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Open access

Davit L. Aghayan, Egidijus Pelanis, Åsmund Avdem Fretland, Airazat M. Kazaryan, Mushegh A. Sahakyan, Bård I. Røsok, Leonid Barkhatov, Bjørn Atle Bjørnbeth, Ole Jakob Elle and Bjørn Edwin

Abstract

Background

Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center.

Patients and methods

LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months.

Results

296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml and hospital stay was 3 days. There was no 90-day mortality in this study. The postoperative complication rate was 14.5%. 189 patients developed disease recurrence. Recurrence in the liver occurred in 146 patients (49%), of whom 85 patients underwent repeated surgical treatment (liver resection [n = 69], ablation [n = 14] and liver transplantation [n = 2]). Five-year overall survival was 48%, median overall survival was 56 months.

Conclusions

LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.

Open access

Oana Bodean, Octavian Munteanu, Diana Voicu, Luciana Arsene, Ana Uzunov, Florina Pauleţ and Monica Cîrstoiu

Abstract

With the growth of the aging population worldwide, osteoporosis represents a serious health problem, which implies higher morbidity and costs, despite the continuous advances in treatment options. It involves both sexes, although menopausal women are mainly affected. This article is a brief review of literature on current osteoporosis treatment options.

Open access

D.N. Tarniţa, D.C. Grecu, M.C. Tenovici, R.C. Văduva, A.D. Tudora, A. Grecu, I.L. Petrovici and B. Căpitănescu

Abstract

A 20-year-old patient presented to the emergency service with radial distal epiphysis after a minor trauma. The radiological examination indicated a fracture at the radial distal epiphysis on the background of a tumor that occupied the radial epiphysis in its entirety, with cortical burglary in some places. When consulting the oncologist, a surgical intervention for biopsy material harvesting was performed. The anatomopathological exam showed: multiple fragments microscopically representing a tumor proliferation consisting of two cell populations, mononuclear cells, densely cellular and strobe pattern; areas of infarction, haemorrhage areas, rare intratumoral osteoid formation zones; appearance of giant cell tumor. The immunohistochemical examination confirmed the anatomopathological diagnosis adding, therefore, the aggressive character and the local relapse. The oncologist decided that it did not require oncology treatment but only orthopedic treatment. Orthopedic treatment required repeated surgery at intervals of about 5 months apart, caused by tumor recurrence. The first intervention consisted of 1/ 3 distal radius resection and replacement with a graft harvested from the peroneum. Tumor recurrence after 5 months required extirpation of tumor tissue and filling of caries caused in the graft with a fluid bone substitute. Recurrence after another 5 months required removal of the graft that was invaded by the tumor and cubitusmetacarpal arthrodesis fixed with a screw plate. Currently, the patient is undergoing complementary oncology treatment finally initiated by a medical oncologist.

Open access

Andrei Popescu, Andrei Haidar and Rodica Maricela Anghel

Abstract

Recent years have brought major advances in the treatment of malignant melanoma. One such an advance is the treatment with BRAF tyrosine-kinase inhibitors in metastatic malignant melanomas that harbor mutations in the BRAF gene. The trials that have been performed in this setting have demonstrated superior response rates and increased overall survival, however, they mostly included patients with melanomas carrying the more common V600E and V600K mutations, not being able to assess the benefit of these treatments in situations where more rare mutations of the BRAF gene are present. We present the evolution of a patient with malignant melanoma with a rare V600M mutation in the BRAF gene, that was eventually treated with vemurafenib. Also we present a brief review of the major phase III trials that showed benefit with tyrosine-kinase inhibitors in BRAF mutated melanoma, with respect to the BRAF mutations included.

Open access

D. Anghelescu, E. Popescu, A. Cursaru, A. Dimitriu, R. Ene and C. Cîrstoiu

Abstract

Objectives. Sacral tumors represent about 1-4,3% of all bone tumors. They typically present with an abundance of blood vessels. Due to their anatomical localization, they are hard to approach surgically. Thus, a presurgical neoadjuvant therapy is indicated. The preoperative angiography with the embolization of the nutritive arteries decreases the perioperative blood loss and the symptomatology, and even decreases the volume of the tumors that cannot be surgically approached. Materials and methods. The principle of embolization consists in the targeting of the nutritive tumoral artery and in obturating it with embolic agents (polyvinyl alcohol, embospheres, etc.) through selective catheterization under angiographic control. The biopsy of the tumor is essential for certain diagnosis. The histological type of the tumor and the degree of differentiation influence the tumor’s physiopathology and often influence the therapeutic decision regarding its degree or recurrence. In some cases in which the tumor’s degree of extension increases the surgical risk, serial embolization can be used as a primary method of treatment. Because of the late onset symptomatology, when they are discovered they are extended and the degree of invasion in adjacent tissues is so high that it requires en bloc resection with nerve root sacrifice to assert complete excision and low recurrence rates. Results. The patients who undergo surgical treatment usually bleed, and the perioperative blood loss and the need for blood transfusion volumes were halved in the cases in which presurgical transarterial embolization was performed. Conclusions. Transarterial embolization of sacral tumors is a procedure indicated as a neoadjuvant presurgical therapy to decrease the blood loss risks and for the tumors that cannot be surgically removed it is used in the palliative treatment to reduce symptomatology.

Open access

A.N. Marinescu, A.I. Nicula and G. Iana

Abstract

It is a power point program, which through a succession of steps, allows the obtaining of one shorter diagnosis, from a long list of possible ones, by choosing a character of the bone lesion. The aim of this program is to facilitate the differential diagnosis of this particular aspect of a bone lesion - the cystic, expansile osteolytic bone lesion - from a radiological point of view, but not only. The location, age, pain and other condition will be considered and will represent the first criteria in the differentiation. In this differential diagnosis, we discovered not only benign tumor lesions but also malign bone lesions or other non-tumoral conditions. We considered that this program could be easily used by the radiologist or the orthopedist in training and useful by also employing a representative photo gallery.

Open access

C.A. Coroleucă, C.B. Coroleucă, D. Comandaşu, A. Nastas, D. Mihai, M.M. Cîrstoiu and E. Brătilă

Abstract

Introduction. Soft tissue tumors are a rare pathology encountered in the pregnant patient. Considering the patient’s potential vital risk, the concomitant evolution of pregnancy and the possible infertility acquired after treatment, the therapeutic conduct of these tumors is a challenge to current medical practice. Material and method. The paper aims to present certain cases of soft-tissue tumors diagnosed in pregnant women as well as a retrospective analysis of literature. Results. The diagnosis of certainty was significantly delayed in the case of pregnant patients. The treatment plan was complex and had to take into account the type and the location of the primary tumor, growth rate, associated symptom, age of pregnancy, as well as minimize the fetal toxic effects. Conclusions. The identification of a soft-tissue tumor during pregnancy is associated with limited diagnostic methods. A multidisciplinary team should establish the therapeutic approach for softtissue tumors diagnosed in the pregnant patient. The therapeutic approach should be individualized in each case in order to achieve a balance between tumor treatment, pregnancy outcome, and subsequent reproductive capacity of the patient.

Open access

V. Georgeanu, T. Atasiei, D. Gartonea, B. Shazam, G. Goleşteanu and Şt. Cristea

Abstract

Introduction. Soft Tissue Sarcomas (STS) is a group of rare malignant tumors with mesenchymal tissue origin. At present, over 50 histopathological types with typical chromosome changes are described. Treatment is multidisciplinary, centered on the surgical approach. Method. Between 2014 and 2016, 12 STS cases were treated in our clinic: 3 liposarcomas, 2 synovial sarcomas, 1 angiosarcoma, 2 rhabdomyosarcomas, 2 myxofibrosarcomas, 1 fibroblast sarcoma and 1 clear cell sarcoma. With the exception of angiosarcoma that benefited only from chemotherapy, the other cases were surgically approached, followed by radiotherapy in 7 cases, and chemotherapy in one case. Results. Patient follow-up was for a minimum of 2 years. In 3 cases (fibroblast sarcoma, clear-cell sarcoma, synovial sarcoma), a local recurrence occurred between 3 and 9 months. In 2 cases (fibroblastic sarcoma, synovial sarcoma), pulmonary metastases occurred between 6 and 18 months and the patients died at 8 months and 2 years respectively. The rest of the cases were clinically and imagistically assessed (local MRI, lung CT) at 6 months for at least 2 years and showed no signs of local recurrence or metastasis. Conclusions. The evolution of STS depends on the histological type and to the stage of diagnosis (local extension, degree of differentiation and presence of metastases). Therapeutic approach should be centered on an accurate resection, within the limits of oncological safety even with re-resection. Postoperative radiotherapy is used in most of the cases, and chemotherapy is reserved for special cases with unfavorable local evolution or metastasis.

Open access

Lucia Mazur-Nicorici, Victoria Sadovici-Bobeica, Maria Garabajiu and Minodora Mazur

Abstract

Introduction. The aim of the research was the study of the adherence to treatment in patients with systemic lupus erythematosus.

Methods. Cross-sectional study including 132 consecutive patients with systemic lupus erythematosus (SLICC, 2012 classification criteria). We collected clinical and socio-demographic data, socio-economic status; we assessed SLEDAI-2k disease activity, and estimated the adherence to treatment by Morisky questionnaire.

Results. Our results demonstrated that low adherence to treatment in patients with systemic lupus erythematosus was in only 11.36% of patients, while 43.18% and 45.46% of the patients were scored as moderate and high adherence, respectively. A moderate/high adherence to treatment was associated to a high level of education (r = −0.51, p < 0.05, 95% CI = −0.25 to −0.66), low disease activity (r = 0.38, p < 0.05, 95% CI = 0.25 to 0.53) and low indices of physician global assessment (r = −0.31, p<0.05, 95% CI = −0.23 to −0.71). The sub-analysis of the adherence to each drug demonstrated that the highest adherence was to treatment with glucocorticosteroids – 92.85%, followed by hydroxychloroquine and aspirin – 92.15% and 89.79%, respectively.

Conclusion. In our cohort, the adherence to treatment was high in 45.46%, moderate in 43.18% and low in only 11.36% cases. High adherence to treatment was associated to low disease activity. The adherence was positively influenced by the age at the onset of the disease and a high educational level.