledge of cutaneous adverse reactions in new therapies is mandatory in order to have a proper management of oncologic patients. Recognizing target therapy toxicities by both oncologists and dermatologists, understanding therapeutic mechanisms and choosing optimum treatments for oncologic patients are critical. A correct evaluation of skin toxicity can allow for an adequate decision regarding treatment dose or discontinuation, impacting therapy response and patient survival.

DIABETIC MACULAR EDEMA.

Diabetic macular edema (DME) remains the most common cause of vision loss among diabetic patients. New understanding of the underlying pathophysiology has interest in the potential benefits of the specific pharmacologic therapy, such as treatment with intraocular steroids, anti-vascular endothelial growth factor (VEGF), and protein kinase C-beta (PKCß) inhibition. At the last time, laser photocoagulation, according to the guidelines of the Early Treatment of Diabetic Retinopathy Study (ETDRS), continues to be primary standard care treatment in most communities. Optical coherence tomography (OCT) is very useful in monitoring macular edema progression and response to treatment.

[Considerations in a case of refractive surgery]. / Consideratii pe marginea unui caz de chirurgie refractiva.

We present a case report of a 38 year old patient, with medium myopia LASIK --operated, with rhegmatogenous retinal detachment. We present the seriated surgical interventions (posterior vitrectomy with silicone oil, followed by the extrusion of the silicone oil and the extraction of complicated cataract with IOL-CP implantation).

[Malyugin ring--an alternative in the treatment of a miotic pupil]. / Inelul malyugin--alternativa în tratamentul pupilei "refractare".

Small pupil and Intraoperative Floppy Iris Syndrome (lFIS) has always been a challenge in cataract surgery. Iris dilation and mechanical stabilization can be achieved by using intraoperative iris retractors, preferably before capsulorhexis. Malyugin ring is a mechanical iris expansion device, which presents many advantages (gently relaxes the iris tissue, implants easier and less traumatic). The disadvantages of using Malyugin ring consists primarily in the high cost and in an increased duration of surgical procedure.

[Retinal detachment with retinoschisis--case report]. / Decolare de retina cu retinoschizis--caz clinic.

We present the case of a 43 year old patient diagnosed with rhegmatogenous retinal detachment and retinoschizis, a rare case of disease association. Surgery is recommended and we practice 23 gauge vitrectomy, laser retinopexy, criopexy in the periphery and internal heavy oil tamponade. Postoperatory evolution was favorable.

[Clinical and functional considerations in some cases of postoperative endophthalmitis]. / Consideratii clinice si functionale pe marginea unor cazuri de endoftalmita postoperatorie.

We present 3 cases of postsurgery endophthalmitis, with good initial operatory technique, which were admitted in our hospital within variable time, to which a second surgery was performed, with good postoperative evolution, without any inflammatory signs and preserving the eye. We analyse the pre and post-operative treatment of endophthalmitis, but also the ways to prevent the appearance of this post-operative complication.

Intraprocedural predictors of successful ablation of slow pathway for atrioventricular nodal reentrant tachycardia.

Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common causes of paroxysmal supraventricular tachycardia. For many years, the pharmacological approach was the only therapeutic modality available for managing this arrhythmia. More recently transcatheter radiofrequency (RF) ablation has become a safe and effective alternative to medical therapy. During the last 2 years, 20 patients with AVNRT were evaluated in our department. The diagnosis was made using the classical electrophysiological protocols with three multipolar catheters placed in AV node-His region, coronary sinus and a mapping/ablation catheter. In all cases, a discontinuous AV conduction curve during programmed atrial stimulation with progressively increasing prematurity was demonstrated associated with AV nodal echo beats and induction of the arrhythmia. Typical AVNRT was present in 19 patients. One patient with typical AVNRT also had inducible unusual (slow-slow) AVNRT. An additional patient had unusual slow-slow variant of AVNRT. The arrhythmia was treated in all cases by RFA of the slow AV node pathway, guided by anatomic and electrophysiologic criteria. RF ablation was successful in all patients. Two patients had clinical recurrence of arrhythmia; all have undergone successful reablation. No patient had significant complications of the procedure. As intraprocedural predictors for successful RF ablation were considered the slow pathway potentials with evidence of the junctional accelerated rhythm during RF current delivery and modification of AV node physiology with noninducibility of arrhythmia after RF ablation. The persistence of slow pathway with or without single AV node echo beat during a limited numbers of atrial extrastimuli was accepted as a successful procedure. In all cases, the AV node physiology was tested also after autonomic modulation of AV node. In both cases with clinical recurrence, the intraprocedural RF ablation results were misevaluated probably because of the autonomic modulation of fast pathway electrophysiology masking the persistence of slows pathway conduction. In conclusion invasive electrophysiological evaluation and RF ablation not only eliminate AVNRT, but also provide a unique opportunity to gain insights into the complexity of AV node physiology. This complexity makes more difficult the evaluation of the success of slow pathway ablation for AVNRT and a careful examination of multiple criteria is necessary for a good procedural result.