According to the consensus and the recommendations of the European Neuroendocrine Tumor Society (ENETS), the frequency of appendicular neuroendocrine tumors (NETs) is 0.15-0.6/100 000 a year. They are found a little more often in women aged between 40 and 50. Neuroendocrine neoplasms of the appendix are about 30 to 80% of all appendicular tumors. Their evolution is usually asymptomatic. They are diagnosed accidentally during a conventional or laparoscopic appendectomy. In the past, the surgical approach used to depend on the localization of the tumor. Currently, its localization is not a significant factor in the choice of a surgical approach. Our purpose wass to present the consensus guideline and the recommendations of ENETS 2017 for surgical procedures in neuroendocrine neoplasms of the appendix and analyze the difference in the survival rate in different surgical interventions. The literature overview includes studies on surgical treatment of neuroendocrine neoplasms of the appendix and takes into consideration the last consensus guideline of ENETS 2017 on the topic. ENETS recommends a simple appendectomy in well- differentiated appendix tumors smaller than 2 cm, regardless of their localization. Right hemicolectomy is performed for in tumors sized between 1 cm and 2 cm with positive resection lines, with deep mesoappendiceal invasion, high proliferation activity (G2) and vascular invasion. For tumors over larger than 2 cm – right hemicolectomy is recommended. Although current studies have pointed out no significant differences in survival rates between appendectomy for neuroendocrine neoplasms of the appendix and right hemicolectomy, ENETS 2017 suggests that the latest consensus guidelines should be followed.
The phenomenon “vessels within vessels” was initially described by Merchant S et al. as arteries found free-floating inside the lumen of veins. We have described another version of the “vessels within vessels”complex, composed of arteries found inside the lumen of lymphatic vessels. The purpose of the present study was to describe the structure of the lympho-arterial vascular complex in a breast tissue specimen from a male subject using three- dimensional tissue reconstruction. A histological specimen from a 64 year-old male subject diagnosed with gynecomastia was used. The tissue sample was sectioned in a multi-step manner. An overall of approximately 150pm thick tissue material was sampled. Immunostaining with anti-CD34 antibody and anti-podoplanin antibody was performed. Three-dimensional reconstruction of the vessel within the vessel structure was performed with “Reconstruct” software When the reconstruction of the breast parenchyma was revealed as a 3D image, it became apparent that the arterial vessel was situated inside the lymphatic vessel and could be followed along the entire length of the vascular segment studied. We have proved that these vascular complexes are not artificial phenomenon and do exist. The function of the vascular complexes is still uncertain, and is probably related to lymph propulsions in the initial collector vessels.
The aim of the study was to define the spectrum and susceptibility of microorganisms, isolated from diabetic foot ulcers in patients with poorly controlled diabetes, treated at the clinic of surgery, and compare microbial findings of specimens collected superficially and from deep tissues. The study included 19 patients with type 1 and 2 diabetes with clinical signs of infection. All patients were with poorly controlled diabetes and staged from 3rd to 5th grade according to the Wagner diabetic foot scale. Swab samples from non-debrided wounds and biopsy samples from deep tissues were collected from each patient. Specimens were inoculated on media for isolation of aerobic and anaerobic bacteria. Identification and susceptibility testing of the isolated oiganisms were performed by conventional methods, and VITEK 2 and mini API Systems (bioMerieux, France). A total of 88 bacterial isolates were cultured, comprising 56 clinical strains. Gram positive bacteria were the most common isolated organisms (53.57%), followed by Gram negative bacteria (26.78%) and anaerobic bacteria (19.64%). Staphylococcus aureus was the most common organism detected (10 strains), followed by Enterococcus spp. (7 strains), Escherichia coli (7 strains), Bacteroides spp. (6 strains) and various other organisms of low incidence. Polymicrobial infection was detected in 17 (89.47%) of the patients. In most of the cases infections were caused by 3 bacterial species. Mixed aerobic/anaerobic infections were detected in 9 (47.3%) patients. In 15 (78.94%) patients, there was a coincidence of bacterial findings from superficial and deep tissue samples. The strains isolated were susceptible to commonly used antimicrobials for treatment of diabetic foot infection. The predominant part of the diabetic foot infections were polymicrobial, caused by association between two or three microbial species. In half of the cases the infection was mixed. There was a good correlation between microbial findings from superficial swabs and deep tissue specimens when they were delivered to the microbiology laboratory immediately after collection.
Pulmonary embolism (PE) is a relatively common cardiovascular emergency, though its exact incidence is difficult to assess. Accurate diagnosis is critical because of the high 30-day mortality in patients in whom the diagnosis is missed on admission. Doubt for PE is often raised by the presence of risk factors for venous thromboembolism (VTE), which are categorized into inherited and acquired. Among these, the importance of inherited/genetic thrombophilic factors is increasingly recognized. The most frequent markers of inherited thrombophilia are Factor V Leiden (FVL) and G2021OA prothrombin gene mutation. Among the inherited factors causal to thrombophilia, the C677T variant in methylentetrahydrofolate reductase (MTHFR) gene as well as factors like P1A1/P1A2 polymorphism in platelet glycoprotein Ilb/IIIa (P1A2) and hypofibrinolytic polymorphism 4G/4G in PAI-1 gene are discussed with controversial results. In our study, thrombophilic and hypofibrinolytic genetic variants were identified in 54.2% of 115 patients with PE. The most common significant genetic defects were FVL- 16.5% in patients versus 6.2% in controls (OR=3.102; p=0.05), G20210A PT 5.7% versus 2.1% (OR=2.983; p>0.05). P1A2 was found in 27.3% patients versus 19.9% in controls (OR= 1.523, p>0.05) and PAM 27.8% versus 22.6% (OR =1.501 p>0.05). MTHFR C677T carriage was inverse: 6.7% in patients versus 13.4% in controls. (OR=0.461 p=0.05). Of all the patients studied, 15.65% had a history of recurrent embolic incidents. The risk of recurrence was higher for the carriers of FVL and G20210A prothrombin gene mutation. The association between carriage of thrombophilic genetic factor and the early onset of the first embolic episode was found in the patients with PE. The awareness of risk factors and risk stratification is a critical issue in treatment and prevention policy. Preventive measures should be taken in particular medical conditions.
Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean number of harvested lymph nodes was nine. This study indicated that using robotic surgery for rectal cancer does not lead to worsening the quality of TME. Further studies in this field are necessary.
Over the last decade, there has been a steady trend in increasing the incidence of colorectal cancer on a global scale. The relative share of patients under the age of 40 increases with each year. There is also a tendency for the incidence to be almost the same in males and females. Despite the efforts of the National Cancer Institute (NCI) to establish and implement adequate screening for disease prevention, 45.8% of patients were diagnosed in the advanced (third and fourth) stages of the disease. In 44.7% of patients, it was in the first and second stages, and the stage was unspecified in the remainder .
The prognosis in patients with colorectal cancer has been significantly improved. Precise staging of the tumor, adequate interpretation of predictive and prognostic factors is essential in the choice of therapeutic behavior. On the other hand, an inappropriate therapy administered to a patient with a diagnosed cancer can lead to disease progression, metastasis, and death, which can be avoided by adequate, patient-specified treatment.
Prostate cancer (PC) is the most common type of cancer in men inanumber of countries. The choice of surgical technique for radical prostatectomy (RP) concerns both patients and urologists. The choice is not easy to make, since data is still limited due to the lack of large multicentric randomized research trials. For three years (2011-2014), 244 patients with limited prostate cancer were operated in the Urology Clinic of the University Hospital in Pleven. Robot-assisted radical prostatectomy (RARP) was performed on 35 patients (14%), open retropubic radical prostatectomy (ORP) - on 199 patients (81%), and laparoscopic RP - on 12 patients (5%). The preoperative and post-op results from the first two groups were compared. For the follow-up period of 12 months, functional results in 82 patients of the ORPgroup were compared to the results in the 35 patients of the RARPgroup. The operative time was significantly longer in the RARPgroup, and blood loss was lower. The catheter stay was shorter in patients with RARP. The percentage of significant postoperative complications was 0%in the patients with RARPand 3%in the patients with an ORP. RARPpatients demonstrated better continence: 91%vs. 87%and erectile function46%vs.40%at 12 months.
Cancer of the cervix causes internal, external compression or both of the upper urinary tract in 50-60%of patients in advanced stages. Retrograde stenting is the most widely used technique for desobstruction of the upper urinary tract in urology practice. Diversion of urine flow is an alternative, achieved by nephrostomy of one or both kidneys.We studied retrospectively 33 women with upper urinary tract obstruction caused by carcinoma of the uterine cervix operated on between March 2014 and March 2015 in the urology clinic at the University Hospital in Pleven, Bulgaria. Apercutaneous nephrostomy (PNS) was placed in 17 patients, and 11 patients hadaretrograde catheterization with ureteral stent type JJ. Five patients were treated with both methods. Placement ofa JJstent was the first choice procedure for all patients since it providesabetter quality of life. PNSimproves renal function faster than retrograde JJstenting. Therefore, the first method of choice for patients with an untreated primary cervical, uterine cancer is the placement of PNS. Retrograde JJstenting is the method of choice in patients who undergo surgery and radiation therapy withoutarelapse of the disease.