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Introduction. Interstitial Cells of Cajal (ICCs) play a critical role in the regulation of gastrointestinal motility and have been implicated in various functional gastrointestinal disorders. Recent research indicates a possible association between ICCs and the tumor risk of Gastrointestinal Stromal Tumors (GISTs). This research aims to examine the clinical, histopathological, and biomolecular characteristics of ICCs and their relevance in assessing GIST risk. Materials and Methods. This study examined fourteen GIST patients who underwent surgical intervention at the Surgery Department of Carol Davila Nephrology Hospital in Bucharest. Parameters including age, gender, tumor location/ dimensions were scrutinized. Immunohistochemistry employing markers CD117, DOG-1, and CD34 was employed to ascertain the presence of ICCs and GISTs. Results. The GIST risk stratification revealed distribution with 35.71% very low-risk, 21.42% low-risk, 14.28% intermediate-risk, and 28.57% high-risk categories. Predominantly, 57.14% of cases fell within the very low-risk and low-risk categories. Positive immunoreactivity for CD117 and DOG-1 was noted in 92.86% of patients, while CD34 exhibited positivity in 85.71% of cases. Gastric GISTs manifested heightened marker expression. Notably, immunohistochemistry unveiled robust positivity for CD117, DOG-1, and CD34, illustrating a positive correlation between elevated ICC levels and high-risk GISTs. Conclusions. The findings propose an association between ICC levels and high-risk GISTs, accentuating the diagnostic utility of CD117, DOG-1, and CD34 markers in GIST assessment.

Background and Objectives. Hernia recurrence is still a great challenge for surgeons regarding the optimal surgical technique, the best alloplastic material and the management of risk factors (advanced age, female sex, body mass index, smoking, diabetes, the presence of connective tissue disorders, chronic cough, etc.). The present study attempts to assess the impact of these factors in hernia recurrence, as well as the integration of the prosthetic material at the tissue level, in order to reduce possible postoperative complications. Material and Methods. A retrospective study was performed on 108 patients operated (between January 2012 and December 2022) for recurrence of inguinal, umbilical and incisional hernias. Demographic data and comorbidities were analyzed in relation to hernia recurrence. Fragments of unintegrated and well-fitted mesh were sampled and examined microscopically to assess tissue-level implications. Results. The strongest factors associated with hernia recurrence were obesity (p=0.001), diabetes mellitus (p=0.003), high blood pressure (p=0.003) and atrial fibrillation (p=0.044). Microscopic analysis of unintegrated mesh fragments revealed the presence of foreign body granulomas and predominance of thin fibrillar type 3 collagen, whereas well-integrated material showed thick type I collagen fibers and low inflammatory infiltrate. Conclusions. Insufficient oxygen supply, an altered inflammatory response, and diminished proliferative capacity during the wound healing stages resulted in abnormalities in the development of mature granulation tissue. Therefore, to reduce the risk of hernia recurrence, it is essential to have a surgical treatment that must manage all these possible factors.

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role.

Purpose and objectives. The purpose of this paper was to compare the “outcomes” of patients with peritonitis according to the surgical method selected (laparoscopic vs. conventional/open), in the treatment of such a severe pathology, in order to obtain an efficient management of postoperative morbidities and the reduction of the mortality rate (currently estimated at 5% - 40%). Material and method. We carried out a retrospective, observational, non-randomized study on a sample of hospitalized patients, based on a descriptive and analytical epidemiological investigation, supported by the laparoscopic experience of the General Surgery Clinic in “Sf. Ioan” Emergency Clinical Hospital of Bucharest in the last decade (01.01.2009-31.12.2018). Results. We identified a sample of 378 patients with peritonitis, of which 109 were operated laparoscopically (i.e. 28.84%), and 269 patients (i.e. 71.16%) were operated traditionally. Following a rough analysis, it was observed that patients who underwent open surgery were hospitalized on an average 4.73 days longer than those operated laparoscopically (11.67 days vs. 6.94 days), the effect being statistically significant (p < 0.01). In the traditionally operated group of patients, the average duration of surgery was 46.31 minutes longer than those operated laparoscopically (113.92 vs. 67.60), the effect being also statistically significant (p < 0.01). Conclusions. The conventional surgical approach is statistically significantly associated with an increased duration of operative time and hospitalization in patients with peritonitis and can be considered a factor of severe evolutive prognosis in the therapeutic management of this pathology.

The CD34 protein was identified almost four decades ago as a biomarker for hematopoietic stem cell progenitors. CD34 expression of these stem cells has been exploited for therapeutic purposes in various hematological disorders. In the last few decades, studies have revealed the presence of CD34 expression on other types of cells with non-hematopoietic origins, such as interstitial cells, endothelial cells, fibrocytes, and muscle satellite cells. Furthermore, CD34 expression may also be found on a variety of cancer stem cells. Nowadays, the molecular functions of this protein have been involved in a variety of cellular functions, such as enhancing proliferation and blocking cell differentiation, enhanced lymphocyte adhesion, and cell morphogenesis. Although a complete understanding of this transmembrane protein, including its developmental origins, its stem cell connections, and other functions, is yet to be achieved. In this paper, we aimed to carry out a systematic analysis of the structure, functions, and relationship with cancer stem cells of CD34 based on the literature overview.

Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient’s prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.

Introduction: Acute mesenteric ischemia represents one of the most severe pathological entity that needs rapid diagnosis and initiation of treatment in order to reduce the mortality rate and the long-term morbidity. Material and method: A monocentric, retrospective study that included 68 patients with acute mesenteric ischemia with or without bowel infarction has been undertaken within the General Surgery Department of the “Sfântul Pantelimon” Clinical Emergency Hospital from Bucharest, Romania, between January 2014 and January 2019, a 2nd grade hospital, according to the provisions of the Order of the Ministry of Public Health no. 1764 of 22 December 2006 on the approval of criteria for the classifi cation of local, county and regional emergency hospitals in terms of competences, material and human resources and their capacity to provide emergency medical care and medical care for patients in critical condition, published in the Federal Law Gazette of Romania, Part I, no. 63 of 26 January 2007. Results and conclusions: Acute mesenteric ischemia is associated with poor outcomes, high morbidity and mortality rates, making the early diagnosis and treatment initiation imperative in order to prevent severe complications, such as transmural bowel infarction, and, thus, potentially decreasing the morbidity and mortality rates.

The interstitial cells of Cajal (ICC) represent a particular network formed by some peculiar cells that were first described by the great neuroanatomist, S. Ramon y Cajal. Nowadays, the ICC have become a fascinating topic for scientists, arousing their curiosity; as a result, there is a vast number of published articles related to the ICC. Today, everybody widely accepts that the ICC represent the pacemaker of the gastrointestinal tract and are highly probable to be the origin cells for gastrointestinal tumors (GISTs). Recently, Cajal-like cells (ICLC) were described, which are found in different organs but with an as yet unknown physiological role that needs further study. New information regarding intestinal development indicates that the ICC (fibroblast-like and muscle-like) and intestinal muscle cells have the same common embryonic cells, thereby presenting the same cellular ultrastructure. Nowadays, there is a vast quantity of information that proves the connection of the ICC and GISTs. Both of them are known to present c-kit expression and the same ultrastructural cell features, which includes minimal myoid differentiation that is noticed in GISTs, therefore, supporting the hypothesis that GISTs are ICC-related tumors. In this review, we have tried to highlight the origin and distribution of Cajal interstitial cells based on their ultrastructural features as well as their relationship with gastrointestinal stromal tumors.

Introduction: The present study aims to determine the mean duration of the conservative management that can be tolerated by the patients with intestinal obstruction secondary to the postoperative peritoneal adhesions, in order to postpone the surgical intervention. Material and method: The data of the patients with intestinal obstruction secondary to postoperative peritoneal adhesions were retrospectively collected and analysed. The number of readmissions, the type of the therapeutic management, the duration of the conservative treatment, the number of surgical reinterventions and the intraoperative aspect represented the studied variables. Results: 543 patients with intestinal obstruction secondary to postoperative peritoneal adhesions, admitted in the Surgical Department of “Sfântul Pantelimon” Emergency Hospital from Bucharest, Romania, between January 2014 and July 2018, were enrolled in the study. 233 patients underwent conservative treatment, 310 patients being surgically treated. The mean interval necessary for the monitoring of the patients non- operatively treated was 7 days, within a range of 2 to 14 days. For the surgically treated cases, the mean monitoring interval was 5 days, within a range of 1 to 14 days. Among the patients that underwent surgical treatment, there were 276 cases of adhesiolysis, 31 cases of intestinal resection with anastomosis and 3 cases of intestinal resection with terminal ileo- or colostomy. Conclusion: Under strict monitoring, a signifi cant number of cases of intestinal obstruction secondary to postoperative peritoneal adhesions can, successfully, be treated using conservative management, within 7-10 days.

Introduction: The presence of the peritoneal adhesions during surgery represents an element that can negatively influence the intra- and postoperative evolution of the patients. This article aims to evaluate the impact of the peritoneal adhesions on the postoperative recovery of the patients. Material and method: The data of 1407 patients undergoing laparoscopic cholecystectomy between January 2014 and October 2018 were retrospectively analyzed. Patients were organized into two groups: the case group, consisting of patients for whom peritoneal adhesions were identifi ed during the surgical intervention, and the control group, with patients that had no postoperative peritoneal adhesions. The degree of association between the presence of the peritoneal adhesions and the operative time, the risk of laparoscopic conversion to laparotomy and the risk of intra- or postoperative complications was analyzed. Results: For 537 patients (38.16%) included in the study postoperative peritoneal adhesions were identifi ed at the time of the laparoscopic cholecystectomy. A direct association was observed between the presence of postoperative peritoneal adhesions and the risk of conversion, a longer operative time or period of hospitalization and the risk of postoperative ileus. Conclusions: Postoperative peritoneal adhesions represent an independent risk factor for the increasing morbidity and mortality rates in patients undergoing laparoscopic cholecystectomy.

Tuberculosis is in the top 10 causes of death worldwide, being one of the most deadly infectious diseases. It is estimated that one of three people from the entire earth population has a latent infection with M tuberculosis. This aerobic bacterium possesses the ability to persist in host tissues for years and to begin replication once immunity declines. The lungs are most frequent site of infection as the Mycobacterium tuberculosis is carried by aerosol droplets and is commonly transmitted by respiratory route. The second way of transmission is by contaminated food. Intestinal contamination coexists with pulmonary tuberculosis and only 10% represent primitive enteric diseases. The ileocecal region is involved most frequently. Even in this context isolated appendicular involvement remains rare. We report the case of appendicular tuberculosis in a 17-year-old woman with no evidence of other location of disease elsewhere in the body.

As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions documented to be androgen dependent, namely male androgenic alopecia and benign prostatic hyperplasia. Therapeutic results are maintained as long as the drug is administered, with treatment cessation generally leading to the return of symptomatology for each condition. In addition, during the therapeutic phase, several adverse effects have been reported, some of which persist long or indefinitely after treatment cessation, known as “post-finasteride syndrome.” Herein we present and discuss the most common finasteride side effects, along with a psycho-neuroendocrine rationale that could explain the persistence of many adverse effects after treatment cessation. Moreover, we argue that finasteride adverse effects occurring during finasteride administration should be delineated from postfinasteride side effects (encountered after treatment cessation), suggesting the need to be addressed separately within a therapeutic perspective. Until a tailored therapeutic approach of postfinasteride syndrome becomes available, we have noted that hand preference and sexual orientation seem to be useful as possible predicting factors for finasteride side effects and postfinasteride syndrome. Finally, even though finasteride administration is considered relatively safe, literature data urges prudence. Specifically, recent studies report that some subjects receiving finasteride develop severe depressive episodes including suicidal thoughts, in part due to persistent sexual side effects.

The nontraumatic perforations of the small intestine are pathological entities with particular aspects in respect to diagnosis and treatment. These peculiarities derive from the nonspecific clinical expression of the peritonitis syndrome, and from the multitude of causes that might be the primary sources of the perforation: foreign bodies, inflammatory diseases, tumors, infectious diseases, etc. Accordingly, in most cases intestinal perforation is discovered only by laparotomy and the definitive diagnosis is available only after histopathologic examination. Small bowel malignancies are rare; among them, lymphomas rank third in frequency, being mostly B-cell non Hodgkin lymphomas. Only 10% of non-Hodgkin lymphomas are with T-cell. We report the case of a 57 years’ old woman with intestinal T-cell lymphoma, whose first clinical symptomatology was related to a complication represented by perforation of the small intestine. Laparotomy performed in emergency identified an ulcerative lesion with perforation in the jejunum, which required segmental enterectomy with anastomosis. The nonspecific clinical manifestations of intestinal lymphomas make from diagnosis a difficult procedure. Due to the fact that surgery does not have a definite place in the treatment of the small intestinal lymphomas (for cases complicated with perforation), and beyond the morbidity associated with the surgery performed in emergency conditions, prognosis of these patients is finally given by the possibility to control the systemic disease through adjuvant therapy.