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Mental health can be negatively affected during life to varying degrees, from minor indispositions created by daily debates, to major psycho-social traumas that have a significant and long-term impact. Physical injuries, especially those involving limb amputation, are probably the most traumatic and hard to accept events, as they cause severe biological, psychological and social damage to the individual. Losing a limb or part of a limb leads to significant physical disability, changes in physical appearance and self-esteem, difficulty returning to work and problems with social integration. Consequently, after an amputation operation, the patient's recovery must be approached with great care. Some of the patients adapt relatively easily to the new condition, while others successfully benefit from intensive recovery programs. Unfortunately, a small group of patients fail in post-operative recovery and some even believe that isolation/suicide could be a possible solution for their difficulties. The psychological response/behavior of patients to limb amputations is dependent on many factors, such as: personality, level of education, social status, the environment and culture from which it originates, the support from society in terms of their integration, age, gender, the affected limb and extent of amputation, accessibility to different methods of recovery/prosthetics, etc. This complexity of the factors involved in the post-operative recovery period of the amputee patient causes the rehabilitation programs to be extremely elaborate on the one hand, but also highly personalized according to the individual characteristics, on the other hand. In this review, aspects of the psychological rehabilitation of patients undergoing limb amputation are presented and updated. It seems that such measures should be approached interdisciplinary with the patient and initiated even before surgery, if possible, to achieve the best possible results.

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.

Inflammatory bowel disease is a group of conditions of unknown etiology, represented by Crohn's disease and ulcerative colitis and characterized by the presence of intestinal wall inflammation. From the first cases described to date, several studies have been performed to elucidate the cause of inflammatory bowel disease. Generally, the genetic factors predispose to their occurrence while epigenetic and environmental factors trigger them. Genetic factors are mutations of the genes involved in the response and recognition of immune cells to different pathogens. The most studied epigenetic and environmental factors are smoking (which predisposes to Crohn's disease and can be protective for ulcerative colitis), lack of vitamin D, a diet rich in sugars and low in flavonoids and fibers. The diagnosis is usually established by endoscopy and biopsy. Recent technologies can perform live biopsies such as endocytoscopy or confocal laser endomicroscopy, with an accuracy of 100% compared to classical methods. Therapy involves several classes of drugs, preferably in association with diet and lifestyle changes. In case of complications or in non-responsive diseases, surgery must be considered, as documented for ulcerative colitis that can be cured by removing the entire colon. The purpose of this review is to present recent findings on pathology, as well as modern diagnosis and treatment methods for IBD. [ABSTRACT FROM AUTHOR]

Giant pancreatic pseudocysts are considered those cysts whose dimensions exceed 10 cm and are sporadically reported in the literature. Although there are multiple treatment modalities, there are currently no treatment guidelines or consensus on the best therapeutic approach for giant pancreatic pseudocysts. We report the case of a 32-year-old male patient with a giant pancreatic pseudocyst after an episode of acute pancreatitis, which was treated by internal surgical drainage through cyst-jejunal anastomosis. This surgical procedure was followed by the formation of a retroperitoneal abscess which was resolved by ultrasoundguided drainage. The subsequent evolution of the patient was favorable, without other complications. Given their complex anatomical relations, the treatment of giant pseudocysts requires strategies adapted to the local conditions. The optimal choice of the operative time and of the therapeutic strategy is based on clinical considerations and the effectiveness of the method used can be assessed by a long-term follow-up. [ABSTRACT FROM AUTHOR]

Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding. [ABSTRACT FROM AUTHOR]

The gastrointestinal microbiome contains at least 100 trillion microorganisms (bacteria, viruses, fungi), whose distribution varies from the mouth to the rectum spatially and temporally throughout one's lifetime. The microbiome benefits from advancing research due to its major role in human health. Studies indicate that its functions are immunity, metabolic processes and mucosal barrier. The disturbances of these functions, dysbiosis, influence physiology, lead to diabetes, inflammatory bowel disease, obesity and colon tumorigenesis. The third most common form of cancer, colorectal cancer, is the result of many factors and genes, and although the link between dysbiosis and this type of cancer is poorly characterized, it has been shown that some bacterial species and their metabolites have a critical role in developing colorectal cancer. Also, gut microbiota plays a role in the inflammatory response and immune process perturbations during the progression of colorectal cancer. Some new technologies, such as metagenome sequencing, facilitated the progress by analyzing the metabolic and genetic profile of microbiota, revealing details about the bacterial composition, host interactions, and taxonomic alterations. This review summarizes the studies regarding the link between gut microbiota and colorectal cancer, targeting new therapeutic strategies. [ABSTRACT FROM AUTHOR]

Esophageal tumors are uncommon in pediatric population and most of them are benign. Esophageal hamartomas have been reported extremely rare in children. These can present as intramural tumors of the esophageal wall or as polyps. Dysphagia is the main symptom described in their case, but other specific symptoms are also reported. Such symptoms encountered in clinical practice are represented by obstructive apnea episodes and bradycardia, poor weight gain, epigastric or retrosternal pain, hematemesis or melena, dysphonia or tracheal sounds. Diagnosis can be delayed due to the insidious onset and non-specific symptoms, therefore patient's compliance to follow-up and broad, careful evaluation are mandatory. Preoperative imagistic assessment is extremely important for a precise definition of the tumor's anatomical relations, especially when facing large tumors located in the posterior mediastinum. Herein we report a case of a large chondromatous polypoid hamartoma of the esophagus in a 9 years old boy, emphasizing over the diagnosis and surgical challenges we have met, along with comments on illustrative similar cases reported in the literature. [ABSTRACT FROM AUTHOR]

Prostate cancer represents the leading malignant tumor in men over 50 years of age with 400,000 new cases being diagnosed yearly in Europe. Even if the incidence rate is higher than the mortality rate, still there is an increasing trend when speaking of its mortality. The increasing incidence of the metabolic syndrome, the unhealthy lifestyle, the high lipid and Calcium intake, the high spread of infections with Human Papilloma Virus, Human Herpes Virus, the excess of androgen consumption and the longer life expectancy, are few of the main causes of prostate cancer increasing incidence. The new systemic therapies such as immunotherapy with Checkpoint Inhibitors or Poly, ADP-Ribose Polymerase inhibitors and local experimental procedures addressing tumor destruction, such as High- Intensity Focused Ultrasound, the Cryo and Focal Laser Ablation, provide good outcomes and become new promising tools for prostate cancer therapy. Physicians consider these methods worth using; the efficacy of some specific categories of patients being arguments for their use in the current protocols even though solid data regarding the improvement of global mortality rates are not yet published. The current article focuses on the newest systemic and local experimental treatment tools highlighting their benefits, especially for hormone-resistant prostate cancer. [ABSTRACT FROM AUTHOR]

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a "burnout syndrome" in the last few months. The particularity of the presented case is the severe coronary artery disease in a young patient without discovering the main etiology of the advanced atherosclerotic process. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/monthly. [ABSTRACT FROM AUTHOR]

In very few cases stated in the literature, the vermiform appendix might be contained in a hernial sac. This distinctive pathology is described as Amyand's hernia and has the very small occurrence of about 1%. We report the case of a 62-year-old man that presented for a reducible tumoral mass located in the right inguinal region. Amyand’s hernia was the intraoperative diagnostic. We performed hernioplasty (using the Lichtenstein tension-free mesh repair with a composite polypropylene mesh) without appendectomy. This case matches the type 1 Lossanoff and Basson’s classification and has no facile management. Due to the clinical specificities of each case that presents with defining features of an Amyand’s hernia, surgical management depends on the recommendations stated in the literature, as well as the surgeon’s judgment based on experience. [ABSTRACT FROM AUTHOR]

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects. [ABSTRACT FROM AUTHOR]

THE HUMAN MICROBIOME, AS A WHOLE, AND DUE TO THE COMPLEXITY OF THE GENE, IS THE ONE THAT MAKES THE MAJOR DIFFERENCE BETWEEN INDIVIDUALS OF A SPECIES, OUR VARIABILITY, AS REPORTED ONLY ON ITS OWN GENOME, WAS ESTIMATED TO BE 0.1%. THE STUDY OF THE INFANT GROUP OF PROBIOTICS IN THE CONTEXT OF AN EPISODE OF DIARRHEAL DIARRHEA INDIRECTLY DEMONSTRATES THE IMPORTANCE OF HEALTHY MICROFLORA BY: RAPID NUTRITIONAL RECOVERY, REDUCING THE DURATION OF HOSPITALIZATION, REDUCING THE RISK OF SUBSEQUENT RECURRENCE. BUCCOPHARYNGEAL RECOLONIZATION WITH SAPROPHYTIC BACTERIA SALIVARIUS STREET HAD A POSITIVE ASPECT IN RELIEVING SYMPTOMS, RESTORING THE NORMAL PHARYNGEAL MACROSCOPIC APPEARANCE, AVOIDING ANTIBIOTIC THERAPY. [ABSTRACT FROM AUTHOR]

ANAMNESIS, OR PHYSICIAN-PATIENT DISCUSSION, HAS REMAINED AN ESSENTIAL AND PRELIMINARY STEP FOR ESTABLISHING A CORRECT DIAGNOSIS SINCE HIPPOCRATES. THE RISK OF POSSIBLE ERRORS SHOULD BE MINIMIZED BY PROVIDING SOME PARAMETERS: ACCURACY, GOING THROUGH "CHRONOLOGICAL" INTERVIEWING PHASES, EMPATHY TOWARDS THE PATIENT AND CARETAKERS, PROVIDING A CALM ENVIRONMENT WITHOUT DISTURBANCE, WITHOUT DISTURBANCE, ADAPTING MEDICAL LANGUAGE AND USING DISCERNING MEDICAL TERMS ACCORDING TO THE PARTICULARITIES INTELLECTUALS OF THE INTERLOCUTOR. NOT COMMITTING TO ANY STAGE, ACCURATE AND USEFUL INFORMATION COLLECTION HELPS TO QUICKLY APPLY PROPER TREATMENT, SHORTER HOSPITALIZATION, AND EASIER RECOVERY OF THE PATIENT, THE MORE IT IS ABOUT A CHILD. [ABSTRACT FROM AUTHOR]

ENDOMETRIOSIS IS CHARACTERIZED BY THE PRESENCE OF UTERINE MUCOSAL TISSUE OUTSIDE THE UTERUS. ABDOMINAL WALL ENDOMETRIOSIS (AWE) IS A RARE ENTITY, USUALLY DEVELOPED IN THE FERTILE PERIOD OF WOMEN. IT MEANS ENDOMETRIOSIS OUTSIDE THE PERITONEUM. PARIETAL ENDOMETRIOSIS INCLUDE, BESIDE AWE, PERINEAL ENDOMETRIOSIS. IT CAN BE PRIMARY ENDOMETRIOSIS (WHICH IS QUITE RARE, SUCH AS UMBILICAL), OR, MORE OFTEN, SECONDARY, AFTER SURGICAL OR GYNECOLOGICAL PROCEDURES. SCAR ENDOMETRIOSIS IS DUE TO INTRAOPERATIVE DISEMINATION AND IS MORE FREQUENTLY LOCATED TO C-SECTION SCAR. THE SYMPTOMS INCLUDE CATAMENIAL PAIN, PALPABLE MASS WITH OR WITHOUT CYCLIC VARIATIONS, AND EVEN EXTERNAL HAEMORRAGE SYNCRONOUS WITH MENSTRA. CYCLICITY OF PAIN OR OF MASS DIMENSIONS' VARIATION IS NOT PRESENT IN ALL CASES. DIFFERENTIAL DIAGNOSIS SHOULD BE MADE WITH STITCH GRANULOMA, ABSCESS, LIPOMA, HEMATOMA, SEBACEOUS CYST, SEROMA, HERNIA, OR EVEN MALIGNANT TUMORS. IMAGISTIC METHODS, SUCH AS ULTRASOUND, MRI AND CT SCAN ARE USEFULL FOR DIAGNOSIS. SURGICAL EXCISION OF ENDOMETRIAL MASS IS UNANIMOUSLY CONSIDERED TO BE THE ONLY CURATIVE TREATMENT. [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.)

Oncology patients often have a nutritional status, which is usually weak and therefore have special needs. Factors such as nausea, lack of appetite, postoperative ileus, postoperative pain, difficulty in swallowing, bedridden state, affect the alimentation capacities of oncology patients, leading to malnutrition over time. Neoplastic cachexia becomes a risk factor per se, which adds to the already precarious condition of the patients. They increase the risk for any further medical maneuvers. For patients in intensive care units, intubated, things become even more difficult, requiring parenteral and enteral nutrition. [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.)

GALLBLADDER CARCINOMA IS FAR TO BE AN EXTREMELY RARE DIAGNOSTIC. IT REPRESENTS THE FIFTH LOCATION IN FREQUENCY ORDER FOR DIGESTIVE TRACT MALIGNANCY. IT IS MORE FREQUENT THAN CHOLANGIOCARCINOMA. WE NOTICED RECENTLY (LAST YEARS) AN INCREASING NUMBER OF GALLBLADDER CARCINOMAS IN OUR CLINIC. MOST OF THEM ARE NOT DIAGNOSED PRE-OPERATIVELY. SOME CASES ARE INTRAOPERATIVE SURPRISES AND SOME ARE EVEN POST-OPERATIVE SURPRISES FROM HISTOPATHOLOGY LAB. THE ONCOLOGIC CORRECT SURGICAL TREATMENT ASSUMES A PRE-OPERATIVE DIAGNOSTIC, WHICH, UNFORTUNATELY, IS VERY RARE. SOME SPECIFIC CASES WITH AN ULTRASOUND RESULT SUGGESTING A TUMOR OF THE GALLBLADDER UNDERGO AN ABDOMINAL CT SCAN OR MRI THAT COULD CONFIRM THE DIAGNOSIS. THE MOST COMMON MISMATCH IS ACUTE CHOLECISTITIS. IN THE LAST FIVE YEARS (2014-2018), WE TREATED IN OUR SURGICAL CLINIC 11 CASES OF GALLBLADDER CARCINOMA. [ABSTRACT FROM AUTHOR]

INTRODUCTION. THE DIVERTICULAR DISEASE REPRESENTS A COMMON PATHOLOGY IN DEVELOPED OR DEVELOPING COUNTRIES. FOR ABOUT 80% OF PATIENTS THE DISEASE IS ASYMPTOMATIC (DIVERTICULOSIS), 20% DEVELOPING NON-SPECIFIC DIGESTIVE SYMPTOMS (UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE) OR CMPLICATIONS, SUCH AS ACUTE DIVERTICULITIS. MATERIAL AND METHOD. THE AIM OF THE RESEARCH IS TO PRESENT THE THERAPEUTICAL APPROACH IN COLONIC DIVERTICULOSIS, UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE AND ACUTE DIVERTICULITIS, A REVIEW OF THE RECENT MEDICAL LITERATURE BEING MADE TO SUPPORT THE INFORMATION PROVIDED. RESULTS. THE DATA AVAILABLE FROM THE LAST 10 YEARS REGARDING THE SUBJECT HAVE BEEN ANALYZED. OVER THE PAST 5 YEARS 6 DIFFERENT THERAPEUTIC GUIDELINES FOR THE COLONIC DIVERTICULAR DISEASE HAVE BEEN REGISTERED. THERE ARE NO CLEAR INDICATIONS REGARDING THE MEDICAL TREATMENT IN ASYMPTOMATIC COLONIC DIVERTICULOSIS, THE INDICATIONS BEING ALSO LIMITED IN THE CASE OF LOWERING THE RISK OF DIVERTICULOSIS BY INCREASING THE FIBER INTAKE. THERE IS NOT YET A THERAPEUTIC STANDARD IN ASYMPTOMATIC DIVERTICULAR DISEASE, VARIOUS THERAPEUTIC STRATEGIES WITH FIBERS, PROBIOTICS, RIFAXIMIN OR MESALAZINE BEING TAKEN INTO CONSIDERATION. AN AGREEMENT HAS BEEN REACHED IN THE TREATMENT OF THE ACUTE DIVERTICULITIS, THE LATEST GUIDELINES DEMONSTRATING THE FACT THAT ANTIBIOTICS CAN BE ADMINISTERED ONLY IN CAREFULLY SELECTED CASES, AVOIDING THEIR ROUTINE USE. THE RESULTS OF THE VARIOUS STUDIES REGARDING THE PRIMARY OR SECONDARY PROPHYLAXIS IN ACUTE DIVERTICULITIS AND THE EFFICACY OF RIFAXIMIN OR MESALAZINE ARE HETEROGENOUS. CONCLUSIONS. THE THERAPEUTIC MANAGEMENT IN COLONIC DIVERTICULOSIS AND IN UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE, AS WELL AS THE PRIMARY AND SECONDARY PROPHYLAXIS STRATEGIES REPRESENT REAL CHALLENGES OF THE DAILY MEDICAL PRACTICE. [ABSTRACT FROM AUTHOR]