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  • Author: Simona Gurzu x
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Open access

Ciortea Carmen Diana, Gurzu Simona, Zdrob Simona Maria and Jung I

Abstract

Objective: To perform a retrospective clinico-pathological and immunohistochemical analysis of malignant melanomas. Methods: One-hundred sixty consecutive cases diagnosed in the Department of Pathology of the County Emergency Clinical Hospital of Tîrgu Mureș, Romania, between January 2000 - December 2009, were used. Of these, 47 cases were melanoma metastases that were excluded from the study; this research was focused on the study of 113 primary melanomas (PMs). In 20 cases of PMs (11 cutaneous, 5 choroidal, and 4 melanomas of the anal canal) immunohistochemical stains were performed using the antibodies p53, Ki67, ER (estrogen receptor), CD8 and CD31. Results: Cutaneous PMs prevailed (83%) followed by choroidal (11%), digestive tract (4%) and nasal mucosa PMs (2%). Independent of their location, PMs predominantly affected females (58%) over age 50. Regarding cutaneous cases, lower limbs (49%) were more affected, followed by the head and neck (18%) and the trunk (18%). We noted negativity or low p53-nuclear positivity in cutaneous and digestive tract PMs; p53 was overexpressed in choroidal melanomas. On the other hand, although the proliferative index Ki67 was also quite low in cutaneous PMs, its percentage increased in choroidal and digestive tract PMs. CD8 was positive in cutaneous PMs and negative in choroidal and digestive tract cases. While in cutaneous PMs we noted a predominated angiogenesis by intussusception, in digestive tract melanomas there was a predominance of sprouting and pseudoglomeruloid mechanisms. Conclusions: Choroidal PMs display the highest p53 and Ki-67 expression, compared to cutaneous MMs. Tumor angiogenesis seems to present a specific pathway in cutaneous PMS compared to the gastrointestinal cases

Open access

Irina Luciana Gurzu, Maria Enea, Simona Mihaela Slătineanu, Bogdan Gurzu and Brândușa Constantin

Open access

Ioana Hălmaciu, Simona Gurzu, B A Suciu, S I Comișel, L Dénes, Lacrima Boc and Klara Brînzaniuc

Abstract

Objective: The aim of this study was to analyze in parallel the 6th and the newest 7th AJJCC/UICC (American Joint Committee on Cancer/ International Union Against Cancer) staging system in order to highlight changes brought by the new staging system.

Methods: We analyzed data obtained retrospectively from 134 hospitalized patients diagnosed with gastric carcinomas, who underwent surgery at the Surgery Clinics of the County Emergency Clinical Hospital of Tîrgu Mureș, Romania between 2008-2010. The data have been obtained from histopathology reports, and the analyzed parameters were the following: age, gender and pTNM staging. For all cases included in the study restaging was performed according to the 7th AJJCC/UICC staging system.

Results: 71.66% of cases were adenocarcinomas, 7.46% mucinous adenocarcinoma, 14.17% signet ring cell carcinoma, and 6.71% undifferentiated carcinoma. The signet ring cell carcinomas predominated before 65 years of age (p = 0.003). Compared to the 6th staging system, in the new system pT2 percentages decreased significantly from 38.8% to 6.71%, and pT4 increases from 11.19% to 55.97% (p <0.0001). The pN3 cases increased from 20.9% to 45.52%, because all cases classified as pN2 in the old staging system, became pN3 in the new system. Some of the pN1 cases turned into pN2 in the new system (p = 0.004). Stage IV cases also decreased from 29.85% to 14.94%, due to regrouping of stage III.

Conclusions: There are significant changes between the two staging systems. The new staging system aims to achieve a better postoperative follow-up.

Open access

A Tudor, C Molnar, C Copotoiu, VO Butiurca, C Nicolescu, Tudor Bianca and Gurzu Simona

Abstract

Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches.

Methods. Our experimental model is based on ten piglets, which were divided into 2 groups. In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas.

Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group.

Conclusions. In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

Open access

A Tudor, VO Butiurca, C Nicolescu, Bianca Tudor, Simona Gurzu, C Molnar and C Copotoiu

Abstract

Introduction. Although in recent years there have been various versions of pancreatic - digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.

Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.

Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico - digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ductomucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).

Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.

Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

Open access

Tivadar Bara, Tivadar Bara, Radu Neagoe, Daniela Sala, Simona Gurzu, Ioan Jung and Cristian Borz

Abstract

Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

Open access

Marius Harpa, Ionela Movileanu, Leslie Sierad, Ovidiu Cotoi, Horațiu Suciu, Terezia Preda, Dan Nistor, Carmen Sircuța, Klara Brânzaniuc, Radu Deac, Simona Gurzu, Lucian Harceaga, Peter Olah, Dan Simionescu, Michael Dandel and Agneta Simionescu

Open access

Marius Mihai Harpa, Ionela Movileanu, Leslie Neil Sierad, Ovidiu Simion Cotoi, Horatiu Suciu, Carmen Sircuta, Terezia Preda, Dan Nistor, Klara Branzaniuc, Radu Deac, Michael Dandel, Simona Gurzu, Lucian Harceaga, Peter Olah, Agneta Simionescu and Dan Simionescu

Abstract

Background: We hypothesized that an ideal heart valve replacement would be acellular valve root scaffolds seeded with autologous stem cells. To test this hypothesis, we prepared porcine acellular pulmonary valves, seeded them with autologous adipose derived stem cells (ADSCs) and implanted them in sheep and compared them to acellular valves.

Methods: Fresh porcine pulmonary valve roots were decellularized with detergents and enzymes. ADSCs were isolated from subdermal fat and injected within the acellular cusps. Valves were then implanted in an extra-anatomic pulmonary position as RV to PA shunts: Group A (n=6) consisted of acellular valves and Group B (n=6) of autologous stem cell-seeded acellular xenografts. Sheep were followed up for 6 months by echocardiography and histologic analysis was performed on explanted valves.

Results: Early evolution was favorable for both groups. All Group A animals had physiologic growth without any signs of heart failure and leaflets were found with preserved structure and mobility, lacking signs of thrombi, inflammation or calcification. Group B sheep however expressed signs of right ventricle failure starting at one month, accompanied by progressive regurgitation and right ventricle dilatation, and the leaflets were found covered with host tissue. No cells were found in any Group A or B explants.

Conclusions: Acellular stabilized xenogeneic pulmonary valves are reliable, stable, non-immunogenic, non-thrombogenic and non-calcifying scaffolds with excellent hemodynamics. Seeding these scaffolds with autologous ADSCs was not conducive to tissue regeneration. Studies aimed at understanding these novel observations and further harnessing the potential of stem cells are ongoing.