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Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Background: Heart failure, stroke and death are major dangers associated with atrial fibrillation (AF), a common abnormal heart rhythm. Having a gastrointestinal (GI) procedure puts patients at risk for developing AF, especially after large abdominal surgery. Although earlier research has shown a possible connection between postoperative AF and higher mortality, the exact nature of this interaction is yet uncertain. Methods: To investigate the relationship between AF and death after GI procedures, this research carried out a thorough meta-analysis and systematic review of randomized controlled studies or clinical trials. Finding relevant randomized controlled trials (RCTs) required a comprehensive search across many databases. Studies involving GI surgery patients with postoperative AF and mortality outcomes were the main focus of the inclusion criteria. We followed PRISMA and Cochrane Collaboration protocols for data extraction and quality assessment, respectively. Results: After GI surgery, there was no statistically significant difference in mortality between the AF and non-AF groups, according to an analysis of the available trials (p = 0.97). The mortality odds ratio (OR) was 1.03 (95% CI [0.24, 4.41]), suggesting that there was no significant correlation. Nevertheless, there was significant heterogeneity throughout the trials, which calls for careful interpretation. Conclusion: Despite the lack of a significant link between AF and death after GI surgery in our study, contradictory data from other research highlight the intricacy of this relationship. Discrepancies may arise from variations in patient demographics, research methodology and procedural problems. These results emphasize the necessity for additional extensive and varied studies to fully clarify the role of AF in postoperative mortality in relation to GI procedures. Comprehending the subtleties of this correlation might enhance future patient outcomes and contribute to evidence-based therapeutic decision making. [ABSTRACT FROM AUTHOR]

Traumatic abdominal wall hernias (TAWHs) are uncommon health conditions that involve a disruption of the muscular layers after a blunt abdominal injury. A consensus in the management of TAWHs has not been established, owing to the scarce number of reported cases. These hernias can occur under a broad array of clinical presentations, from stable and asymptomatic patients to emergency situations with associated intra-abdominal injuries. The aetiology of TAWHs is diverse and can occur at all ages, however it is more likely to be reported in children and elderly patients. Clinical findings must be correlated with a CT scan, which will confirm the diagnosis. Early diagnosis and treatment were found to be associated with a lower risk of complications and mesh use during the surgical repair is an efficient mean of reducing recurrences after the surgical repair. However, the timing of repair and surgical solution still depends on the patient's condition.

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specific mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fistula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime.

To modulate the bioactivity and boost the therapeutic outcome of implantable metallic devices, biodegradable coatings based on polylactide (PLA) and graphene oxide nanosheets (nGOs) loaded with Zinforo™ (Zin) have been proposed in this study as innovative alternatives for the local management of biofilm-associated periprosthetic infections. Using a modified Hummers protocol, high-purity and ultra-thin nGOs have been obtained, as evidenced by X-ray diffraction (XRD) and transmission electron microscopy (TEM) investigations. The matrix-assisted pulsed laser evaporation (MAPLE) technique has been successfully employed to obtain the PLA-nGO-Zin coatings. The stoichiometric and uniform transfer was revealed by infrared microscopy (IRM) and scanning electron microscopy (SEM) studies. In vitro evaluation, performed on fresh blood samples, has shown the excellent hemocompatibility of PLA-nGO-Zin-coated samples (with a hemolytic index of 1.15%), together with their anti-inflammatory ability. Moreover, the PLA-nGO-Zin coatings significantly inhibited the development of mature bacterial biofilms, inducing important anti-biofilm efficiency in the as-coated samples. The herein-reported results evidence the promising potential of PLA-nGO-Zin coatings to be used for the biocompatible and antimicrobial surface modification of metallic implants. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Nasobiliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted. [ABSTRACT FROM AUTHOR]

Exploring silver-based and carbon-based nanomaterials' excellent intrinsic antipathogenic effects represents an attractive alternative for fabricating anti-infective formulations. Using chemical synthesis protocols, stearate-conjugated silver (Ag@C18) nanoparticles and graphene oxide nanosheets (nGOs) were herein obtained and investigated in terms of composition and microstructure. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) characterizations revealed the formation of nanomaterials with desirable physical properties, while X-ray diffraction (XRD) analyses confirmed the high purity of synthesized nanomaterials. Further, laser-processed Ag@C18-nGO coatings were developed, optimized, and evaluated in terms of biological and microbiological outcomes. The highly biocompatible Ag@C18-nGO nanostructured coatings proved suitable candidates for the local modulation of biofilm-associated periprosthetic infections. [ABSTRACT FROM AUTHOR]

Gastrointestinal cancers are characterized by a frequent incidence, a high number of associated deaths, and a tremendous burden on the medical system and patients worldwide. As conventional chemotherapeutic drugs face numerous limitations, researchers started to investigate better alternatives for extending drug efficacy and limiting adverse effects. A remarkably increasing interest has been addressed to chitosan and cyclodextrins, two highly versatile natural carbohydrate materials endowed with unique physicochemical properties. In this respect, numerous studies reported on fabricating various chitosan and cyclodextrin-based formulations that enabled prolonged circulation times, improved cellular internalization of carried drugs, preferential uptake by the targeted cells, reduced side effects, enhanced apoptosis rates, and increased tumor suppression rates. Therefore, this paper aims to briefly present the advantageous properties of these oligo- and polysaccharides for designing drug delivery systems, further focusing the discussion on nanocarrier systems based on chitosan/cyclodextrins for treating different gastrointestinal cancers. Specifically, there are reviewed studies describing promising solutions for colorectal, liver, gastric, pancreatic, and other types of cancers of the digestive system towards creating an updated framework of what concerns anticancer chitosan/cyclodextrin-based drug delivery systems. [ABSTRACT FROM AUTHOR]

The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1–0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite its small size, the vermiform appendix is an organ with several physiological roles and various pathologies, the most common of which is acute appendicitis. The other pathologies of the vermiform appendix, especially its neoplasia are rare and often go unnoticed and are accidentally identified during appendectomies performed for other reasons. In the early stages, most appendiceal neoplasms are not detected; however, in the advanced stages, they may mimic the symptoms of acute appendicitis. In addition, due to massive mucus production, mucinous neoplasms, especially adenocarcinomas, may fistulize into adjacent structures, some identified after perforated organ pathology. The general treatment for appendiceal pathologies, including neoplasms, is complete surgical excision of the appendix, with or without the right hemicolectomy. Life expectancy is somewhat longer for low-grade mucinous tumors and peaks for well-differentiated, small, metastasis-free neuroendocrine tumors of the appendix occurring in children. The vermiform appendix is a muscular cylindrical structure originating near the junction of the cecum and ileum, averaging 9 cm (5–35 cm) in size. As the most mobile viscera, it can adopt several positions, the most common being the retrocecal position. Perceived as an atavistic organ lacking physiological relevance, the vermiform appendix appears to be involved in immune function, serving in the maturation of B lymphocytes and the production of immunoglobulin A, in endocrine function, excreting amines and hormones in the 2–3 mL of mucus secreted daily, and in digestive function, by storing beneficial bacteria from where they can recolonize the colon. With a lumen of about 6 mm, the vermiform appendix has a reduced storage capacity, so any blockage of the appendix with fecoliths (fecaliths), seeds derailed from the colon, or enlarged lymph nodes prevents drainage and intraluminal accumulation of secreted mucus. Unable to relax, the appendix wall severely limits its intraluminal volume, so mucus accumulation leads to inflammation of the appendix, known generically as appendicitis. In addition, the vermiform appendix may be the site of the development of neoplastic processes, which may or may not involve mucus production, some of which can significantly affect the standard of living and ultimately lead to death. In general, mucinous tumors may have a better prognosis than non-mucinous tumors. This review takes a comprehensive path, starting by describing the anatomy and embryology of the vermiform appendix and further detailing its inflammatory pathologies, pathologies related to congenital anomalies, and appendix tumors, thus creating an up-to-date framework for better understanding, diagnosis, and treatment of these health problems. [ABSTRACT FROM AUTHOR]

Simple Summary: An analysis of the presence of mutations of 105 genes in appendiceal cancers through the lens of the reviewed literature supports the view that in most of them, the inactivation of tumor suppressor genes, such as TP53 and SMAD4, is required in parallel with the reactivation of genes with oncogenic potentials, such as KRAS, GNAS, and BRAF, which support the main tumor processes, cell proliferation, angiogenesis, and evasion of apoptosis. Of all appendiceal cancers, the most mutated genes are reported in mucinous neoplasms of the appendix, not including those in the RAS–RAF–MEK–ERK signaling pathway, followed by low-grade appendiceal mucinous neoplasms, appendiceal goblet cell adenocarcinomas, and mucinous adenocarcinomas of the appendix, in which this signaling pathway is most frequently affected, showing its importance in their tumorigenesis. Microsatellite instability rarely occurs in appendix cancers, being reported only in adenocarcinomas. In appendiceal cancers, the most frequently mutated genes are (i) KRAS, which, when reactivated, restores signal transduction via the RAS–RAF–MEK–ERK signaling pathway and stimulates cell proliferation in the early stages of tumor transformation, and then angiogenesis; (ii) TP53, whose inactivation leads to the inhibition of programmed cell death; (iii) GNAS, which, when reactivated, links the cAMP pathway to the RAS–RAF–MEK–ERK signaling pathway, stimulating cell proliferation and angiogenesis; (iv) SMAD4, exhibiting typical tumor-suppressive activity, blocking the transmission of oncogenic TGFB signals via the SMAD2/SMAD3 heterodimer; and (v) BRAF, which is part of the RAS–RAF–MEK–ERK signaling pathway. Diverse mutations are reported in other genes, which are part of secondary or less critical signaling pathways for tumor progression, but which amplify the phenotypic diversity of appendiceal cancers. In this review, we will present the main genetic mutations involved in appendix tumors and their roles in cell proliferation and survival, and in tumor invasiveness, angiogenesis, and acquired resistance to anti-growth signals. [ABSTRACT FROM AUTHOR]

Postoperative adhesions are a frequent complication encountered after surgical procedures, mainly after intraperitoneal interventions. To this day, the pathophysiological mechanism behind the process of adhesions formation is not completely known. There are many strategies proposed as prophylaxis methods, involving surgical techniques, drugs or materials that prevent adhesions and even state of the art technologies such as nanoparticles or gene therapy. The aim of our review is to present these innovative approaches and techniques for postoperative adhesions prevention. After a thorough scientific database query, we selected 84 articles published in the past 15 years that were relevant to our topic. Despite all the recent groundbreaking discoveries, we are at an early stage of understanding the complexity of the adhesion formation mechanism. Further investigations should be made in order to create an ideal product for safe clinical use for prevention. [ABSTRACT FROM AUTHOR]

Background: Telemedicine is the service of delivering medical care from a distance through the means of modern technology. It has many advantages, including improved access, decreased costs for both patients and clinics, more flexibility and availability, as well as more precise and individualized therapies. However, it is equally important to take into consideration all the challenges associated with this innovative way of providing care. This virtual technology has had an exponential growth, especially since the beginning of the COVID-19 pandemic, because it delivers great outcomes and suggests exciting future promises. Methods: The study involved the collection of responses from an online questionnaire comprising 26 questions that was distributed to healthcare professionals in Romania. Results: The questionnaire was completed by a number of 1017 healthcare professionals. We investigated and analyzed whether telehealth is seen as an important constituent of the healthcare system, if it is perceived as necessary, safe, well-managed by lawmakers, and easy to use, what advantages it has, what common practices specialists already employ and, additionally, the openness toward becoming more digitally educated for the purpose of streamlining the use of telemedicine. Conclusions: This paper reports on the perception of telemedicine among healthcare professionals in Romania, as constructive feedback represents an essential piece of the puzzle in assuring the smooth transition toward this facet of modern healthcare. [ABSTRACT FROM AUTHOR]

Background: Incisional hernias represent a common complication following a midline incision, generating impairment, lower quality of life, and social costs. The aim of this narrative review is to determine in which manner risk factors - such as age, gender, postoperative complications, and even the overall health system - impact the satisfaction and expectations of the patients. Methods: A literature search was performed through PubMed, Web of Science, and SpringerLink, addressing both international and national articles. Only full-text articles published in the last 12 years were chosen. Each individual positive or negative factor was then targeted. Results: Statistically, the majority of patients were satisfied with the outcomes of the reparative surgery. Even so, complications can still occur, which are more likely to appear in the early postoperative stages. In most of these cases, the patients complained of strenuous movement, chronic pain, or recurrence, leaving the option of another surgical repair up to the patient's wishes. On the one hand it seems that robotic-assisted surgery (RAS), absorbable sutures, suture fixation without tacks, and the male gender were associated with a better quality of life and less recurrence or other complications. On the other hand, lack of communication between patients and health personnel, chronic health diseases, and the female gender were linked to a tendency of developing more complications and therefore, a lower quality of life. Conclusion: Statistically, in most of the cases, the patients were satisfied with the results. While it is safe to say that an incisional hernia repair increases the quality of life, there is still a small, but significant percentage of people that do not benefit from it as much as they expected. More awareness should be raised and the communication between patients and health personnel improved. [ABSTRACT FROM AUTHOR]

Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives. Materials and Methods: We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. Results: The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. Conclusions: Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure. [ABSTRACT FROM AUTHOR]

Duodenal gangliocytic paragangliomas are rare neuroendocrine tumors primarily localized in the periampullary area. Though mostly asymptomatic, they can present with various symptoms, most often jaundice, anemia and abdominal pain. The present paper is a case series report, describing our personal experience with patients presenting to the Emergency Unit with different symptoms due to duodenal gangliocytic paraganglioma. Endoscopic resection is safe and indicated in most of the cases, being also associated with lower medical costs. EUS plays a central role in the pre-resection management and in surveillance, and immunostaining is decisive to ascertain the tumor histologic origin. In addition to reporting our experience, we researched the literature regarding these rare tumors and performed a comprehensive review. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (Hp), a well-known human pathogen, causes one of the most common chronic bacterial infections and plays an important role in the emergence of chronic progressive gastric inflammation and a variety of gastrointestinal diseases. The prevalence of Hp infection varies worldwide and is indirectly proportional to socio-economic status, especially during childhood. The response to the eradication therapy significantly depends on the antibiotic resistance specific to each geographical region; thus, currently, given the increasing prevalence of antimicrobial resistance (especially to clarithromycin, metronidazole, and levofloxacin), successful treatment for Hp eradication has become a real challenge and a critical issue. The most incriminated factors associated with multidrug resistance (MDR) in Hp proved to be the overuse or the improper use of antibiotics, poor medication adherence, and bacterial-related factors including eflux pumps, mutations, and biofilms. Up to 30% of first-line therapy fails due to poor patient compliance, high gastric acidity, or high bacteremia levels. Hence, it is of great importance to consider new eradication regimens such as vonoprazan-containing triple therapies, quintuple therapies, high-dose dual therapies, and standard triple therapies with probiotics, requiring further studies and thorough assessment. Strain susceptibility testing is also necessary for an optimal approach. [ABSTRACT FROM AUTHOR]

With the prevalence of digitalization in all aspects of modern society, health assessment is becoming digital too. Taking advantage of the most recent technological advances and approaching medicine from an interdisciplinary perspective has allowed for important progress in healthcare services. Digital health technologies and biotelemetry devices have been more extensively employed for preventing, detecting, diagnosing, monitoring, and predicting the evolution of various diseases, without requiring wires, invasive procedures, or face-to-face interaction with medical personnel. This paper aims to review the concepts correlated to digital health, classify and describe biotelemetry devices, and present the potential of digitalization for remote health assessment, the transition to personalized medicine, and the streamlining of clinical trials. [ABSTRACT FROM AUTHOR]

Encompassing a group of complex and heterogeneous diseases, cancer continues to be a challenge for patients and healthcare systems worldwide. Thus, it is of vital importance to develop advanced treatment strategies that could reduce the trends of cancer-associated morbidity and mortality rates. Scientists have focused on creating performant delivery vehicles for anti-cancer agents. Among the possible materials, cyclodextrins (CDs) attracted increasing interest over the past few years, leading to the emergence of promising anti-tumor nanomedicines. Tackling their advantageous chemical structure, ease of modification, natural origin, biocompatibility, low immunogenicity, and commercial availability, researchers investigated CD-based therapeutical formulations against many types of cancer. In this respect, in this paper, we briefly present the properties of interest of CDs for designing performant nanocarriers, further reviewing some of the most recent potential applications of CD-based delivery systems in cancer management. [ABSTRACT FROM AUTHOR]

Artificial intelligence has the potential to revolutionize modern society in all its aspects. Encouraged by the variety and vast amount of data that can be gathered from patients (e.g., medical images, text, and electronic health records), researchers have recently increased their interest in developing AI solutions for clinical care. Moreover, a diverse repertoire of methods can be chosen towards creating performant models for use in medical applications, ranging from disease prediction, diagnosis, and prognosis to opting for the most appropriate treatment for an individual patient. In this respect, the present paper aims to review the advancements reported at the convergence of AI and clinical care. Thus, this work presents AI clinical applications in a comprehensive manner, discussing the recent literature studies classified according to medical specialties. In addition, the challenges and limitations hindering AI integration in the clinical setting are further pointed out. [ABSTRACT FROM AUTHOR]

In this review, we focus on gut microbiota profiles in infants and adults colonized (CDC) or infected (CDI) with Clostridioides difficile. After a short update on CDI epidemiology and pathology, we present the gut dysbiosis profiles associated with CDI in adults and infants, as well as the role of dysbiosis in C. difficile spores germination and multiplication. Both molecular and culturomic studies agree on a significant decrease of gut microbiota diversity and resilience in CDI, depletion of Firmicutes, Bacteroidetes , and Actinobacteria phyla and a high abundance of Proteobacteria , associated with low butyrogenic and high lactic acid-bacteria levels. In symptomatic cases, microbiota deviations are associated with high levels of inflammatory markers, such as calprotectin. In infants, colonization with Bifidobacteria that trigger a local anti-inflammatory response and abundance of Ruminococcus , together with lack of receptors for clostridial toxins and immunological factors (e.g., C. difficile toxins neutralizing antibodies) might explain the lack of clinical symptoms. Gut dysbiosis amelioration through administration of "biotics" or non-toxigenic C. difficile preparations and fecal microbiota transplantation proved to be very useful for the management of CDI. [ABSTRACT FROM AUTHOR]

Cutaneous T-cell lymphomas (CTCL) are a group of clinicopathologically definable monoclonal Tcell proliferations with skin involvement. Primary cutaneous CD4+ small T-cell lymphomas (CD4+ SMPTCL) are a rare entity, mostly characterized by the appearance of nodules/plaques/ulcerations in the upper part of the body. We present a rare case of a patient who addressed our surgical clinic for 2 subcutaneous nodules that appeared few months before and grew rapidly. The clinical exam revealed one subcutaneous nodule on the left abdominal upper quadrant and one ulcerated nodule involving the left thigh, as well as bilateral axillary adenopathies. The final diagnosis following the histopathological and immunohistochemical exams is of small T-cell non-Hodgkin malignant peripheral lymphoma, a rare disorder usually involving the upper part of the body. This disease usually has an indolent course, while spontaneous regression was reported in almost 30% of cases. Lesions that do not disappear spontaneously may be treated using different approaches such as intralesional steroids, radiotherapy or, as in the presented case, surgical excision. General prognosis for patients with primary cutaneous CD4+ small T-cell lymphomas is favorable, having an estimated 5-year disease-free survival rate of 100%. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is one of the most common and leading causes of cancer death worldwide, with an increasing risk and prevalence. Although the usage of 18-FDG PET-CT in gastric cancer evaluation remains a matter of debate and is not consistently recommended by international guidelines, our descriptive review aims to highlight its actual role in the diagnostic accuracy, staging, therapeutic management, and relapse monitoring of this malignancy. Methods: The current research was conducted using scholarly databases including PubMed, Scopus, and Google Scholar by searching useful science journals, references, and abstracts on the topic. The keywords used were "gastric cancer" AND "PET-CT". Results: 18-FDG PET-CT remains a promising method with increasing clinical utility not only across a wide variety of malignancies, but also among gastric cancer patients. Conclusions: We are certain that with further improvements, this technique could improve the diagnosis and evaluation of gastric cancer, and make it more approachable and accurate. [ABSTRACT FROM AUTHOR]

LARS is a widely spread complication in patients suffering from rectal cancer who had undergone a low anterior resection. Until recently it was very difficult to adequately quantify the impact that this syndrome has on patients' quality of life. In 2012, a special score was developed and validated in Denmark widely known as the LARS score. Since then, it is on the road to be validated in many countries all around the world. Our study aimed to test its applicability on patients from Romania. The results were conclusive with available literature, thus proving its usefulness and validation in our country. [ABSTRACT FROM AUTHOR]

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures. Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant. Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse. [ABSTRACT FROM AUTHOR]

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Hypopituitarism is the main complication of nonfunctioning pituitary macroadenomas. A 64-yearold patient was admitted for marked asthenia, generalized muscle contractions, acroparesthesia and lumbar pain. Clinical examination revealed grade I obesity, discrete eyelid edema, negative Chwosteckand Trousseau signs. Hormonal profile showed the presence of somathotropic pituitary insufficiency, low testosterone levels (of 1.3 ng/mL, normal: 1.68-7.58ng/mL), gonadotropin and prolactin levels within the normal range, normal values for TSH (Thyroid Stimulated Hormone) and FT4 (Free Thyroxine). On admission, low serum and urinary cortisol values were obtained, with an appropriate response after the Synacthen test. The MRI (Magnetic Resonance Investigation) examination revealed a pituitary macroadenoma of 20/21/21 mm, compressing the optic chiasm and thalamus, with bilateral 180-degree involvement of the internal carotid artery. The ophthalmological examination described a lower scotoma in the left eye, without amputation of the visual field. Thyroid and glucocorticoid hormone replacement therapy was recommended, along with neurosurgical intervention. In pituitary macroadenomas, the close proximity to the optic chiasm and carotid arteries limits the curative therapeutic potential and increases the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Inguinal hernia is one of the most common surgical pathologies, which appears mainly due to the weakening of the abdominal muscles. Currently, the gold standard in the repair of inguinal hernias by open approach is the Lichtenstein procedure, while the gold standard of laparo-endoscopic procedures are the pre-peritoneal transabdominal technique (TAPP) and the total extraperitoneal technique (TEP). The purpose of this study is to evaluate, for a period of 4 years, the cases of inguinal hernias operated both by laparoscopic and open procedures to analyze their characteristics, under the conditions in which none was imposed as absolute gold standard for groin hernias. The present study was retrospective and descriptive, including a number of 214 cases hospitalized with the diagnosis of inguinal hernia. In the surgery of the groin hernia, both laparoscopic and open procedures have demonstrated their feasibility. Our study shows the preference for open surgery in elderly patients and those with comorbidities, as well as a faster evolution, with earlier discharge in the case of laparoscopic interventions. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the main stress factors for the pharmacist in the community pharmacy in Romania and how the pharmacists manage the tensions generated by professional ethics, patient attitudes and pharmacy management, and the degree of professional satisfaction of pharmacists. Materials and Methods: The study was conducted over 7 months. The population surveyed consisted of 376 pharmacists working in the community pharmacy. They completed a questionnaire consisting of six representative sections for each category of factors considered: demographic data, pharmacy satisfaction, stress factors determined by patient attitudes, stress factors determined by pharmacy management, ethical stress factors and other factors, items designed to reveal the physical / psychological impairment of community pharmacists. Results and Discussion: As a result of the responses received, community pharmacists are satisfied with their profession, but the problems faced by the current pharmaceutical market, but also patients' attitudes, the pressure of pharmacy management and the responsibility of the profession generates harm to their health and negatively influence the activity in the community pharmacy. Conclusion: It is highlighted that the community pharmacist's satisfaction with this profession is diminishing and it is necessary that further analysis be carried out to remove or diminish the influence of these factors. [ABSTRACT FROM AUTHOR]

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe). [ABSTRACT FROM AUTHOR]

This paper assesses the influence of a number of factors taken into account when a brand name drug is replaced by a generic one. It also evaluates responses of health professionals -- physicians and pharmacist--and patients regarding the issue of switching. We compared and contrasted their responses in order to identify new points of cooperation for the intended benefit of the patient. Thus, the sample drew from all three groups, consisting of 50 doctors, 50 pharmacists, and 50 patients. We collected information regarding the age, residence, income level, and education level for the patients, and age and experience for the specialists. Based on responses to the survey, replacing the original medication with a generic one raises many issues, such as lack of information for the patient and specialist, lack of collaboration between physician and pharmacist, ineffective communication between specialist and patient, and the influence of the overall profit motive. [ABSTRACT FROM AUTHOR]

In literature, synchronous colorectal cancer refers to the simultaneous presence of two or more malignant lesions located along different segments of the large intestine or separated by at least 4 cm, detected either pre-, intraoperatively or after maximum 6 month since a surgery addressed to a colon tumor. The incidence of synchronous tumors is approximately 3,5% of all cases of colorectal carcinoma, while in others it reaches up to 8,4%. It is believed that this difference is mainly due to false negative results. The present paper presents the case of a 75-year-old patient, with a history of essential hypertension and type 2 insulin requiring diabetes who came to the emergency room accusing diffuse abdominal pain and bloating accompanied by the absence of intestinal transit for fecal matter over the past 6 days and an episode of vomiting. The results of the investigations correlated with the patient's symptomatology indicate the diagnosis of bowel obstruction. The exploratory laparotomy reveals an ulcero- vegetative, partially stenotic mass lesion in the sigmoid colon with a diameter of about 5/6 cm. A second ulcero-vegetative, stenotic mass was identified at the hepatic flexure of the colon with a diameter of approximately 8/7 cm. No metastatic lesions on the liver or in the abdominal cavity were noted. Right hemicolectomy with end-to-end ileotransverse-anastomosis and end-to-end colorectal anastomosis were performed. The present paper aims to expose the particular aspects in the diagnosis and treatment of bowel obstruction by synchronous tumors on a patient with abdominal symptomatology attenuated on the background of neurological complications of diabetes. [ABSTRACT FROM AUTHOR]

Inguinodynia occurs in 5-18% of athletes practicing football, hockey and other sports, a fact that can finish their career prematurely. This is a controversial symptom in the clinical assessment of a patient in general and even more so in a patient practicing a performance sport. Inguinal pain can be attributed to a variety of osteoarticular, musculoaponeurotic, abdominal or uro-gynecological pathologies. Differential diagnosis involves multiple, complex investigations, not always available to the clinician. If the clinical appearance is not relevant, considering the physical profile of the patient, the physician may neglect a lesion easily identifiable in a normal patient. The therapeutic management of inguinal pain, until the identification of its etiology, may include physical rest, passive and active physical therapy, intravenously administered corticotherapy, and if the diagnosis of an inguinal parietal defect is confirmed, varied, open or laparoscopic surgery, tissue or alloplastic procedures will be performed. Choosing the right therapeutic attitude and the right surgical procedure is sometimes difficult, and only a tailor-made, targeted therapy for each patient can lead to remarkable results. However, this paper aims to draw some general directions of the therapeutic attitude. [ABSTRACT FROM AUTHOR]

Intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS- a condition that can impair the function of nearly every organ system) is a high mortality complication of incisional hernia repair. This review aims to present the current evidence on the relation between incisional hernia repair and the risk of developing IAH, and the impact of IAH on surgical care. IAH is defined by a sustained or repeated pathological elevation in intra-abdominal pressure (IAP) greater 12 mmHg. ACS has a high mortality rate, ranging from 40-100%, so it is important to: recognize the risk factors, use preventive techniques, monitor the intraabdominal pressure, and act early to decrease the pressure before it leads to organ dysfunctions. Hernia dependent risk factors are an incisional hernia volume/peritoneal volume calculated using volumetric CT calculation > 20% and a maximum transverse hernia diameter > 10cm. The reference standard for intermittent IAP measurements is via the bladder with a maximal instillation volume of 25mL of sterile saline. Recommend measures to reduce IAP both invasive and noninvasive: decompressive laparotomy in case of ACS, sedation and analgesia, neuromuscular blockade, body positioning, nasogastric/colonic decompression, promotility agents, diuretics and continuous renal replacement therapies, fluid resuscitation strategies, percutaneous catheter drainage (PCD), and different temporary abdominal closure (TAC) techniques among those requiring an open abdomen. [ABSTRACT FROM AUTHOR]

Mixed adenoneuroendocrine carcinoma (MANEC) is an exceptionally rare type of cancer associated to the gastrointestinal tract, without a clearly established and optimal therapeutic management. These tumors present with non-specific symptoms or histopathological findings to distinguish them from pure adenocarcinomas. We report the case of a 64-year-old male diagnosed with a high grade mixed adeneuroendocrine carcinoma of the gastric antrum, stage T2N3Mx. The patient underwent radical gastrectomy and the histopathological examination of the surgically resected specimen revealed a tumor mass containing both adenocarcinoma and poorly differentiated neuroendocrine components. Immunostaining for Chromogranin A and Synaptophysin was positive in the neuroendocrine component and negative in the adenocarcinoma component, which was positive for CK7 and CK20. Ki67 proliferation index was 95%. Using this report as reference, we also discuss the imunohistopathological features, clinical behavior and therapeutic management of mixed adenoneuroendocrine carcinomas, presenting a brief review of literature regarding this rare, yet highly aggressive tumor. [ABSTRACT FROM AUTHOR]