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Background. Biliopancreatic tumors (BPT) are among the most aggressive solid malignancies, and their incidence is rising. Good patient outcome relies heavily on a multidisciplinary approach to therapy, including timely access to endoscopy, surgery and chemo/radiotherapy. We aimed to evaluate current practices as reflected in the management and outcome of patients diagnosed with BPT in the setting of a low-resource medical system in order to identify areas suitable for improvement.

Copyright of Studia Universitatis Babes-Bolyai, Philologia is the property of Babes-Bolyai University, Cluj-Napoca, Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Skin toxicity in patients receiving novel therapeutic cancer agents has become a very important marker in determining drug activity, but it can also severely impact their quality of life. About half of the patients receiving this type of oncologic treatment will develop cutaneous reactions, that is why adequate understanding and management of these side effects is very important for drug adherence and patients’ quality of life.

Cormac McCarthy is well-known within the literary world for his rather bleak writing, and The Road (2006) is without doubt one of the novels that exemplifies this characteristic the most. In an attempt to join the already extensive critical literature on McCarthy from an original perspective, the purpose of this paper is to examine The Road by combining the analysis of the post-apocalyptic narrative's elements with a focus on the characters' journey itself. To this end, my approach would bring into discussion Corin Braga's concept of the "anarchetype", the opposite term for the archetype understood in a cultural sense, namely as a recurring model or an artistic constant. I argue that this concept, representative for the vision of the decentred postmodern subject, structures McCarthy's novel through the way in which it builds the plot out of episodes that succeed one another in an unpredictable way. [ABSTRACT FROM AUTHOR]

An introduction is presented in which editor discusses various articles within the issue on topics including role played by slogans and catchwords in the construction of utopian-in-theory; development of utopia as a genre and dystopian aspects of James Joyce's book "Ulysses."

Ever since Christopher Columbus set foot in America, the leitmotif of the travel narratives written by those visiting it has been that of shaping the unknown territories according to prefabricated ideas. The importance held by the myth of neverending expansion in American culture has also created a fascination for everything situated beyond the culturally constructed borders of the country. Cormac McCarthy's The Border Trilogy tackles both these matters, as it is centred around the frontier between Mexico and the southwestern part of the United States. This paper will analyse the patterns of movement taken up by these characters in crossing the borders, while also using Corin Braga's concept of the "anarchetype" to characterize them as products of an in-between state in which the characters cannot follow a clearly structured route anymore because they belong to both and neither of the two extremes simultaneously. [ABSTRACT FROM AUTHOR]

The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the

After the two World Wars and the rise of totalitarian regimes, dystopian narratives have begun to spread within the literary and social imaginary in an attempt to warn against the grim future of such socio-political realities. Lately, considering its continuous developments, technology has also become the subject of very heated debates: will it contribute to the qualitative enhancement of human life? Or, on the contrary, will it become another factor that will threaten humanity's existence (and maybe even its dominance) on earth? The aim of this paper is to answer these questions by closely examining Westworld (Jonathan Nolan, Lisa Joy, HBO Entertainment, 2016 - present), one of the series that has addressed the relationship between humans and artificial intelligence in a very complex manner during the past few years. [ABSTRACT FROM AUTHOR]

The end of the 19th century brought a major change in regards to humanity’s relationship with divinity and with the idea of creation. According to Friedrich Nietzsche, ‘God is dead’, so no one holds the supreme authority upon the creation act anymore. As a result, man himself began to create fictional worlds through logos, in order to fill the void left by the disappearance of divinity. Among the many methods that explain the generative process of these worlds there is the archetypal one from the Jungian psychology, the relational one from reader-response theories and the ‘chaotic’, theoretically objective one, based on hazard theories. Starting from here, this essay will try to analyze comparatively Michael Ende’s novel, The Neverending Story, and Jorge Luis Borges’ short story, The Library of Babel, with the purpose of exploring the contrast that is prefigured – at a structural, interpretive and text-reader relationship level – between the unconscious and the mechanical patterns of creating new worlds. [ABSTRACT FROM AUTHOR]

Copyright of Paliatia: Journal of Palliative Care is the property of HOSPICE Casa Sperantei Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Combat engineers structures are responsible for support missions in battlefields, which determines their involvement in the four specific domains: mobility, countermobility, survivability and general support. Inevitably, all these missions lead to ensuring the viability of the roads for land vehicles and the runway for aircraft. Air Force combat engineers must ensure the maintenance of the necessary infrastructure for take-off, landing or even parking of aircraft by carrying out the asphalting missions. The Air Force combat engineers capabilities are highlighted by the multitude of missions carried out which are constantly being diversified. Based on the idea that the combat engineers intervention in an emergency situation regarding the infrastructure of a runway or a platform must be efficient, this paper aim to highligh this fact through a study of the equipment used and their characteristics. [ABSTRACT FROM AUTHOR]

Copyright of Dermatovenerologia Journal is the property of Societatea Romana de Dermatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper is intended to address the evolution of the profession of notary public focusing specifically on the Great Union and the period that followed, reaching to this day. The work concerns not only the institution of the notary seen from the singular context, but also the collaboration and interdependence of the activity with the real estate advertising registers. In order to provide a fuller analysis, our approach follows a comparison with the regulation of notarial law in other EU countries and not only by showing that unitary practice and interstate cooperation is the key to the development of the profession of notary public. [ABSTRACT FROM AUTHOR]

Endometrial cancer is the sixth most common female tumor, with both incidence and mortality increasing worldwide. Although the localized disease is curable by surgery, with a five-year overall survival rate of 96%, in advanced stages the five-year survival rate drops to less than 20%. Platinum-based chemotherapy represented the standard of care in first-line chemotherapy, but 50% of patients progressed within one year. Today, because of the newest classification of four molecular subgroups of endometrial cancer, we can identify patients who can benefit from immunotherapy or targeted therapy, and we can offer those women a longer overall survival rate, with a better quality of life. The recent advances in immunotherapy opened other options for women with the MSI subset of tumors and, given the wealth of targets in endometrial cancer, the challenge will be to choose the proper treatment and sequencing to obtain the best outcome in the first or second line of therapy for our patients. Since endometrial cancer is the only gynecologic cancer with an increasing incidence and death rate, it is crucial to identify effective treatments and to find therapeutic combinations that can improve the medication performance while reducing drugs toxicities. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is the 12th most common cancer worldwide, with around 338,000 new cases diagnosed in 2012 (2% of the total). In Europe, pancreatic cancer is the 6th leading cause of cancer death. Pancreatic cancer has become the third leading cause of cancer death in the United States, with the lowest five-year survival rates of any solid tumour (8 %). Surgical resection offers the only chance of cure. However, only 15 to 20 percent of patients have a resectable pancreatic cancer at diagnosis, the majority has either locally advanced or metastatic cancer. The best outcomes to date in chemotherapy were achieved with the FOLFIRINOX (fluorouracil plus leucovorin, irinotecan, and oxaliplatin) regimen, demonstrating an 11.1-month median survival. While patients receiving chemotherapy generally report better overall quality of life, extended survival with chemotherapy does not always correspond to reduced symptom burden. All patients with newly diagnosed pancreatic cancer should have a full assessment of symptom burden, psychological status, and social support as early as possible. Many patients with locally advanced or metastatic disease will benefit from formal palliative care consultation and services. Early referral and initiation of palliative care services improve clinical and quality of care outcomes. Patients with locally advanced and metastatic pancreatic cancer should be offered aggressive treatment of pain and other symptoms related to the cancer like anorexia and weight loss, depression and anxiety, biliary obstruction, gastric outlet obstruction, ascites, and venous thromboembolism. [ABSTRACT FROM AUTHOR]

Cancerul de col uterin ocupă locul doi pe plan mondial în cadrul tumorilor maligne la femei, cu o incidență de aproximativ 528.000 de noi cazuri raportate anual și aproximativ 266.000 de decese raportate în 2012. Există o legătură strânsă între prezența virusului papiloma uman (HPV), cancerul de col uterin și al precursorilor săi. HPV poate fi identificat în mai mult de 99% din totalul cazurilor de cancer de col uterin, iar infecția cu HPV este acum acceptată că o cauză necesară pentru majoritatea cancerelor de col uterin. Toate pacientele diagnosticate cu carcinom invaziv de col uterin vor trebui evaluate clinic prin examen vaginal și rectal, imagistic prin tomografie computerizată, rezonanță magnetică nucleară sau PET-CT. Sistemul FIGO este cel mai utilizat sistem pentru stadializarea cancerului de col uterin. Sistemul de stadializare FIGO este bazat în special pe examinare clinică, de aceea examinarea pelvină efectuată de un clinician cu experiență este de o importanță critică. Numeroși factori influențează alegerea tratamentului pentru cancerul de col uterin, incluzînd dimensiunea tumorii, stadiul, caracteristicele histologice, evidența invaziei ganglionilor limfatici, factorii de risc în apariția complicațiilor post-intervenție chirurgicală sau radioterapie și preferințele pacientelor. În principiu, în carcinomul microinvaziv (std. IA1) tratamentul de elecție este reprezentat de chirurgia conservativă (conizație excizională sau histerectomie extrafascială). În cancerele invazive în stadii incipiente (std. IA2, IB1, unele IIA) tratamentul de elecție este reprezentat de histerectomie radicală sau histerectomia radicală modificată, trachelectomia radicală (dacă se dorește prezervarea fertilității) sau radioterapia. În cancerele local avansate (std. IB2 până la IVA) tratamentul de elecție este reprezentat de radiochimioterapie. Tratamentul la pacientele cu boală metastatică este reprezentat în principal de chimioterapie sistemică, însă bolnavele sunt încurajate să participe la studii clinice. [ABSTRACT FROM AUTHOR]

The present paper discusses two possible responses to ethical pluralism. Starting from the premise that there exists a multitude of irreducible moral values, the paper analyzes two of the possible responses to this fact, namely ethical promiscuity and tolerance. The first one, as defined by Ivanhoe, promises to outdo tolerance and to solve the insufficiencies of the latter. However, the paper analyzes the main claims and arguments in favor of ethical promiscuity, putting in light the fact that this view does not actually manage to deal with the problem of clashing and mutually excluding moral values. [ABSTRACT FROM AUTHOR]

Tolerance Between Vice and Virtue. The concept of tolerance seems to occupy a very important place in the Western culture, gaining the statute of a supreme unquestionable virtue. Yet, there are also voices that warn about its dangers. Starting from this premise, the present paper aims to analyse different approaches on tolerance and the difficulties they raise. For this purpose, the research investigates the main arguments in favour of tolerance which then serves as a background for a critical examination of the contemporary approaches. The intention is to determine whether the new lines of thought are doomed to failure just like the ones they have replaced. [ABSTRACT FROM AUTHOR]

Background: Palliative chemotherapy is the treatment designed for terminal cancer patients to prolong survival and ease symptoms but not cure disease. Best Supportive Care (BSC) is the treatment of choice when cure is not achievable with anticancer agents and involves management of disease-related symptoms. Advanced cancer is generally characterized by loss of moving possibilities, increasing resting time, and gradual loss of interactional capacity. The end of life is defined by: evolution of the malignant disease, depletion of conventional anticancer alternatives and signs of approaching death. Objective: To highlight the importance of delivering palliative chemotherapy lines in order to prolong survival, to control patients' symptoms at the end of the life and to support the family in accordance to the ethical and legal rules for our country. The aim of the whole treatment applied is to enhance quality of life by the relief of symptoms, once they occur. Methods: We report the case of a 48 year old female patient, diagnosed with stage IV ovarian cancer, who received three chemotherapy lines. She was hospitalized with severe pain (lumbar and right thigh), dyspnea, and anorexia with important nausea. The therapeutic attitude focused on controlling the patient's symptoms and to provide counseling for the family as well. Conclusion: Best supportive care for cancer patients is a mainstay of palliative care. The goal of palliative care is to achieve the best quality of life for patients and their families. [ABSTRACT FROM AUTHOR]

Background Breast cancer is the most common female cancer worldwide with an incidence increasing by 1% yearly. About 20% of breast cancer patients present metastases and around 50% of those with an operable breast cancer experience relapse. Despite the new era of cancer treatment, the average survival for patients with metastatic breast cancer is still between 2 and 4 years. The quality of life of these patients should be one of the primary end points of the treatment. Case series We present an analysis of a 5 cases of patients with metastatic breast cancer showing that chemotherapy, immunotherapy and osteoclast inhibitors modified the levels of quality of life by significantly improving it. The patients filled in a questionnaire (Edmonton Symptom Assessment System) to assess their quality of life before treatment initiation in our clinic, after the first 3 cycles of chemotherapy, and after the last cycle. We found that quality of life was improved especially in terms of pain control, relief of tiredness, appetite and well-being. Despite disease progression and development of new metastasis, the patients did not experience important changes in their clinical status. They maintained a good performance status that allowed us to alternate multiple lines of therapy and to control the disease with minimal toxicity. Conclusion Metastatic breast cancer is a disease with a long natural evolution, but a well conducted treatment with a multidisciplinary approach may achieve a quality of life comparable with that of women of a similar age with no personal history of breast carcinoma. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common malignancy in women, whereas metastases to the breast from extra mammary malignancies are very rare, accounting for only 0.43% of all malignant breast tumors, with an often poor prognosis: about 80% of patients dying within 1 year of diagnosis. Case report: We present two cases of female patients treated for extra mammary malignancies which developed breast metastases. The first patient, 59 years old, was diagnosed in April 2014 with small cell lung carcinoma, sub diaphragmatic lymph nodes and bone metastases, developed under chemotherapy breast metastasis. This was revealed on a clinical examination in December 2014 and certified in March 2015 by immunohistochemistry as a mammary metastasis of small cell lung carcinoma. The second patient, 45 years old, was diagnosed in February 2012 with sigmoid adenocarcinoma and bilateral ovarian metastases. In January 2015 she performed a digital mammography and a breast tumour was discovered. This was certified in March 2015 by immunohistochemistry as a mammary adenocarcinoma metastasis, intestinal type (colonic). Conclusions: The breast is an uncommon site for metastatic disease. The most frequent source of the metastatic breast lesions are the contralateral breast, lymphomas, melanomas, prostate cancers, lung carcinomas, ovarian carcinomas, renal cell carcinomas, and intestinal tumours. It is important to be acutely aware of both common and uncommon metastases to the breast and to include these appropriately in the differential diagnosis for the optimal patient management. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the importance of pain control for improving cancer patients' adherence to treatment. Pain can cause feelings of discouragement, hopelessness and despair. If not treated promptly and effectively, cancer pain may affect patient compliance with treatment and his quality of life. Methods: We report the case of a 64 year old patient, diagnosed with lung cancer of the right upper lobe and multiple metastases (bone, liver, adrenal), hospitalized for severe pain (upper thoracic T3-T5 and thoracolumbar T12 rachialgia). On examination the patient assesses the intensity of his pain at a level of 7-8 on the visual- analogue scale (VAS), with exacerbations up to level 10. The therapeutic attitude focused both on controlling the chronic disease and the relief of debilitating symptoms (pain). Conclusion: Early initiated palliative care can increase therapeutic compliance in oncology patients. Pain is not an accidental symptom in cancer disease. It is part of cancer disease thus pain management should be an integrating part of antineoplastic therapy. [ABSTRACT FROM AUTHOR]

Cervical cancer ranks second worldwide in the malignancies in women, with an incidence of approximately 528,000 new cases reported annually and approximately 266,000 deaths reported in 2012. There is a strong link between the presence of human papillomavirus (HPV) cervical cancer and its precursors. HPV can be identified in more than 99% of all cases of cervical cancer and HPV infection is now accepted as a necessary cause for the majority of cervical cancers. All patients diagnosed with invasive cervical carcinoma should be evaluated clinically by vaginal exam and rectal imaging by computed tomography, magnetic resonance imaging or PET-CT. FIGO system is most widely used staging system for cervical cancer. FIGO staging system is mainly based on clinical examination, pelvic examination therefore performed by a clinician with experience, which is critically important. Many factors influence the choice of treatment for cervical cancer, including tumour size, stage, histological characteristics and lymph node invasion obvious risk factors for complications after surgery or radiotherapy and patients' preferences. Basically, in micro invasive carcinoma (std. IA1) the treatment of choice is conservative surgery (excisional conisation or hysterectomy extra fasciala). In invasive cancers in early stages (std. IA2, IB1, some IIA) the treatment of choice is radical hysterectomy or modified radical hysterectomy, radical trachelectomia (if desired fertility preservation) or radiotherapy. In locally advanced cancers (std. IB2 to IVA) the treatment of choice is radio chemotherapy. Treatment of patients with metastatic disease is primarily systemic chemotherapy, but the patients are encouraged to participate in clinical trials. [ABSTRACT FROM AUTHOR]

Prostate cancer is currently considered the most common form of cancer that affects the male population. Population screening of men between 55 and 69 years by PSA reduce the rate of death from prostate cancer by 21%. After diagnosis, prostate cancer should be classified to estimate the aggressiveness of the disease, its prognosis and to assess accurately treatment. In men with low-risk disease, monitoring activities represent a therapeutic option. If intermediate risk may be taken into account radical prostatectomy or external radiotherapy plus androgen deprivation therapy (ADT) may be considered. In patients with high-risk treatment the options include external radiotherapy plus hormonal therapy given for at least 2 years or, in cases well selected, can be considered radical prostatectomy accompanied by extended lymphadenectomy. In patients with metastatic hormone-naive disease, treatment options are androgen deprivation therapy (ADT) or hormone therapy plus Docetaxel, depending on the presence or absence of visceral damage, and the extent of damage in metastatic bone of the patient's performance status. In patients with metastatic prostate cancer castration-resistant (CRPC) (after administration of Docetaxel) there are several treatment options, including: Abiraterone, Enzalutamide, Cabazitaxel and Radium-223. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

Introduction: When discussing cytotoxic chemotherapy, the way the drugs are administered is as important as choosing the regimen. Several aspects like hyperhydration, emesis, the period of administration, diet and allergic reactions have to be taken into consideration. Method: Recent literature on these five main topics was revised. Most relevant data was collected and summarized in an attempt to familiarize any reader with this matter. Conclusion:These aspects are of utmost importance in reducing toxicity, thus enabling more extended treatment compliance, administration of effective doses and better oncological outcomes. [ABSTRACT FROM AUTHOR]

Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-differentiated lipomatous tumors sometimes labelled as atypical lipomatous tumors. For elimination of inadequate or excessive treatment it has been advocated that the term well-differentiated liposarcomas be retained for retroperitoneal/mediastinal tumors and atypical lipomatous tumors for the rest of the sites. The most important prognostic factor for ALT/WD liposarcoma is anatomic location, overall mortality ranging from 0% for ALT of the extremities to more than 80% for WD liposarcomas occurring in the retroperitoneum if the patients are followed up for 10-20 years. Primary treatment of ALT/WD liposarcoma is represented by a complete, preferably wide-margin surgical resection. The role of radiation therapy for atypical lipomatous tumors/well-differentiated liposarcomas is still unclear. Despite the side effects of postoperative radiation therapy it has been shown that in patients with positive surgical margins postoperative RT in doses over 64Gy, improves local control. [ABSTRACT FROM AUTHOR]

Introduction: Usually patients with nasopharyngeal carcinoma have weight loss due to the tumor itself and to the radiochemotherapy. Weight loss increases the incidence of complications during the treatment, influences the performance status and the prognostic of the disease. The aim of this retrospective study is toinvestigate the influence of BMI, age, histological type of NPC and stage of disease on the prognostic of patients with nasopharyngeal carcinoma. Methods: We analyzed 27 patients with nasopharyngeal cancer, admitted in Medical Oncology Clinic of Elias University Emergency Hospital between2010-2015. All patients undergo radiotherapy with concurrent chemotherapy, adjuvant chemotherapy and gene targeted therapy. We calculated BMI before the beginning of the treatment. Results: We remarked that normal and overweight patients had the best results at 3 years after the treatment. 78% of patients with complete response post radio-chemotherapy had complete remission at 3 years after finishing treatment. Underweight patients had the worse results and poor prognostic due to higher rates of tumor remnants or local-regional recurrence Conclusions: Nutritional status has an important impact over the response rate and tolerance of the treatment, performance status and quality of life. Being associated with a poor prognostic, cachexia must be treated properly, in order to improve patient's physical and functional status, quality of life and overall survival. [ABSTRACT FROM AUTHOR]

Introduction: When discussing cytotoxic chemotherapy, the way the drugs are administered is as important as choosing the regimen. Several aspects like hyperhydration, emesis, the period of administration, diet and allergic reactions have to be taken into consideration. Method: Recent literature on these fi ve main topics was revised. Most relevant data was collected and summarized in an attempt to familiarize any reader with this matter. Conclusion:These aspects are of utmost importance in reducing toxicity, thus enabling more extended treatment compliance, administration of effective doses and better oncological outcomes. [ABSTRACT FROM AUTHOR]