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Open access

Kazimierz Rembiasz, Andrzej Budzyński, Jan Kulawik, Maciej Matłok, Marcin Migaczewski, Alicja Hubalewska-Dydejczyk and Filip Gołkowski

Laparoscopic Transperitoneal Approach to Adrenal Gland Malignancies

Even though there is not enough good data, the use of laparoscopic approach in malignant disease is regarded by some controversial issue. On the other hand it seems that transperitoneal access to the adrenal gland allows for effective and safe oncological removal of adrenal gland neoplasms.

The aim of the study was to present our experience with the use of transperitoneal approach in patients with adrenal gland malignancies.

Material and methods. From March 2003 till May 2009 we performed 200 laparoscopic transperitoneal adrenalectomies. There were 82 hormonally silent tumors (1.5-14 cm in diameter) and 118 hormonally active (63 pheochromocytomas, 26 Conn's syndrome, 25 Cushing's syndrome and 4 virylizing tumors).

Results. 197 procedures were completed laparoscopically and 3 were converted (including one for inability to assess resectablility of the tumor). 14 tumors (7%) were overtly malignant; 7 arising form the adrenal (adrenal cortex - 3, pheochromocytoma - 3, lymphoma - 1) and 7 metastatic (squamous cell cancer of the lungs - 2, clear cell carcinoma of the kidney - 2, collecting duct carcinoma of the kindey - 1, hepatocellular cancer - 1, NET lung tumor - 1). Further 19 tumors (9.5%) were assessed histologically as potentially malignant (pheochromocytomas - 16, tumors of neural origin - 2, oncocytomas - 1). One malignant tumor was unresectable other were operated radically. Progression of the cancer was observed in 3 patients with metastatic tumors.

Conclusions. Laparoscopic transperitoneal adrenalectomy allows for safe and radical removal of adrenal gland malignancies. Longer follow-up and larger patients volume are needed for better evaluation of long-term results.

Open access

Tomasz Miłek, Piotr Ciostek, Witold Woźniak, Andrzej Lewczuk, Robert Petryka, Jakub Słowik and Mirosław Jarosz

Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers

The aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage IV cancers with the use of self-expanding stents.

Material and methods. Within a one-year period, from October 2007 to September 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. Eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. Each patient was assessed on the Karnofsky performance scale. The condition for eligibility, except for emergent circumstances, was performance status below 70. Endoscopy to collect biopsy samples for histopathologic examination and abdomen and chest CT scans were performed. Local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. Moreover, the presence and severity of coexisting disorders were also thoroughly examined. The procedures were performed using a c-arm X-ray system and endoscope. Following the introduction of the endoscope to the area of cancerous narrowing, a guide tube was inserted through the stricture under fluoroscopic control. Under combined endoscopic and radiological control, after contrast administration above the narrowing, a stent to expand the stricture was placed and released. The result of stent placement was documented by radiologic photographs, and a subsequent X-ray check was performed 48 hours after stent implantation.

Results. A total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. During implantation into a stricture secondary to sigmoid colon cancer, the stent slipped down and incompletely filled the tumor lumen. In this case, a short supplementary stent was added, which yielded a satisfactory result of the procedure. In another case, the stent migrated and adhered to the gastric wall, which further impaired passage through the patient's gastrointestinal tract. A feeding jejunostomy was performed in this patient, which was considered the best course due to the patient's extremely poor general condition.

Conclusions. 1. Stent implantation in the gastrointestinal tract lumen in the setting of inoperable carcinomas under endoscopic and X-ray control is effective and safe. 2. In the case of gastrointestinal tract sub-obstruction in patients with left colon cancers and in poor general condition, this procedure should be considered prior to pursuing surgical operations.

Open access

Emese Rita Markovics, Kinga Dörner, Orsolya Birta and Julia Popa

Introduction

In this case report we present the aesthetical correction of crowded anterior teeth in a patient who has refused the orthodontic treatment. We also discuss how this correction can be resolved from the point of view of dental prosthetic and what measurements can be helpful in order to collect the data used to restore a satisfying smile on the patient’s face using dental ceramic restoration. Case presentation: A 32-year-old patient complained about his crowded incisors. We examined the incisal curvature, the proportion between the height and the width of the teeth, and the relation between the widths of the teeth and the golden proportion. The results of the measurements were compared to the characteristic values of the ideal denture. After the examination of the dental plaster cast, calculating the difference between the existing space and the necessary space, we were able to calculate the lack of space, which caused the crowded teeth. Conclusion: Along the prosthetic planning, these measurements may serve as a guideline to the dentist as an objective basis for the formation of an aesthetic denture and smile.

Open access

Eszter Mild, Erzsébet Lázár, Judit-Beáta Köpeczi, Enikő Kakucs, Marius Găzdac, Annamária Pakucs, Cezara Tudor and István Benedek

Abstract

Background: High-dose chemotherapy and autologous stem cell transplantation have become a standard curative treatment in various hematologic malignancies. Many factors can affect the success of mobilization and hematopoietic stem cell harvesting.

Aim: The aim of this study was to analyze factors that lead to mobilization failure.

Material and Methods: We conducted a retrospective study on 19 patients with failure of stem cell harvesting. All patients were administered high doses of GCS-F (filgrastim, 15 μg/kg/day) and 0.24 mg/kg of plerixafor on day +5 or +10 of harvesting.

Results: The median age of the study population was 51 years (range 35–67) and 52.6% (n = 10) were males. The study group included 4 (21%) subjects with multiple myeloma, 6 (31.5%) with Hodgkin lymphoma, 8 cases (42.1%) with non-Hodgkin lymphoma and 1 patient with chronic lymphocytic leukemia. Each patient received 2.78 (range 1–5) lines of chemotherapy, administered in 11.57 (range 2 to over 20) cycles of treatment.

Conclusion: In hematologic malignancies it is very important to collect stem cells in time, in order to reduce mobilization failure. As we have shown in our studied cases, multiple lines of polychemotherapy with or without radiotherapy lead to mobilization failure.

Open access

Csaba Dudás, Zoltán Forgó and Bernadette Kerekes-Máthé

Abstract

Background: The need for the whitening effects of toothpastes became primary for most users. Changes in the surface roughness of restoration materials after tooth brushing are inevitable, and the abrasion is known to increase the possibility of dental plaque accumulation. Aim of the study: To evaluate in vitro surface roughness changes of different dental restorative materials after tooth brushing simulation. Material and methods: Fifty specimens of two composite materials (Evicrol, Super-Cor), two glass ionomer materials (Glassfill, Kavitan Cem) and a silicate cement (Fritex) were prepared according to the manufacturer’s instructions. Each group of specimens was divided in three subgroups for tooth brushing simulation: using two different types of toothpaste and without toothpaste. Before and after 153 hours of tooth brushing simulation with a custom-made device, the surface roughness was measured with a surface roughness tester. Statistical analysis was performed after collecting the data. Results: All materials exhibited changes in surface roughness after the use of both toothpastes. The self-curing composite showed the less change and glass ionomer materials showed the greatest changes in surface roughness. Conclusions: The surface changes of dental materials depended on their composition and the cleaning procedure. Although self-curing composite was the most resistant to surface changes, its surface roughness values were high. Light-curing composite presented the lowest surface roughness values, even after brushing with toothpastes. The “medium” labeled toothbrush caused significant changes without toothpaste on the surface of light-curing composite, glass ionomer and silicate cement materials.

Open access

Carmen Corina Şuteu, Theodora Benedek and Rodica Togănel

Abstract

Introduction: Pulmonary arterial hypertension (PAH) is a complex disease with poor prognosis. Serum uric acid has been proposed as a potentially non-invasive and objective parameter for prognosis and response to therapy.

Objectives: To investigate the potent relationship between serum uric acid levels and functional and echocardiographic parameters in children with PAH.

Methods: Serum uric acid levels were measured in 34 children with PAH and were correlated with the functional class, 6-minute walk test, and echocardiographic parameters at baseline and at 12 months follow-up.

Results: In pediatric PAH patients serum uric acid levels were higher compared with the control subjects (p = 0.001). In the high uric acid group serum uric acid levels were correlated with 6-minute walk test (p = 0.008), and with several echocardiographic parameters, such as pulmonary vascular resistance (p = 0.04), fractional area change (p = 0.05), left ventricle eccentricity index (p = 0.04), right atrial area (p = 0.03), right ventricle myocardial index (p = 0.01), and pericardial effusion (p = 0.001), markers of right ventricular overload and dysfunction.

Conclusions: Serum uric acid levels are easy to collect and measure, and correlate with both functional and echocardiographic parameters that reflect right ventricular dysfunction.

Open access

Gabriela Musat, Alina Anghel, Lucia Radu and Roxana Decusara

Abstract

BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations.

OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders.

MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months.

RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity.

CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.

Open access

Monica Chiţu, Nora Rat, Diana Opincariu, Alexandra Stănescu, András Mester, Theodora Benedek and Imre Benedek

Study (ADenosine Vasodilator Independent Stenosis Evaluation II). JACC Cardiovasc Interv . 2015;8:824-833. 35. Nijjer SS, Sen S, Petraco R, et al. Pre-angioplasty instantaneous wave-free ratio pullback provides virtual intervention and predicts hemodynamic outcome for serial lesions and diffuse coronary artery disease. JACC Cardiovasc Interv . 2014;7:1386-1396. 36. Van Belle E. DEFINE REAL: a prospective, observational, non-randomised, European, multicentre registry, collecting real-life information for the utilisation of iFR in assessing coronary