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Despite incessant research, colorectal cancer (CRC) is still one of the most common causes of fatality in both men and women worldwide. Over time, advancements in medical treatments have notably enhanced the survival rates of patients with colorectal cancer. Managing metastatic CRC involves a complex tradeoff between the potential benefits and adverse effects of treatment, considering factors like disease progression, treatment toxicity, drug resistance, and the overall impact on the patient's quality of life. An increasing body of evidence highlights the significance of the cancer stem cell (CSC) concept, proposing that CSCs occupy a central role in triggering cancer. CSCs have been a focal point of extensive research in a variety of cancer types, including CRC. Colorectal cancer stem cells (CCSCs) play a crucial role in tumor initiation, metastasis, and therapy resistance, making them potential treatment targets. Various methods exist for isolating CCSCs, and understanding the mechanisms of drug resistance associated with them is crucial. This paper offers an overview of the current body of research pertaining to the comprehension of CSCs in colorectal cancer. [ABSTRACT FROM AUTHOR]

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Schwannoma is a tumor that originates from the Schwann cells that surround a neuron's axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they account for only 0.2% of gastric tumors. We present the case of a 56-year-old asymptomatic patient who was diagnosed, following a routine ultrasound examination, with an abdominal tumor. An abdominal MRI confirmed the gastric origin of the tumor. Although a subsequent upper-digestive endoscopic ultrasound was performed, a definitive diagnosis could not be established. Thus, a laparoscopic wedge resection of the stomach was performed. The immunohistochemical examination of the tumor established the diagnosis of benign schwannoma. Despite the availability of advanced endoscopy and imaging techniques, the diagnosis of gastric schwannoma is very rarely preoperative. The immunohistochemical identification of S-100 on the surgical specimen confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Byline: Stefan. Patrascu, Catalin. Copaescu, Valeriu. Surlin, Sandu. Ramboiu, Alice. Dragoescu, Sorin. Stanilescu, Dan. Cristian, Bogdan. Ungureanu, Daniela. Burtea, Ana. Patrascu, Florin. Turcu, Adrian. Saftoiu Background: Natural orifice transluminal endoscopic [...]

Objectives: The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF). Materials and Methods: We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014–31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21–94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn's disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded. Results: The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%. Conclusion: PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy. [ABSTRACT FROM AUTHOR]

Oral microbiota have shown a higher bacterial diversity in patients with cancers of the digestive tract, with higher levels of periopathogens. Recent studies have shown that Fusobacterium links to gastro-intestinal neoplastic tissue and accelerates its progression, as well as worsening patient outcome. The present pilot study was carried out between February and December 2020 to evaluate the possible association between the abundance of some periopathogens (Fusobacterium nucleatum, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola and Tannerella forsythia) in subgingival plaque and periodontal status with characteristics of gastric cancer. The study was performed on a sample of 24 patients with gastric cancer from the 1st Department of Surgery and Department of Gastroenterology within the Clinical County Hospital of Emergency of Craiova, Romania. The patients' oral cavity was examined, gingival crevicular samples were collected, and signs of periodontal disease were recorded. On the histopathological exam, the differentiation grade and size of the tumour were registered. Our results showed that, from the periopathogens studied, the most abundant bacteria were F. nucleatum followed by T. forsythia in all groups. In our present study, the strong correlation between tumour dimension and all periodontal parameters but also between tumour dimension and F. nucleatum could suggest a positive association between periodontal disease, tumoral growth and periopathogens implication in this process. [ABSTRACT FROM AUTHOR]

Abstract Pancreatic neuroendocrine tumors are a rare entity with an incidence between 2 per million to 5 per 100 000. Association with pancreatitis (acute or chronic) is rare and is considered to be determined by the tumoral obstruction of pancreatic ducts, but sometimes occurs without any apparent relationship between them. Non-functional neuroendocrine pancreatic tumors are usually diagnosed when either very large or metastatic. Small ones are occasionally diagnosed when imagery is performed for other diagnostic reasons. Intraoperative discovery is even rarer and poses problems of differential diagnosis with other pancreatic tumors. Association with chronic pancreatitis is rare and usually due to pancreatic duct obstruction by the tumor. We describe the case of a patient with a small non-functioning neuroendocrine tumor in the pancreatic tail accidentally discovered during surgery for delayed traumatic splenic rupture associated with chronic alcoholic pancreatitis. The tumor of 1.5cm size was well differentiated and confined to the pancreas, and was resected by a distal splenopancreatectomy. Conclusions Surgeons should be well aware of the rare possibility of a non-functional neuroendocrine tumor in the pancreas, associated with chronic pancreatitis, surgical resection being the optimal treatment for cure. Histopathology is of utmost importance to establish the correct diagnosis, grade of differentiation, malignancy and prognosis. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2114470176676003.

The increased incidence of colon cancer patients requiring emergency surgery should raise more interest in its complete morphopathological characterization. We performed a retrospective analysis of all colon cancer patients admitted through the emergency setting and operated in our Institution during the last 5 years. Special emphasis was put on the morphological features of the cases, such as histopathologic type, grading, TNM staging, tumoral inflammatory infiltrate, perineural and vascular invasion. We identified 104 patients that underwent radical colon cancer surgery in the emergency setting between 2017 and 2021. Most cases were located on the sigmoid colon and were diagnosed as either locally advanced (92%) or metastatic disease (19%). Vascular invasion was identified in 29% of specimens, while perineural invasion was found in 38% of cases. Colon cancer patients undergoing emergency radical surgery display independent risk factors for the postoperative and the overall oncologic outcomes, such as comedo-necrosis, high lymph node involvement, locally advanced or metastatic disease, and perineural and vascular invasion. [ABSTRACT FROM AUTHOR]

Background and aims. The role of angiogenesis in progression and metastasis of gastric cancer has been studied over the last years. The aim of our study was to assess the microvessel density and vascular endothelial growth factor (VEGF) expression in correlation with prognosis, survival and the risk for upper gastrointestinal (GI) bleeding as well. Method. We prospectively assessed angiogenesis in 40 patients with gastric carcinoma. Microvessel density was calculated using CD31 and CD34 markers, and VEGF expression was assessed in biopsy samples. The tumor stage was established using imaging methods: CT scan for M and N stage and endoscopic ultrasound for T and N stages. The correlation between pathological markers and tumor stage, survival rate and risk of upper gastrointestinal bleeding was assessed. Results. The study included 40 patients with gastric cancer; among them 8 patients presented with upper GI bleeding. The average microvessel density was 10.21 for CD31 and 11.85 for CD34 in all patients VEGF was positive only in 45% of patients. The microvessel density was higher in patients with advanced TNM stage, and a correlation with the risk of UGIB and survival rate was also found. VEGF expression correlated with TNM stage and with the risk of upper GI bleeding. Conclusions. Microvessel density (estimated by CD34) was involved in locally advanced disease, while VEGF was correlated with loco-regional extension and distant metastasis in gastric cancer patients. There was a clear correlation between angiogenic parameters, survival rate and the risk of upper GI bleeding. [ABSTRACT FROM AUTHOR]

Background/aims: Natural orifice translumenal endoscopic surgery (NOTES) still poses numerous challenges, even in cases of relatively simple surgical procedures. This study aims to assess the feasibility of transgastric resectional interventions using commonly available endoscopic equipment as well as to offer a safe closure method of the gastric access site., Methodology: Ten pigs underwent pure transgastric endoscopic oophorectomy using a single channel endoscope. The gastric defect was closed using over-the-scope clips (OTSC™, OVESCO Endoscopy). After 2 weeks the animals underwent autopsies., Results: All procedures were successful. Transgastric access time varied from 4.46 to 33.24 minutes. The peritoneal exploration took 31 minutes and oophorectomy needed in average of 21 minutes (range 15-28 minutes). The animals for which the gastric access site was closed with OTSC™ survived for 2 weeks without complications., Conclusion: This study demonstrates the technical feasibility and safety of pure transgastric endoscopic oophorectomy using conventional endoscopic instrumentation in a porcine model. OTSC™ closure system is an easy to use and reliable gastric closure method.