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Vălean D, Zaharie R, Țaulean R, Usatiuc L, Zaharie F. Recent Trends in Non-Invasive Methods of Diagnosis and Evaluation of Inflammatory Bowel Disease: A Short Review. Int J Mol Sci 2024; 25:2077. [PMID: 38396754 PMCID: PMC10889152 DOI: 10.3390/ijms25042077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Inflammatory bowel diseases are a conglomerate of disorders causing inflammation of the gastrointestinal tract, which have gained a significant increase in prevalence in the 21st century. As they present a challenge in the terms of diagnosis as well as treatment, IBDs can present an overwhelming impact on the individual and can take a toll on healthcare costs. Thus, a quick and precise diagnosis is required in order to prevent the high number of complications that can arise from a late diagnosis as well as a misdiagnosis. Although endoscopy remains the primary method of evaluation for IBD, recent trends have highlighted various non-invasive methods of diagnosis as well as reevaluating previous ones. This review focused on the current non-invasive methods in the diagnosis of IBD, exploring their possible implementation in the near future, with the goal of achieving earlier, feasible, and cheap methods of diagnosis as well as prognosis in IBD.
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Affiliation(s)
- Dan Vălean
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania; (D.V.); (R.Ț.); (F.Z.)
- Department of General Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400347 Cluj-Napoca, Romania
| | - Roxana Zaharie
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania; (D.V.); (R.Ț.); (F.Z.)
- Department of Gastroenterology, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400347 Cluj-Napoca, Romania
| | - Roman Țaulean
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania; (D.V.); (R.Ț.); (F.Z.)
- Department of General Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400347 Cluj-Napoca, Romania
| | - Lia Usatiuc
- Department of Patophysiology, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400347 Cluj-Napoca, Romania;
| | - Florin Zaharie
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania; (D.V.); (R.Ț.); (F.Z.)
- Department of General Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400347 Cluj-Napoca, Romania
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Moiș E, Hajjar NA, Moldovan S, Nechita VI, Vălean D, Puia IC, Furcea L, Puia A, Iancu C, Popa C, Zaharie F, Rusu I, Graur F. Microscopic Positive Margins in Gastric Adenocarcinoma Following Oncological Resection: Prognostic Factors and Long-Term Survival. Ann Ital Chir 2024; 95:91-97. [PMID: 38469603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND In the context of gastric cancer, surgical resection stands as the sole curative treatment. Central to influencing overall survival are the resection margins. This research aims to identify the factors influential in determining microscopically positive resection margins (R1) and to evaluate overall survival. METHODS Our study encompassed 549 patients diagnosed with adenocarcinoma of the stomach who underwent curative-intent surgery between January 2011 and December 2021 in our Surgery Department. We investigated the incidence of positive margins (R1) and their impact on survival rates, as well as the determinants of R1. The standardization of R1 involved ensuring a margin distance of less than 1 mm from the tumor line to the margin. RESULTS The incidence of R1 margins was 13.29% (73 patients). Among these, proximal R1 margins were observed in 29 patients (39.72%), while 49 cases (67.12%) presented circumferentially positive margins, with 20 cases (27.39%) exhibiting distally positive margins. Nineteen patients (26.02%) had two R1 margins, and 3 patients had all resection margins microscopically positive (4.10%). Factors such as tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading demonstrated significance (p < 0.01) in the occurrence of positive R1 margins. CONCLUSION Tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading could be regarded as factors for predicting microscopically positive margins. Moreover, positive resection margins have a detrimental impact on overall survival.
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Affiliation(s)
- Emil Moiș
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Nadim Ai Hajjar
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Septimiu Moldovan
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Vlad-Ionuţ Nechita
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Dan Vălean
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Ion-Cosmin Puia
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Luminița Furcea
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Aida Puia
- Department of Community Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Cornel Iancu
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Ioana Rusu
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Florin Graur
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
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Ursu Ș, Ciocan A, Ursu CP, Gherman CD, Ciocan RA, Pop RS, Spârchez Z, Zaharie F, Al Hajjar N. Role of Metabolomics in Pathogenesis and Prompt Diagnosis of Gastric Cancer Metastasis-A Systematic Review. Diagnostics (Basel) 2023; 13:3401. [PMID: 37998537 PMCID: PMC10670422 DOI: 10.3390/diagnostics13223401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Gastric cancer is the fourth most frequently diagnosed form of cancer and the third leading cause of cancer-related mortality worldwide. The aim of this review is to identify individual metabolic biomarkers and their association with accurate diagnostic values, which can predict gastric cancer metastasis. MATERIALS AND METHODS After searching the keywords, 83 articles were found over a period of 13 years. One was eliminated because it was not written in English, and two were published outside the selected period. Seven scientific papers were qualified for this investigation after eliminating duplicates, non-related articles, systematic reviews, and restricted access studies. RESULTS New metabolic biomarkers with predictive value for gastric cancer metastasis and for elucidating metabolic pathways of the metastatic process have been found. The pathogenic processes can be outlined as follows: pro-oxidant capacity, T-cell inactivation, cell cycle arrest, energy production and mitochondrial enzyme impairment, cell viability and pro-apoptotic effect, enhanced degradation of collagen extracellular matrix, migration, invasion, structural protein synthesis, and tumoral angiogenesis. CONCLUSION Metabolic biomarkers have been recognized as independent risk factors in the molecular process of gastric cancer metastasis, with good diagnostic and prognostic value.
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Affiliation(s)
- Ștefan Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Cristina-Paula Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (C.D.G.); (R.A.C.)
| | - Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (C.D.G.); (R.A.C.)
| | - Rodica Sorina Pop
- Department of Community Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Avram Iancu Street, No. 31, 400347 Cluj-Napoca, Romania;
| | - Zeno Spârchez
- Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania;
| | - Florin Zaharie
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
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Moiș E, Graur F, Horvath L, Furcea L, Zaharie F, Vălean D, Moldovan S, Al Hajjar N. Perineal Hernia Mesh Repair Using Only the Perineal Approach: How We Do It. J Pers Med 2023; 13:1456. [PMID: 37888067 PMCID: PMC10608043 DOI: 10.3390/jpm13101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Perineal hernia is a rare complication of rectal surgery. Different types of surgical approach have been described, but none of them have proven their superiority. Although there are many methods of closing the defect, we selected two cases to present from a series of five cases, in which the perineal hernia was successfully resolved surgically using only the perineal approach. The reconstruction of the perineal floor and closure of the defect were performed using a synthetic polypropylene mesh. The significance of this Technical Note article lies in the fact that we describe, step by step, a surgical technique for perineal hernia using just a perineal approach.
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Affiliation(s)
- Emil Moiș
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Graur
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Levente Horvath
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Luminița Furcea
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Dan Vălean
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Septimiu Moldovan
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
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Alexa AL, Ciocan A, Zaharie F, Valean D, Sargarovschi S, Breazu C, Al Hajjar N, Ionescu D. The Influence of Intravenous Lidocaine Infusion on Postoperative Outcome and Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer Patients. A Pilot Study. J Gastrointestin Liver Dis 2023; 32:156-161. [PMID: 37345602 DOI: 10.15403/jgld-4962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS In the last years increasing scientific evidence drew attention on the potential effects of anesthetic drugs on postoperative outcome in cancer patients. Local anesthetics, especially lidocaine, have been intensively studied in relation with postoperative outcome in colorectal cancer patients. Our study objectives were to investigate the effects of perioperative intravenous lidocaine infusion on neutrophil-to-lymphocyte ratio and short-term postoperative outcome. Additionally, we also looked at 1 year outcome after intended radical colorectal cancer surgery. METHODS 150 patients scheduled for colorectal cancer surgery were randomized to receive sevoflurane anaesthesia with or without 48 hours lidocaine infusion. RESULTS 73 patients were included in the group A (sevoflurane) and 77 in the group B (sevoflurane with lidocaine). Lidocaine infusion did not modify neutrophil-to-lymphocyte ratio at 24 hours after surgery (p=0.58). Patients receiving intravenous lidocaine had significantly lower morphine consumption (p=0.04), faster mobilization time (p=0.001) and fewer days spent in the hospital (p=0.04). Moreover, at 1 year follow- up, patients in group B had a significant decreased rate of recurrences (p=0.03). There was no significant difference in 1 year survival (p=0.22). CONCLUSIONS In our study, intravenous lidocaine infusion hastened the postoperative recovery of patients in terms of mobilization, hospital discharge and opioid consumption and reduced 1 year recurrence rate. Further studies on larger groups of patients are needed.
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Affiliation(s)
- Alexandru Leonard Alexa
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania.
| | - Andra Ciocan
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Florin Zaharie
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Dan Valean
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Sergiu Sargarovschi
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania.
| | - Caius Breazu
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Romania.
| | - Nadim Al Hajjar
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Daniela Ionescu
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca, Romania; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania; Outcome Research Consortium, Cleveland, USA.
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Zaharie F, Valean D, Zaharie R, Popa C, Mois E, Schlanger D, Fetti A, Zdrehus C, Ciocan A, Al-Hajjar N. Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience? World J Gastrointest Surg 2023; 15:847-858. [PMID: 37342852 PMCID: PMC10277938 DOI: 10.4240/wjgs.v15.i5.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.
AIM To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.
METHODS Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).
RESULTS There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).
CONCLUSION Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Dan Valean
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Roxana Zaharie
- Department of Gastroenterology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
| | - Calin Popa
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Emil Mois
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Diana Schlanger
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Alin Fetti
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Claudiu Zdrehus
- Department of Anaesthesiology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Andra Ciocan
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Nadim Al-Hajjar
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
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Grizzi F, Chiriva-Internati M, Miranda E, Zaharie R, Hajjar NA, Zaharie F, Del Arco CD, Fernández-Aceñero MJ, Bresalier RS, Moiş E. Sperm protein antigen 17 and Sperm flagellar 1 cancer testis antigens are expressed in a rare case of ciliated foregut cyst of the common hepatic duct. Pathol Res Pract 2023; 247:154546. [PMID: 37224658 DOI: 10.1016/j.prp.2023.154546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Ciliated foregut cysts (CFCs) are frequently described in liver, pancreas and gallbladder and generally considered benign although one case of squamous cell metaplasia and five cases of squamous cell carcinoma arising from a ciliated hepatic foregut cyst have been reported. Here we explore two cancer-testis antigens (CTAs), Sperm protein antigen 17 (SPA17) and Sperm flagellar 1 (SPEF1) expression in a rare case of CFC of the common hepatic duct MATERIALS AND METHODS: 3 µm-thick CFC sections were immunohistochemically treated with antibodies raised against human SPA17 or SPEF1. In silico Protein-Protein Interaction (PPI) network and differential protein expression were also investigated RESULTS: Immunohistochemistry revealed SPA17 and SPEF1 in the cytoplasm of ciliated epithelium. SPA17, but not SPEF1, was also detected in cilia. The PPI networks demonstrated that other CTAs are significantly predicted functional partners with SPA17 and SPEF1. The differential protein expression demonstrated that SPA17 was higher in breast cancer, cholangiocarcinoma, liver hepatocellular carcinoma, uterine corpus endometrial carcinoma, gastric adenocarcinoma, cervical squamous cell carcinoma, bladder urothelial carcinoma. SPEF1 expression was higher in breast cancer, cholangiocarcinoma, uterine corpus endometrial carcinoma and kidney renal papillary cell carcinoma CONCLUSIONS: Our study suggests that further characterization of SPA17 and SPEF1 in patients with CFCs might provide significant insights to understand the mechanisms underlying their potential to malignant transformation.
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Affiliation(s)
- Fabio Grizzi
- Department of Immunology and Inflammation, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Maurizio Chiriva-Internati
- Departments of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Roxana Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florin Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | | | | | - Robert S Bresalier
- Departments of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emil Moiş
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Popa C, Schlanger D, Prunoiu VM, Puia IC, Zaharie F. A novel step-by-step training program for transanal endoscopic surgery. BMC Med Educ 2023; 23:327. [PMID: 37170198 PMCID: PMC10176938 DOI: 10.1186/s12909-023-04296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The objective of our study is to develop an effective training platform for transanal endoscopic surgery and to validate a step-by-step training program for learning the basic skills necessary for this approach. METHODS We have designed a two-part study: an experimental study (with the aim to design the training platform and the training exercises - on synthetic and biological material) and a prospective analytical study, in order to validate the training program by enrolling as participants general surgery residents and specialists, without previous experience in transanal endoscopic interventions. The performance of the participants was assessed based on the time of completion, as well as the quality of the execution. RESULTS We have developed three different diameter platforms (5 cm, 7.5 and 10 cm), that can be used with both the TEO and TAMIS platforms; specific exercises were developed to train different surgical skills like manipulation of tissue, cutting, dissection and suturing. Forty participants were enrolled for the validation of the proposed training program (12 young residents, 16 senior residents and 12 specialist surgeons). A statistically significant improvement of the performance time, from round to round, was observed for all participants in all exercises. The time of completion for the exercises, considering the correct technical execution, was the shortest for more experienced surgeons: specialist surgeons, followed by senior residents and young residents. The biological material exercises, that closely recreate intraoperative conditions and had more strict technical requirements, were difficult to be performed by young residents; better completion rates were seen in senior residents, while all the participants in the specialist surgeons group have completed these exercises. CONCLUSIONS Our training program is an effective simulation based educational model for recreating intraoperative conditions particular to transanal endoscopic surgery. The proposed step-by-step training program has demonstrated to be useful in developing the important basic skills needed for transanal endoscopic surgery and assured the progress of all the participants, regardless of their surgical experience.
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Affiliation(s)
- Călin Popa
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
| | - Diana Schlanger
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania.
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania.
| | - Virgiliu Mihail Prunoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Clinic I General and Oncological Surgery "Prof. Dr. Alexandru Trestioreanu", Bucharest, Romania
| | - Ion Cosmin Puia
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
| | - Florin Zaharie
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
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Popa C, Abdul Halim N, Pestean C, Ober C, Elisei R, Al Momani T, Schlanger D, Graur F, Zaharie F, Al Hajjar N. Residents can do it! A hands-on training program in laparoscopic liver surgery for general surgery residents. Eur Surg Res 2023:000528691. [PMID: 36592620 DOI: 10.1159/000528691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Laparoscopic liver resections (LLR) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic "step-by-step" program for LLR performed by residents using the swine training model Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants' performance results in terms of operative time, blood loss, conversion, trainers' intervention and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior attending surgeons who didn't follow the protocol and had not performed LLR previously, and to another 24 residents in a third workshop, who had not taken the training program before but followed the protocol Results: All residents fully completed the surgical procedures. Trained residents achieved better operative times and less blood loss compared to senior surgeons (p<0.017), however, the remaining parameters were comparable. When compared to non-trained residents, those who underwent training achieved significantly better results only in operative times (p<0.001) Conclusion: A continuous LLR "step-by-step" training program on swine for residents is feasible and the "step-by-step" protocol is a valuable tool for a proper surgical education.
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Zaharie F, Valean D, Al-Hajjar N. Surgical technique in the laparoscopic repair of Morgagni hernia in adults. How do we do it? Authors’ reply. Hernia 2022; 26:1711-1712. [DOI: 10.1007/s10029-022-02700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Farc O, Berindan‑Neagoe I, Zaharie F, Budisan L, Zanoaga O, Cristea V. A role for serum cytokines and cell adhesion molecules in the non‑invasive diagnosis of colorectal cancer. Oncol Lett 2022; 24:323. [PMID: 35949613 PMCID: PMC9353784 DOI: 10.3892/ol.2022.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022] Open
Abstract
Colorectal cancer (CRC) remains a major cause of cancer-related mortality. Consequently, new diagnostic and therapeutic approaches are being investigated including the serum levels of cytokines and other molecules, although the results are often inconclusive. Thus, the present study aimed to determine whether serum level of cytokines, cell adhesion molecules or matrix metalloproteinases (MMPs), alone or in combination, may contribute to the non-invasive diagnosis of CRC. The serum levels of nine cytokines [ILs; IL-1β, IL-4, IL-6, IL-8, IL-10, IL-17, IL-22 and IL-33, and interferon (IFN)-γ], two cell adhesion molecules (intercellular adhesion molecule-1 and P-selectin) and an MMP-7 were measured by ELISA in 33 patients with CRC and 35 healthy controls. Combined capacity of all molecules to detect the presence of CRC was assessed by logistic regression. Molecules and molecule combinations were tested for all stages and tumor grades. A significant increase was identified for IL-8 in patients compared with healthy controls; IL-10 was found to be significantly decreased. The biomarker potential of each significantly modified molecule was tested: IL-8 had a sensitivity of 0.865, a specificity of 0.600 and an area under the curve (AUC) of 0.777; for IL-10, sensitivity was 0.65, specificity was 0.69, with an AUC of 0.689. Logistic regression determined the best discriminative potential between patients and control groups for the combination IL-4 + IL-6 + IL-8 + IFN-γ, with 0.97 sensitivity and 0.58 specificity. For the early stages of CRC, the combination IL-6 + IL-8 + IL-22 showed good performance. It was concluded that increased IL-8 had potential as single biomarker in CRC. Cytokine combinations are superior to single cytokine analysis in showing the presence of CRC.
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Affiliation(s)
- Ovidiu Farc
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Ioana Berindan‑Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj‑Napoca, Romania
| | - Florin Zaharie
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Liviuta Budisan
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj‑Napoca, Romania
| | - Oana Zanoaga
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj‑Napoca, Romania
| | - Victor Cristea
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
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Zaharie RD, Popa C, Schlanger D, Vălean D, Zaharie F. The Role of IL-22 in Wound Healing. Potential Implications in Clinical Practice. Int J Mol Sci 2022; 23:3693. [PMID: 35409053 PMCID: PMC8998254 DOI: 10.3390/ijms23073693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/14/2022] Open
Abstract
Wound healing is a complex process that is mediated and influenced by several cytokines, chemokines, and growth factors. Interleukin-22 (IL-22) is a cytokine that plays a critical role in tissue regeneration. Our study is a systematic review that addressed the implications of IL-22 in the healing of wounds caused by external factors. Thirteen studies were included in our review, most of them being experimental studies. Three clinical studies underlined the potential role of IL-22 in day-to-day clinical practice. IL-22 plays a central role in wound healing, stimulating the proliferation, migration, and differentiation of the cells involved in tissue repair. However, overexpression of IL-22 can cause negative effects, such as keloid scars or peritoneal adhesions. The results of the presented studies are promising, but further research that validates the roles of IL-22 in clinical practice and analyzes its potential implication in surgical healing is welcomed.
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Affiliation(s)
- Roxana Delia Zaharie
- Gastroenterology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania;
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Dan Vălean
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
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Zaharie F, Valean D, Popa C, Mois E, Graur F, Munteanu D, Schlanger D, Ciocan A, Puia C, Al Hajjar N. Surgical technique in the laparoscopic repair of Morgagni hernia in adults. How do we do it? Hernia 2022; 26:1389-1394. [PMID: 35013791 DOI: 10.1007/s10029-021-02559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adult Morgagni hernias are rare congenital diaphragmatic hernias, which can present with an array of symptoms based on the size and the contents of it. This article focuses primarily on the laparoscopic repair with transfascial suturing. METHODS A number of five patients over the course of 10 years were admitted in our clinic, one of them being admitted with emergency symptoms. Four of the patients were treated laparoscopically, one of them requiring conversion to open approach. RESULTS The median age was 53 (range 44-71), 80% of the patients being females. Four of the patients received laparoscopic treatment with transfascial suturing, the fifth being converted, but respecting the same technique. The median surgery duration was 110 min, with a median blood loss of 30 ml. Removal of the sac was attempted in two cases. Median hospitalization stay was 3 days, with a median follow-up of 21 months, with no postoperative complications reported. CONCLUSIONS Laparoscopic repair with transfascial suturing provides an feasible and efficient repair, compared to the other laparoscopic techniques. Although no postoperative complications were reported, the removal of the sac still remains an controversial issue.
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Affiliation(s)
- F Zaharie
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Valean
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.
| | - C Popa
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - E Mois
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - F Graur
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Munteanu
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Schlanger
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania
| | - A Ciocan
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - C Puia
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - N Al Hajjar
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
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Graur F, Puia A, Mois E, Pop P, Berar M, Elisei R, Zaharie F, Nechita V, Rusu I, Buiga R, Puia C, Al Hajjar N. Analysis of the MLH1, MLH2, MLH6, PMS2 genes and their correlations with clinical data in rectal mucinous adenocarcinoma. Ann Ital Chir 2022; 93:188-194. [PMID: 34807001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal instability. One of the following genes, MLH1, MLH2, MLH 6, and PMS2, is inactivated, leading to MSI colorectal cancers. AIM This study aimed to analyze the expression of some MMR system genes presenting mutations in mucinous rectal cancer and their correlations with clinical data. METHODS A retrospective study was performed on patients with rectal mucinous adenocarcinoma who underwent surgery between January 2000 and January 2017. We collected a total of 42 patients and analyzed the demographic data, histopathological results and MMR system genes mentioned above. RESULTS Almost 93% of the cases analyzed had MSI-H and only 7% were MSI-L. For MLH1, 50% of stage T2 and 50% of stage T4 had weak expression, while in stage T3, 42.50% had moderate expression. Regarding the N stage, we found that 66.67% of the patients with moderate gene expression (2+) were N2, while 42% of the patients with weak expression were N0. For MSH2, the majority of patients with strong gene expression were in stage T3 (27%). Weak expression was found in 50% of the patients in stage T2, 35% of the patients in stage T3, and 33.3% in T4. In 44.44% of the weak expression was N2, while for strong expression, there was an equivalent percentage of 33.33% in stages N1 and N2. Describing the MSH6 gene, we found that the most heterogeneous results were in stage T3. Weak expression was observed in 38.46% of the patients, while moderate and strong expression was observed in 30.77% and 11.54% respectively. Analysis of PMS2 revealed that 66.67% of the patients in stage T4 had a weak expression of the gene, while the same expression was found in 38.46% of the patients in stage T3. A total of 23.08% of patients in stage T3 had strong gene expression. We also analyzed the overall gene expression. Thus, we found that three patients (7.14%) had only 1, three genes were expressed, nine (21.42%) had two genes and the remaining 27 patients had all 4. The 1-year survival rate in the analyzed lot was 75%, decreasing to 60% in the second year and 35% in the 3rd. There were no statistically significant differences in survival data between the stages or gene expression. CONCLUSIONS Our study showed no statistical difference regarding the survival on different gene expression or staging, consistent with studies that found that mucin expression does not have a significant impact on local recurrence, nor does it affect nodal down staging. KEY WORDS Mucinous adenocarcinoma, Microsatelites instability.
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Fetti AC, Necula A, Puia VR, Zaharie F, Puia A, Al Hajjar N. Laparoscopic cholecystectomy for overlooked duplicated gallbladder. A case report and review of the literature. Ann Ital Chir 2020; 9:S2239253X20034350. [PMID: 34602508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Duplicated gallbladder is a seldom surgical finding that frequently eludes detection on routine preoperative imaging and in some circumstances it might be even overlooked during surgery. Identification of this anomaly and its various types is important in order prevent post operative complications and recurrent symptoms after cholecystectomy. PRESENTATION OF CASE We present a female patient with biliary simptomatology who had previous cholecystectomy. Preoperatory imaging (MRCP) suspects a duplicated gallbladder which was confirmed intraoperatory and cholecystectomy was performed. The postoperative recovery was uneventful. DISCUSSION There are a very small number of reported cases with laparoscopic cholecystectomy for overlooked gallbladder duplication. Preoperative diagnosis holds a major contribution in planning surgery and preventing potential biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. CONCLUSION Accessory gallbladder is a uncommon congenital anomaly that demands particular consideration. Duplicated gallbladder is associated with increased operative difficulty and risks, including conversion to open cholecystectomy common bile duct injury or second cholecystectomy due to overlooked accessory gallbladder. KEY WORDS Duplicated gallbladder, Laparoscopic cholecystectomy, Overlooked accessory gallbladder, Reoperation.
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Pasca S, Ionescu C, Andras D, Eniu D, Muresan MA, Magdo L, Jurj A, Raduly L, Cojocneanu R, Petrushev B, Zaharie F, Irimie A, Berindan-Neagoe I, Muresan MS. Circulating microRNA-194 and microRNA-1228 Could Predict Colon Cancer Proliferation via Phospho S6 Modulation. J Gastrointestin Liver Dis 2020; 29:361-367. [PMID: 32919420 DOI: 10.15403/jgld-2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/10/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Although colon cancer has a decreasing incidence trend in Europe, because of its still high frequency and not fully understood pathogenesis, this malignancy still remains a subject of intense research. The aim of this study was to investigate the role of microRNA-194 and microRNA-1228 in colon cancer proliferation. METHODS RNA was extracted from patients with colon cancer with or without advanced disease and microRNA expression levels were determined through qRT-PCR. Assays were performed on HCT116 cell line and included qRT-PCR, western blotting and cell counting. RESULTS We observed that both microRNAs 194 and 1228 were altered in patients with colon cancer compared with healthy individuals. We observed a lower expression of both microRNA-194 and microRNA-1228 in patients with advanced colon cancer. To validate their pathogenetic role we performed viability and invasion assays on HCT116 cell line transfected with mimics or inhibitors of the mentioned microRNAs, with observable changes in viability and invasion. Furthermore, to determine the altered signaling induced by these microRNAs, we performed western blotting for phospho S6 on HCT116 cells transfected with mimic and inhibitor of the above-mentioned microRNAs with observable differences. CONCLUSION In the current study we have shown that both microRNA-194 and microRNA-1228 alteration was correlated with the presence of advanced colon cancer, a fact that was further validated in vitro through an invasion assay. Moreover, we have also shown that their effect might be mediated through phospho S6 expression.
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Affiliation(s)
- Sergiu Pasca
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Calin Ionescu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 5 th Surgical Department, Municipal Hospital, Cluj- Napoca, Romania. .
| | - David Andras
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Dan Eniu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Department of Surgery, Ion Chiricuta, Oncology Institute, Cluj-Napoca, Romania.
| | - Mihai Andrei Muresan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Department of Surgery, Ion Chiricuta, Oncology Institute, Cluj-Napoca, Romania.
| | - Lorand Magdo
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Ancuta Jurj
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Center for Functional Genomics, Biomedicine and Translational Medicine, Cluj-Napoca, Romania.
| | - Lajos Raduly
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Center for Functional Genomics, Biomedicine and Translational Medicine, Cluj-Napoca, Romania.
| | - Roxana Cojocneanu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Center for Functional Genomics, Biomedicine and Translational Medicine, Cluj-Napoca, Romania.
| | - Bobe Petrushev
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Department of Pathology, Regina Maria Laboratory, Cluj-Napoca, Romania.
| | - Florin Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Alexandru Irimie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Department of Surgery, Ion Chiricuta, Oncology Institute, Cluj-Napoca, Romania.
| | - Ioana Berindan-Neagoe
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Research Center for Functional Genomics, Biomedicine and Translational Medicine, Cluj-Napoca; MEDFUTURE-Research Center for Advanced Medicine, Cluj-Napoca; Department of Functional Genomics and Experimental Pathology, Ion Chiricuta Oncology Institute, Cluj- Napoca, Romania.
| | - Mihai Stefan Muresan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 5 th Surgical Department, Municipal Hospital, Cluj- Napoca, Romania.
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Săftoiu A, Tomulescu V, Tanţău M, Gheorghe C, Dumitru E, Mateescu B, Negreanu L, Jinga M, Seicean A, Ciocîrlan M, Drug V, Mănuc M, Popescu R, Tiu C, Binţinţan V, Calu V, Şurlin V, Turcu F, Zaharie F, Ulmeanu D, Brebu D, Nicolau A, Liţescu M, Diaconescu B, Duţă C, Copăescu C. SRED-ARCE Recommendations for Minimally Invasive Interventions During the COVID-19 Pandemic in Romania. Chirurgia (Bucur) 2020; 115:289-306. [PMID: 32614284 DOI: 10.21614/chirurgia.115.3.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
The Romanian Society of Digestive Endoscopy (SRED) and the Romanian Association of Endoscopic Surgery (ARCE) have decided to establish a joint working group to elaborate specific recommendations for organizing the diagnostic and the minimally invasive interventional procedures, in the context of the COVID-19 pandemic. The recommendations are based on the guidelines of the international societies of endoscopy and gastroenterology (ESGE / BSG / ASGE / ACG / AGA), respectively endoscopic surgery (EAES SAGES) (4-8), on the experience of countries severely affected by the pandemic (Italy, France, Spain, USA, Germany, etc.) and they will be applied within the limits of measures imposed at local and governmental level by the competent authorities. On the other hand, these recommendations should have a dynamic evolution, depending on the upward or downward trend of the COVID-19 pandemic at regional and local level, but also according to the findings of professional and academic societies, requiring regular reviews based on the publica tion of further recommendations or international clinical trials. The objectives of the SRED and ARCE recommendations target the endoscopic and laparoscopic surgery activities, to support their non discriminatory used for diagnostic or therapeutic purposes, pursuing the demonstrated benefits of these procedures, in safe conditions for patients and medical staff.
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Zaharie R, Mois E, Al Hajjar N, Zdrehuș C, Rusu I, Zaharie F. A Rare Case of Ciliated Foregut Cyst of the Common Hepatic Duct. J Gastrointestin Liver Dis 2019; 28:264. [PMID: 31517321 DOI: 10.15403/jgld-419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 11/01/2022]
Affiliation(s)
- Roxana Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Emil Mois
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Claudiu Zdrehuș
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Ioana Rusu
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florin Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Zaharie F, Pop LA, Petrushev B, Jurj A, Muresan MS, Eniu D, Fetica B, Petkov B, Pasca S, Piciu D, Rus I, Deak D, Dima D, Desmirean MS, Tomuleasa C, Berindan-Neagoe I. Next-generation sequencing-based characterization of the invasion by anatomical contiguity in a primary osseous diffuse large B-cell lymphoma. Correlation between the genetic profile of the malignancy and the clinical outcome of the patient. Histol Histopathol 2018; 34:663-670. [PMID: 30467824 DOI: 10.14670/hh-18-067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary bone lymphoma is now a well-described entity in the World Health Organization (WHO) Classification of Tumors of Soft Tissue and Bone as a malignancy of the lymphoid tissue, with at least one mass within bone, without involvement of supraregional lymph nodes or other extranodal sites. In the current paper, we describe the complete characterization of the mutational landscape of a diffuse large B cell non-Hodgkin's lymphoma (DLBLCL) of the tibial plateau. Currently, there is very little data about the genetic landscape of primary osseous lymphomas and about the genetic background of this type of malignancy, resistant to chemotherapy and invading the surrounding tissues. In the current paper, we describe the complete characterization of the mutational landscape of a DLBCL of the tibial plateau. Our data is consistent with already published data, that have shown that MKI67 activation is correlated with lymphoma progression. Along with a high Ki67 index, resistance to chemotherapy occurs with neurogenic locus notch homolog protein 1 (Notch) and KRAS activation. This is the first molecular characterization for the invasion by anatomical contiguity for a primary bone lymphoma and while we only characterized one case and further deep sequencing analyses are required, we can explain the clinical dismal evolution of the patient by correlating them with the genetic landscape of this type of lymphoma.
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Affiliation(s)
- Florin Zaharie
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura-Ancuta Pop
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Department of Pathology, Regina Maria Laboratory, Cluj Napoca, Romania
| | - Ancuta Jurj
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai-Stefan Muresan
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Surgery, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Dan Eniu
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Surgery, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.,Department of Pathology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Bozhidar Petkov
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sergiu Pasca
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Piciu
- Department of Nuclear Medicine, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Dalma Deak
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.,Department of Hematology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Minodora-Silvia Desmirean
- Department of Hematology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.,Department of Hematology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania.
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,MedFuture Research Center for Advanced Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Functional Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
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Zaharie F, Muresan MS, Tomuleasa C, Popa G, Blag C, Zaharie R, Zdrehus C, Dragomir M, Bumbea H, Irimie A, Dima D. Laparoscopic splenectomy for hereditary spherocytosis. A case series and review of the literature. Ann Ital Chir 2018; 7:S0003469X18028701. [PMID: 30221630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hereditary spherocytosis (HS) is a common inherited hemolytic anemia caused by a defective erythrocyte cellular membrane. Irrespective of type of surgery performed, several case reports comparing the two type of procedures, have not proven any significant difference between serum bilirubin, serum hemoglobin, red blood cells' and platelets' count, in the followup period at 6 and 12 months respectively, even if platelet count has maintained high for the first 6 months postoperatively, justifying an oral antiplatelet therapy for this time interval. In the present work, we present the use of LS as the treatment of choice for HS as a case series, with all the characteristics. KEY WORDS Hereditary Spherocytosis, Laparoscopic Splenectomy.
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Bartos A, Ionescu M, Iancu C, Stroescu C, Zaharie F, Brasoveanu V, Hajjar NA, Vasilescu C, Graur F, Hutanu I, Mocan L, David L, Bodea R, Cacovean D, Molnar G, Furcea L, Alexandrescu S, Matei E, Mitulescu G, Ungureanu C, Tonea A, Zamfir R, Popescu I, Dumitrascu T. An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment. Chirurgia (Bucur) 2018; 113:374-384. [PMID: 29981668 DOI: 10.21614/chirurgia.113.3.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
Introduction: National databases for pancreaticoduodenectomies (PD) have contributed to better postoperative outcomes after such complex surgical procedure because the multicentre collection of data allowed more reliable analyses with quality assessment and further improvement of technical issues and perioperative management. The current practice and outcomes after PD are poorly known in Romania because there was no national database for these patients. Thus, in 2016 a national-intent electronic registry for PD was proposed for all Romanian surgical centers. The study aims to present the preliminary results of this national-intent registry for PD after one-year enrollment. Patients Methods: The database was started on October 1st, 2016. Data were prospectively collected with an electronic online form including 102 items for each patient. The registry was opened to all the Departments of Surgery from Romania performing PD, with no restriction. Results: During the first year of enrollment were collected the data of 181 patients with PD performed by 24 surgeons from four surgical centers. The age of patients was 64 years (28 - 81 years), with slightly male predominance (61.3%). Computed tomography was the main preoperative imaging investigation (84.5%). All the PDs were performed by an open approach. The Whipple technique was used in 53% of patients, and a venous resection was required in 14.3% of cases. A posterior approach PD was considered in 16.6% of patients. The stomach was used to treat the distal remnant pancreas in 50.1% of patients. The operative time was 285 min (110 - 615 min), and the estimated blood loss was 400 ml (80 - 3000 ml). The overall morbidity rate was 55.8%, with severe (i.e., grade III-IV Dindo-Clavien) morbidity rate of 10%, and 3.9% in-hospital mortality rate. The overall pancreatic fistula, delayed gastric emptying and hemorrhage rates were 19.9%, 39.8% and 15.5%. Periampullary malignancies were the main indications for PD (78.9%), with pancreatic cancer on the top (48%). Conclusions: To build a prospective electronic online database for PD in Romania appears to be a feasible project and a useful tool to know the current practice and outcomes after PD in our country. However, improvements are still required to encourage a larger number of surgical centers to introduce the data of patients with PD.
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Bodea R, Hajjar NA, Bartos A, Zaharie F, Graur F, Iancu C. Evaluation of P-POSSUM Risk Scoring System in Prediction of Morbidity and Mortality after Pancreaticoduodenectomy. Chirurgia (Bucur) 2018; 113:399-404. [DOI: 10.21614/chirurgia.113.3.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
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Zaharie F, Muresan MS, Tomuleasa C, Popa G. Laparoscopic splenectomy for hereditary spherocytosis. A case series and review of the literature. Ann Ital Chir 2018; 89:569-571. [PMID: 30665220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hereditary spherocytosis (HS) is a common inherited hemolytic anemia caused by a defective erythrocyte cellular membrane. Irrespective of type of surgery performed, several case reports comparing the two type of procedures, have not proven any significant difference between serum bilirubin, serum hemoglobin, red blood cells' and platelets' count, in the followup period at 6 and 12 months respectively, even if platelet count has maintained high for the first 6 months postoperatively, justifying an oral antiplatelet therapy for this time interval. In the present work, we present the use of LS as the treatment of choice for HS as a case series, with all the characteristics. KEY WORDS: Hereditary Spherocytosis, Laparoscopic Splenectomy.
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Frinc I, Ilies P, Zaharie F, Dima D, Tanase A, Petrov L, Irimie A, Berce C, Lisencu C, Berindan-Neagoe I, Tomuleasa C, Bojan A. Transthoracic ultrasonography for the immunocompromised patient. A pilot project that introduces transthoracic ultrasonography for the follow-up of hematological patients in Romania. ACTA ACUST UNITED AC 2017; 55:103-116. [PMID: 28103204 DOI: 10.1515/rjim-2017-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 11/15/2022]
Abstract
In the past decade, there has been significant progress in clinical hematology with the discovery of targeted molecules and thus the achievement of both hematologic and molecular responses. Nevertheless, chemotherapy remains the treatment of choice for many types of hematological malignancies. Aggressive chemotherapy leads to immunosuppression, accompanied by a high rate of infections and an increased rate of treatment-related mortality. Invasive fungal infections as well as more common bacterial and viral infections are frequent in immunocompromised patients as they are difficult to diagnose and treat. Pleuropulmonary infections in immunocompromised patients are diagnosed using clinical examination, imaging and laboratory tests. Many laboratory tests are run for several days before a final result is given and are expensive. Computer tomography is a reliable technique, but it is encumbered by high irradiation and high cost, and can assess lesions larger than 1 cm. Transthoracic ultrasound is a modern method, used in the diagnostic algorithm of pleuropulmonary pathology. It allows the diagnosis of small lesions, can be performed at the patients' bedside, with acceptable costs and no irradiation. A fast, informed and accurate medical decision is essential for a favorable outcome in immunosuppressed patients with an adjacent infection. In the current case series we present the implementation of a new protocol for the follow-up of immunocompromised patients using transthoracic ultrasonography, of great potential use in the clinic.
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Tomuleasa C, Zaharie F, Muresan MS, Pop L, Fekete Z, Dima D, Frinc I, Trifa A, Berce C, Jurj A, Berindan-Neagoe I, Zdrenghea M. How to Diagnose and Treat a Cancer of Unknown Primary Site. J Gastrointestin Liver Dis 2017; 26:69-79. [PMID: 28338116 DOI: 10.15403/jgld.2014.1121.261.haz] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Almost one in every three patients with advanced tumors have distant metastasis at the time of clinical diagnosis. In most cases, the primary tumor site is identified immediately, within a few days. But for some patients, the primary lesion cannot be found after the initial clinical assessment. These cases are called cancers of unknown primary origin (CUPs), a clinical diagnosis very difficult to manage by physicians due to the absence of a standard-of-care for the initial therapeutic regimen, as well as due to the impossibility to include these cases in randomized clinical trials. A cancer of unknown primary site is often associated with a poor prognosis as patients are usually treated with a non-selective empirical therapy. In the current paper, we summarize both the diagnostic challenges for patients with a cancer of unknown primary site as well as the current available therapeutic options, with emphasis on the management of this unique disease entity.
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Affiliation(s)
- Ciprian Tomuleasa
- Department of Hematology,Research Center for Functional Genomics and Translational Medicine,Iuliu Hatieganu University of Medicine and Pharmacy;Department of Hematology,Ion Chiricuta Oncology Institute; Cluj-Napoca, Romania.
| | - Florin Zaharie
- Department pf Surgery,Iuliu Hatieganu University of Medicine and Pharmacy; Department of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj Napoca, Romania
| | - Mihai-Stefan Muresan
- Department pf Surgery,Iuliu Hatieganu University of Medicine and Pharmacy;Departemnt of Surgery, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Laura Pop
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Zsolt Fekete
- Department of Radiotherapy/Oncology,Iuliu Hatieganu University of Medicine and Pharmacy;Department of Radiotherapy, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Ioana Frinc
- Department of Hematology,Iuliu Hatieganu University of Medicine and Pharmacy; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Adrian Trifa
- Departments of Hematology, Ion Chiricuta Oncology Institute;Department of Genetics,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Berce
- Department of Animal Facility; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ancuta Jurj
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology,Iuliu Hatieganu University of Medicine and Pharmacy; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
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Mois E, Graur F, Hajjar NA, Puia C, Cote A, Zaharie F, Bartos A, Momani NA, Pop F, Neagos H, Ciorogar G, Iancu C. The influence of circumferential resection margins on survival following rectal cancer surgery. Ann Ital Chir 2017; 88:S0003469X16026300. [PMID: 27941239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival. METHODS Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the tumor and the resection margin. RESULTS The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of the rectum. CONCLUSIONS Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors. KEY WORDS Abdomino-perineal resection, Circumferential resection margins, Local recurrence, Rectal cancer, Overall survival.
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Ciorogar G, Bartos A, Bartos D, Vesa SC, Pop M, Herdean A, Betea I, Ciorogar A, Mois E, Zaharie F, Iancu C. Rectal cancer: factors predicting short outcomes after radical anterior resection. Ann Ital Chir 2017; 88:505-513. [PMID: 29339590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM This study analyzes risk factors implicated in postoperative complications and mortality after anterior resection in rectal cancer. MATERIAL AND METHODS A total number of 378 patients with anterior rectal resection, diagnosed with rectal cancer and admitted at the IIIrd Surgery Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Romania, between 2009 and 2016. The inclusion criteria were anterior rectal resections with curative visa for rectal cancer. The complications we assessed are the following: anastomotic fistula, intra-abdominal infections, postoperative bowel obstruction and wound infection. RESULTS There was statistical significance regarding male gender, emergency hospitalization, hypoproteinemia and the resumption of intestinal transit. Anterior rectal resection of tumors located on the middle rectum was associated with high rate of anastomotic fistula. Patients with manual suture of anastomosis developed intraabdominal abscess more frequently. In the multivariate analysis, hypoproteinemia and a number of lymph nodes >1 remained independently associated with the occurrence of wound infection. The 30-day mortality rate was 4.8% with 18 deaths and morbidity rate 20.6% with 78 cases. CONCLUSIONS Major complications after radical resection for rectal cancer are dependent on multiple variables such as male patients, those admitted in emergency and patients with hypoproteinemia. Location of tumor on middle rectum, manual suture of anastomosis, number of lymph nodes > 1 were associated with high rate of morbidity. Patients with coronary heart disease and diabetes mellitus didn't had statistical significance, but the rate of morbidity and mortality remains high in this groups. KEY WORDS Complications, Radical anterior resection, Rectal cancer, Risk factors.
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Mois E, Graur F, Al-Hajjar N, Zaharie F, Bartos A, Bodea R, Zaharie T, Rusu I, Iancu C. Microscopically positive (R1) resections do not affect survival in pancreatic head cancer. Ann Ital Chir 2017; 88:491-496. [PMID: 29339587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Obtaining negative microscopic resection margins (R0) in cephalic duodenopancreatectomy (CDP) is the gold standard. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. Regarding R1 resections in CDP (data from the literature show rates between 20-80%), we considered it necessary to perform a study in Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor'' Cluj-Napoca. METHODS Here we present the results of a retrospective study carried out between January 2012 - December 2013 in our Institute. This study includes 63 patients with pancreatic head resections for pancreatic cancer. The circumferential soft tissue margin, the pancreatic transection margin, the bile duct and duodenum/stomach margins were analyzed. We investigated the incidence of R1 and its impact on the survival rates after oncologic pancreatic resections using a nonstandardized pathologic routine protocol. R1 status was defined as the distance of the tumor from the resection margin of ≤ 1 mm. RESULTS Pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 93.65 %. The R1 rate was 36.5 % (23 cases). The circumferential margins were most commonly involved as R1 (91,3%). No statistically significant differences were found between patients with R1 to those with R0 (p ≥ 0.1) regarding 3-year survival. CONCLUSIONS Survival for pancreatic head cancer at 3 years is not influenced by the margins of resection (R1/R0). Microscopic resection margin involvement is not an independent marker of survival. KEY WORDS Circumferential margins, Nonstandardized pathologic protocol, Pancreatic ductal adenocarcinoma, Positive margins R1 Survival.
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Zaharie F, Muresan MS, Petrushev B, Berce C, Gafencu GA, Selicean S, Jurj A, Cojocneanu-Petric R, Lisencu CI, Pop LA, Pileczki V, Eniu D, Muresan MA, Zaharie R, Berindan-Neagoe I, Tomuleasa C, Irimie A. Exosome-Carried microRNA-375 Inhibits Cell Progression and Dissemination via Bcl-2 Blocking in Colon Cancer. J Gastrointestin Liver Dis 2016; 24:435-43. [PMID: 26697569 DOI: 10.15403/jgld.2014.1121.244.375] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second in women. The aim of the current study was to identify whether the miR-375 is indeed down-regulated in metastatic CRC and if it could be considered as a potential minimally invasive prognostic biomarker for CRC. METHODS Exosomes were isolated and characterized from patients with liver metastasis from CCR. The characterization of exosome was performed using TEM/SEM. HCT116 cells were treated with miR-375 mimic, NSM and miR-375 inhibitor. Functional assays included cell counting assay for 14 days, Matrigel invasion assay, apoptosis assay by flow cytometry using Annexin V-FITC, RT-PCR and Western blotting. RESULTS Increased proliferation potential was proven for the cells transfected with miR-375 inhibitor, while the miR-375 mimic decreased the cell number. The cells transfected with the miR-375 inhibitor are aggressive and cross the membrane; 3.84% of the cells transfected with the miR-375 inhibitor entered apoptosis, while 6.45% of those transfected with the non-specific mimic were in programmed cell death, less than those transfected with the microRNA. RT-PCR for Bcl-2 expression showed that Bcl-2 is down-regulated for miR-375 inhibitor and up-regulated for the miR-375 mimic, a result confirmed by Western blotting. CONCLUSION The present study brings to the forefront new data that suggest miR-375 as a new player in controlling the pathways responsible for inhibiting the natural history of CRC tumor cells, via the Bcl-2 pathway.
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Affiliation(s)
- Florin Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mihai Stefan Muresan
- Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Surgical and Gynecological Oncology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Dept of Pathology, Emergency County Hospital, Cluj-Napoca, Romania
| | - Cristian Berce
- Animal Facility, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore-Aristide Gafencu
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sonia Selicean
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ancuta Jurj
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Cojocneanu-Petric
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin-Ioan Lisencu
- Iuliu Hatieganu University of Medicine and Pharmacy; Dept. of Surgical and Gynecological Oncology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Laura-Ancuta Pop
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valentina Pileczki
- Iuliu Hatieganu University of Medicine and Pharmacy;Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Eniu
- Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Surgical and Gynecological Oncology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Mihai-Andrei Muresan
- Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Surgical and Gynecological Oncology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Gastroenterology Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj Napoca; Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania;Dept. of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics and Translational Medicine Iuliu Hatieganu University of Medicine and Pharmacy;Dept. of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.
| | - Alexandru Irimie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Zaharie R, Tantau A, Zaharie F, Tantau M, Gheorghe L, Gheorghe C, Gologan S, Cijevschi C, Trifan A, Dobru D, Goldis A, Constantinescu G, Iacob R, Diculescu M. Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery. J Crohns Colitis 2016; 10:306-14. [PMID: 26589956 PMCID: PMC4957477 DOI: 10.1093/ecco-jcc/jjv215] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. METHODS A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. RESULTS The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. CONCLUSIONS A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
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Affiliation(s)
- Roxana Zaharie
- University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania
| | - Alina Tantau
- University of Medicine and Pharmacy 'Iuliu Hatieganu', 4th Medical Clinic, Cluj-Napoca, Romania
| | - Florin Zaharie
- University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania
| | - Marcel Tantau
- University of Medicine and Pharmacy 'Iuliu Hatieganu', Regional Institute of Gastroenterology and Hepatology ' O. Fodor' Cluj-Napoca, Romania
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania
| | - Cristian Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania
| | - Serban Gologan
- Carol Davila University of Medicine and Pharmacy, Elias University Hospital, Gastroenterology, Bucuresti, Romania
| | - Cristina Cijevschi
- University of Medicine and Pharmacy 'Gr. T. Popa', Gastroenterology and Hepatology Institute, Iasi, Romania
| | - Anca Trifan
- University of Medicine and Pharmacy 'Gr. T. Popa', Gastroenterology and Hepatology Institute, Iasi, Romania
| | - Daniela Dobru
- University of Medicine and Pharmacy, Municipal Hospital, Gastroenterology, Targu-Mures, Romania
| | - Adrian Goldis
- University of Medicine and Pharmacy 'Victor Babes', District Hospital, Gastroenterology, Timisoara, Romania
| | - Gabriel Constantinescu
- Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Gastroenterology Department, Bucuresti, Romania
| | - Razvan Iacob
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania
| | - Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania
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Abstract
BACKGROUND Nanoparticles have a large number of surface atoms, which translates into a significant increase in the surface energy. Once introduced in a biological environment they tend to interact with proteins and form a protein corona shell. The aim of this study was to develop a novel, silver based, bio-nanocomposite for biological applications. Immunoglobulin G (IgG) molecule was chosen for the passivation of the silver nanoparticles (AgNPs) in order to avoid macrophage recognition of the synthesized structures. RESULTS Monodisperse IgG-folinate functionalized silver nanoparticles were obtained, with sizes around 39 nm. UV-Vis and UATR-FT-IR spectroscopies were employed to confirm the successful functionalization of the silver nanoparticles. Atomic force microscopy and dynamic light scattering measurements gave information about the size and shape of the nanoparticles prior and after the passivation with IgG. CONCLUSIONS Immunoglobulin G formed a monolayer around the nanoparticles with the binding site seemingly in the Fc domain, leaving the two Fab regions available for antigen binding. To our knowledge, this is the first report of an IgG-folinate functionalized AgNP bionanostructure developed for biological applications. Graphical abstract:Graphical illustration for IgG-folinate silver nanoparticles functionalization steps.
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Affiliation(s)
- Cristian T. Matea
- />3rd Surgery Clinic, Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Croitorilor 19-21, 400162 Cluj-Napoca, Romania
| | - Teodora Mocan
- />3rd Surgery Clinic, Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Croitorilor 19-21, 400162 Cluj-Napoca, Romania
- />Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Clinicilor 5-7, Cluj-Napoca, Romania
| | - Florin Zaharie
- />3rd Surgery Clinic, Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Croitorilor 19-21, 400162 Cluj-Napoca, Romania
| | - Cornel Iancu
- />3rd Surgery Clinic, Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Croitorilor 19-21, 400162 Cluj-Napoca, Romania
| | - Lucian Mocan
- />3rd Surgery Clinic, Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Croitorilor 19-21, 400162 Cluj-Napoca, Romania
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Zaharie F, Ciorogar G, Zaharie R, Mocan T, Zdrehus C, Mocan L, Berindan-Neagoe I, Achimas P, Iancu C, Tomus C. Laparoscopic rectal resection versus conventional open approach for rectal cancer - a 4-year experience of a single center. J BUON 2015; 20:1447-1455. [PMID: 26854440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study was carried out to compare the therapeutic outcomes and complications of the laparoscopic and the conventional open surgery technique used for treating rectal cancer. Another goal was to find the fastest and most accurate method of treatment for rectal cancer, along with establishing the advantages and disadvantages of the two surgical techniques, depending on cancer location and its stage. METHODS A total of 172 patients diagnosed with rectal cancer and hospitalized in the Department of Surgery III between January 1st 2008 and December 31st 2011 were studied. The laparoscopic approach was performed on 29 (16.8%) patients, and the remaining 143 (83.2%) underwent the conventional Miles/Lloyd-Davies abdominoperineal resection. A longitudinal study was conducted on patients with rectal resection, the used data being obtained from the database of the Department of Surgery III, hospital records, protocols and clinical charts of rectal cancer cases. RESULTS There were no statistically significant differences regarding symptoms, gender, age, body mass index (BMI), tumor site, TNM stage, intraoperative accidents, operative time, and postoperative mortality between the two groups. The laparoscopic group presented advantages regarding antibiotic and analgesic therapy, early mobilization, hospital stay, intraoperative blood loss, resuming oral nutrition, bowel transit resumption, postoperative complications and wound complications. CONCLUSION Laparoscopic abdominoperineal resection for rectal cancer is feasible, safe and effective. It can be safely performed by an experienced team, reducing the rate of postoperative complications, the need for blood transfusions, the adminstration of antibiotics and painkillers, allowing faster bowel transit resumption, shortening hospital stay and providing superior aesthetic results.
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Affiliation(s)
- Florin Zaharie
- Regional Institute of Gastroenterology and Hepatology "Octavian Fodor", Cluj-Napoca, and University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Zaharie F, Cojocneanu-Petric R, Muresan M, Frinc I, Dima D, Petrushev B, Tanase A, Berce C, Chitic M, Berindan-Neagoe I, Pileczki V, Irimie A, Tomuleasa C. Small molecules against B-RAF (BRAF) Val600Glu (V600E) single mutation. Int J Nanomedicine 2015; 10:4897-9. [PMID: 26261416 PMCID: PMC4527569 DOI: 10.2147/ijn.s87405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Florin Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca Romania
| | | | - Mihai Muresan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca Romania
| | - Ioana Frinc
- Department of Hematology, Ion Chiricuta Oncology Institute, Emergency University Hospital, Cluj Napoca Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Emergency University Hospital, Cluj Napoca Romania
| | - Bobe Petrushev
- Department of Pathology, Emergency University Hospital, Cluj Napoca Romania
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest Romania
| | - Cristian Berce
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca Romania
| | - Mariana Chitic
- Department of Hematology, Ion Chiricuta Oncology Institute, Emergency University Hospital, Cluj Napoca Romania
| | | | - Valentina Pileczki
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca Romania
| | - Alexandru Irimie
- Department of Surgery, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Ion Chiricuta Oncology Institute, Emergency University Hospital, Cluj Napoca Romania
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Tomuleasa C, Petrushev B, Vedean M, Irimie A, Zaharie F, Rosu AM, Dima D, Cucuianu A. Bicytopenia as a paraneoplastic syndrome for pseudomyxoma peritonei. Hematologic manifestations of a subtle disease. Int J Gen Med 2015; 8:93-5. [PMID: 25767403 PMCID: PMC4354612 DOI: 10.2147/ijgm.s76376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ciprian Tomuleasa
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania ; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Bobe Petrushev
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Madalina Vedean
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alexandru Irimie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania ; Department of Surgery, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Florin Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ana-Maria Rosu
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Andrei Cucuianu
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania ; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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Muresan M, Zaharie F, Bojan A, Frinc I, Dima D, Selicean S, Gafencu GA, Petrushev B, Cojocneanu-Petric R, Tefas C, Cioca A, Irimie A, Berce C, Berindan-Neagoe I, Tomuleasa C, Achimas-Cadariu P. MicroRNAs in liver malignancies. Basic science applied in surgery. J BUON 2015; 20:361-375. [PMID: 26011324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Liver malignancies represent one of the major public health problems worldwide because of late diagnosis and failure of current treatments to offer a curative option for many of the patients. MicroRNAs (miRs) are small non-coding RNA molecules that are known to regulate the gene expression at a post-transcriptional level through complementary base pairing with thousands of messenger (m)RNAs. Recent data has shown the involvement of miRs in the pathogenesis of many human cancers, including those of the liver, with huge possible impact in the clinic, mainly due to the identification of non-coding RNAs as biomarkers that can often be detected in the systemic circulation. In the current review, we present the importance of miRs in liver cancers by discussing their role in the pathobiology of these diseases, apart from their role as diagnostic and prognostic markers for liver malignancies.
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Affiliation(s)
- Mihai Muresan
- Department of Surgery, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
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Orsolya M, Attila-Zoltan M, Gherman V, Zaharie F, Bolboaca S, Chira C, Bodolea C, Tomuleasa C, Irimie A, Coman I, Ionescu D. The effect of anaesthetic management on neutrophil gelatinase associated lipocalin (NGAL) levels after robotic surgical oncology. J BUON 2015; 20:317-324. [PMID: 25778333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The main objective of this study was to compare the effect of two anaesthetic techniques (general vs combined) on plasma levels of NGAL (Neutrophil Gelatinase Associated Lipocalin) after robotic urogenital oncosurgery. The secondary objective was to correlate NGAL levels with the incidence of acute kidney injury (AKI). METHODS This was a longitudinal prospective study. Forty patients were included and randomized in 2 groups: group C (N=16 cases; combined general-epidural anesthesia) and group G (N=24 cases; control group with general anesthesia). Demographic data, Charlson Comorbidity Index, Apache II, SOFA and ASA scores were similar in both groups. Serum creatinine was determined preoperatively and every 24 hrs for 4 postoperative days to identify AKI according to RIFLE and AKIN criteria. Serum NGAL was determined at 6 and 12 hrs after induction of anesthesia. RESULTS Serum creatinine increased at 24 hrs postoperatively in both groups as compared to baseline, but significant changes were registered only in the G group (p(control) = 0.004). Serum NGAL increased significantly in both groups as compared with baseline levels (pcase=0.0034 vs p(control)=0.0001). The incidence of AKI was 12.50% (95% CI 0.4-34) in the C group and 37.50% (95% CI 17-58) in the G group (p=0.0909), respectively. CONCLUSION Impaired renal function and AKI occurred in robot-assisted laparoscopic urogenital oncosurgery under both general and combined anaesthesia. The incidence of AKI was lower in patients undergoing combined anesthesia compared to general anaesthesia after robotic urogenital oncosurgery but the difference did not reach statistical significance. However, plasma levels of NGAL were significantly increased at 6 and 12 hrs in the general anaesthesia group as compared with combined anaesthesia. NGAL may be a better marker in detecting postoperative acute kidney injury. Further studies are needed.
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Affiliation(s)
- Mihaly Orsolya
- Department of Anesthesiology and Intensive Care Unit, Clinical Emergency County Hospital, Cluj-Napoca, Romania
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Zaharie F, Ciorogar G, Zaharie R, Tantau M, Iancu C, Mocan L. Malignant familial adenomatous polyposis treated by laparoscopic colectomy and ileal pouch anal anastomosis: a case report. J Gastrointestin Liver Dis 2014; 23:445-8. [PMID: 25532006 DOI: 10.15403/jgld.2014.1121.234.mfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The mean age of colorectal cancer in untreated familial adenomatous polyposis (FAP) is 39 years. We present the case of a 21-year-old patient with FAP and colorectal cancer. The patient was detected with significant family history: her mother died at age 45 with colon cancer; two uncles were diagnosed with colon cancer at the age of 40 and 43 and one aunt at the age of 45 with colon cancer and gastric cancer. The treatment was laparoscopic restorative proctocolectomy with total excision of the mesorectum and ileal pouch anal anastomosis completed with endoanal excision of inferior rectal polyps. The histopathological report described a well differentiated rectal adenocarcinoma T1N1aMx developed on a tubulo-villous adenoma located on the rectosigmoid jonction, the rest of the polyps with benign histology.
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Affiliation(s)
- Florin Zaharie
- 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology,Cluj-Napoca, Romania
| | - George Ciorogar
- 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy; Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology,Cluj-Napoca, Romania.
| | - Roxana Zaharie
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology; 3rd Medical Cinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Tantau
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology; 3rd Medical Cinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornel Iancu
- 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy; 3rd Medical Cinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Mocan
- 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy; 3rd Medical Cinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Mocan T, Matea CT, Cojocaru I, Ilie I, Tabaran FA, Zaharie F, Iancu C, Bartos D, Mocan L. Photothermal Treatment of Human Pancreatic Cancer Using PEGylated Multi-Walled Carbon Nanotubes Induces Apoptosis by Triggering Mitochondrial Membrane Depolarization Mechanism. J Cancer 2014; 5:679-88. [PMID: 25258649 PMCID: PMC4174512 DOI: 10.7150/jca.9481] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/23/2014] [Indexed: 01/05/2023] Open
Abstract
Pancreatic cancer (PC) is one of the most lethal solid tumor in humans, with an overall 5-year survival rate of less than 5%. Thermally active carbon nanotubes have already brought to light promising results in PC research and treatment. We report here the construct of a nano-biosystem based on multi-walled carbon nanotubes and polyethylene glycol (PEG) molecules validated through AFM, UV-Vis and DLS. We next studied the photothermal effect of these PEG-ylated multi-walled carbon nanotubes (5, 10 and 50 μg/mL, respectively) on pancreatic cancer cells (PANC-1) and further analyzed the molecular and cellular events involved in cell death occurrence. Using cell proliferation, apoptosis, membrane polarization and oxidative stress assays for ELISA, fluorescence microscopy and flow cytometry we show here that hyperthermia following MWCNTs-PEG laser mediated treatment (808 nm, 2W) leads to mitochondrial membrane depolarization that activates the flux of free radicals within the cell and the oxidative state mediate cellular damage in PC cells via apoptotic pathway. Our results are of decisive importance especially in regard with the development of novel nano-biosystems capable to target mitochondria and to synergically act both as cytotoxic drug as well as thermally active agents in order to overcome one of the most common problem met in oncology, that of intrinsic resistance to chemotherapeutics.
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Affiliation(s)
- Teodora Mocan
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Cristian T. Matea
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Iulia Cojocaru
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Ioana Ilie
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Flaviu A. Tabaran
- 2. Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, Faculty of Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj-Napoca, Romania
| | - Florin Zaharie
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Cornel Iancu
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Dana Bartos
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
| | - Lucian Mocan
- 1. Gastroenterology Institute; Department of Nanomedicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca, Romania
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Spârchez Z, Radu P, Zaharie F, Al Hajjar N, Sparchez M. Percutaneous treatment of symptomatic non-parasitic hepatic cysts. Initial experience with single-session sclerotherapy with polidocanol. Med Ultrason 2014; 16:222-228. [PMID: 25110763 DOI: 10.11152/mu.2013.2066.163.2pr] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIMS Hepatic cysts have a prevalence of 2.5-7% and most of them are asymptomatic. However, large cysts may cause complaints; in such cases an appropriate treatment is necessary (open surgery, laparoscopic deroofing, removal of cystic fluid and injection of a sclerosing agent. The aim of this study was to assess the efficacy and safety of a single session technique with polidocanol in the therapy of symptomatic non parasitic hepatic cysts. MATERIAL AND METHODS. The study included 13 patients with symptomatic liver cysts (range 4-10 cm). All patients underwent percutaneous aspiration of the liver cyst under ultrasound guidance followed by instillation of polidocanol (3%, 4-10 ml). The patients were followed up at 1, 3 and 12 months. The disappearance of the cyst or reduction in volume more than 90% was considered successful. If the fluid was accumulated at 1month the procedure was repeated. If after the second injection the fluid accumulation was more than 50% of the initial volume the case was considered a failure and a laparoscopic deroofing was performed. RESULTS The procedure was successful in 10 patients, 9 after the first instillation and one after the second (76.9%). The mean initial volume of cysts was 228 ml, and the mean reduction in volume at 1, 3 and 12 months was 80.2%, 91.9% and 96.7%. The cyst resolution was gradual with clinically significant cyst reduction achievement within 1 year after therapy. In 3 patients the fluid reaccumulated at the same volume despite 2 instillations. Those 3 cases the procedure was considered failure and the patients were sent to surgery. In 2 patients (one successfully treated and one with treatment failure) bleeding during the first puncture and aspiration appeared and the therapy was postponed for 1 month. There were no significant adverse effects, and all the patients had relief of symptoms after therapy. CONCLUSIONS This initial experience with percutaneous aspiration and polidocanol sclerosis of hepatic cysts demonstrated that the technique is efficient and safe.
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Affiliation(s)
- Zeno Spârchez
- 3rd Medical Department,"O.Fodor" Institute for Gastroenterology and Hepatology,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Pompilia Radu
- 3rd Medical Department,"O.Fodor" Institute for Gastroenterology and Hepatology,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin Zaharie
- 3rd Medical Department,"O.Fodor" Institute for Gastroenterology and Hepatology,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- 3rd Medical Department,"O.Fodor" Institute for Gastroenterology and Hepatology,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Sparchez
- 2nd Pediatric Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Hajjar NA, Tomuş C, Mocan L, Mocan T, Graur F, Iancu C, Zaharie F. Management of bile duct injuries following laparoscopic cholecystectomy: long-term outcome and risk factors infuencing biliary reconstruction. Chirurgia (Bucur) 2014; 109:493-499. [PMID: 25149612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Bile duct injury following cholecystectomy remains a severe complication with major implications for the patient outcome. AIM To assess the outcome of surgical treatment and study the risk factor infuencing biliary reconstruction in patients with bile duct injuries following laparoscopic cholecystectomy. METHODS Between January 2005 and December 2010, 43 patients with bile duct injuries following laparoscopic cholecystectomy were treated to our center. According to Strasberg classification, the types of injuries were as follows: type A in 7 patients (16.28%), type D in 4 (9.3%), type E1 in 9 (20.93%), type E2 in 11 (25.58%), type E3 in 10 (23.25%),and type E4 in 2 (4.65%) patients respectively. Management after referral included endoscopic sphincterotomy in patients with minor lesions (Strasberg type A) and Roux-en-Y hepaticojejunostomy in 36 patients with major duct injuries(Strasberg type D and E). 55.55% of patients with major bile duct injuries have endoscopic or surgical attempts of repair sprior to referral. In case of biliary peritonitis or acute cholangitis, the reconstruction was preceded by prolonged external biliary drainage. RESULTS All minor lesions were successfully treated endoscopically,with outstanding long term results. For patients with major duct injuries, the postoperative mortality and morbidity rate were 5.55% and 25%, respectively. After a median follow-up period of 34.1 (range, 12-68) months, 30 patients(88.23%) remain in good general condition (using McDonald classification) and 4 patients (11.77%) developed a late anastomotic stricture. Multivariate analyses have identified postoperative biliary leak (p=0.012) as an independent predictor factor for the occurrence of late anastomotic stricture. CONCLUSIONS Minor bile duct injuries can be successfully treated endoscopically if proper abdominal drainage is maintained. Roux-en-Y hepaticojejunostomy is feasible and safe with contained morbidity and durable results even when previous surgery has failed. Postoperative biliary leak is a significant predictor for poor long term outcome.
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Bartoş A, Bartoş D, Al-Hajjar N, Puia C, Munteanu D, Bodea R, Mocan L, Zaharie F, Iancu C. Risk factors for complications after duodenopancreatectomy. Initial results after implementing a standardized perioperative protocol. Chirurgia (Bucur) 2014; 109:318-324. [PMID: 24956335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION During 1993-2008 period, in the Surgical Clinic III were conducted several retrospective studies, in order to identify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperative protocol was developed for preparation of patients proposed for DPC, as well as a number of intraoperative technical changes in order to improve postoperative morbidity and mortality. Implementation of the protocol was gradually and inomogenic done in our service. METHODS The study is prospective, conducted in 2009-2012, ina group of 180 patients and aims to evaluate immediate results after DPC for periampular malignancy, looking to analyze the effects of implementation of the protocol mentioned above.We analyzed the rates of complications (pancreatic fistula,blunt pancreatitis, bleeding from the pancreatic blunt, delayed gastric emptiness), and the factors that might influence their occurrence. RESULTS AND CONCLUSIONS of the 180 patients, 10 (5.5%) developed pancreatic fistula and 24 (13.3%) had delayed gastric emptiness. Among the factors that have been significant associated with these complications we mention: the pancreatico-jejunalanastomosis and gastro-jejunal transmesocolic assembly. With the implementation of the protocol, the risk factors previously identified in retrospective studies performed in our service(elevated transaminases, experienced surgical team, etc.) have lost significance, but they have not disappeared entirely, due to fact that the conduit proposed was not entirely followed. We believe that the homogeneous application of a perioperative guide, together with a standardized surgical technique, will lead to improve immediate results after DP.
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Frinc I, Muresan MS, Zaharie F, Petrov L, Irimie A, Berce C, Berindan-Neagoe I, Tomuleasa C. Cancer stem-like cells: the dark knights of clinical hematology and oncology. J BUON 2014; 19:328-335. [PMID: 24965388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
According to recent epidemiological studies, malignant diseases represent the second cause of mortality worldwide and metastasis is the main cause of morbidity and mortality in most cancers. Even if the concept of "cancer stem cells" (CSCs) was anticipated by the genius of Rudolph Virchow, the father of modern pathology, more than 150 years ago, it is only in last few years that that scientists have begun to develop strategies aimed at inhibiting CSCs at a molecular level, the only way cancer can truly be attacked, by crossing the border between histology and molecular biology. The current concise review aims at emphasizing the main characteristics of tumor initiating cells, bridging the basic science to clinical hematology and oncology.
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Affiliation(s)
- Ioana Frinc
- Department of Hematology, Ion Chiricuta Cancer Center, Cluj-Napoca, Romania
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Mocan L, Ilie I, Tabaran FA, Dana B, Zaharie F, Zdrehus C, Puia C, Mocan T, Muntean V, Teodora P, Ofelia M, Marcel T, Iancu C. Surface plasmon resonance-induced photoactivation of gold nanoparticles as mitochondria-targeted therapeutic agents for pancreatic cancer. Expert Opin Ther Targets 2013; 17:1383-93. [PMID: 24188208 DOI: 10.1517/14728222.2013.855200] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Noble metal nanoparticles such as gold nanoparticles can strongly absorb light in the visible region by inducing coherent collective oscillation of conduction band electrons in strong resonance with visible frequencies of light. This phenomenon is frequently termed as surface plasmon resonance (SPR). OBJECTIVES The main objective was to study the effects of laser photoactivated gold nanoparticles (by means of SPR) on human pancreatic cancer cells. RESULTS Gold nanoparticles obtained using standard wet chemical methods (with sodium borohydride as a reducing agent) underwent photoexcitation using 2w 808 nm laser and further administered to 1.4E7 pancreatic cancer cell lines. Flow cytometry, transmission electron microscopy, phase contrast microscopy, quantitative proteomics and confocal microscopy combined with immunochemical staining were used to examine the interaction between photo excited gold nanoparticles and pancreatic cancer cells. CONCLUSION The study shows that phonon-phonon interactions following laser photoexcitation of gold nanoparticles exhibit increased intracellular uptake, as well as mitochondrial swelling, closely followed by mitochondrial inner membrane permeabilization and depolarization. This unique data may represent a major step in mitochondria-targeted anticancer therapies using laser-activated gold nanoparticles.
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Affiliation(s)
- Lucian Mocan
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Department of Nanomedicine , Croitorilor Street, Cluj-Napoca , Romania , +40264-439696 ; +40264-439696 ;
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Zaharie R, Zaharie F, Mocan L, Andreica V, Tantau M, Zdrehus C, Iancu C, Tomus C. Surgical outcome of inflammatory bowel disease - experience of a tertiary center. Chirurgia (Bucur) 2013; 108:812-815. [PMID: 24331319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED BACKGROUNDS/AIM: Despite advances in medical treatment, a large number of patients with inflammatory bowel disease(IBD) require surgery. We aim to evaluate the efficacy and outcome of surgical interventions in patients with chronic inflammatory bowel diseases. MATERIAL AND METHODS We retrospectively analysed the medical records from 221 patients admitted to our institution between 2009-2012 with the diagnosis of IBD. Out of these patients, 55 (24.88 %) were diagnosed with Crohn's disease,while the remaining 166 patients (75.11%) had ulcerative colitis. RESULTS Seventeen of 55 patients with Crohn's disease (30.91%)required surgical management before or during this period. Nine with disease proximal to the transverse colon underwent segmental resections (enteral or colonic) with primary anastomosis, without morbidity. The other 8 patients, with disease distal to the transverse colon, underwent segmental colonic resections (two with primary anastomosis, three with stoma formation) or major colonic resection- subtotal colectomy with ileostomy (1 case) and total proctocolectomy with ileostomy(2 cases). Sixteen of 166 patients with ulcerative colitis(9.64%) required surgery before or during this period. The surgical procedure used included total proctocolectomy with definitive ileostomy (3 cases) and total colectomy with ileostomy(13 cases). 7 of the 13 patients had restorative surgery after total colectomy, 1 remaining with definitive ileostomy due to short vascular pedicle and 5 patients refused restorative surgery. Median daily stool frequency after reconstructive surgery was 7(range 3-12). CONCLUSION For patients with Crohn's disease proximal to the transverse colon, limited resection with primary anastomosis is safe. Major colonic resection (subtotal colectomy or proctocolectomy)is indicated if the disease is located distal to the transverse colon and primary anastomosis should be avoided. Due to unsatisfactory quality of live after reconstructive surgery(stool frequency remains high), total proctocolectomy with end-ileostomy remains a viable alternative for patients with ulcerative colitis.
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Mocan L, Tomus C, Bartos D, Zaharie F, Ioana I, Bartos A, Puia C, Necula A, Mocan T, Iancu C. Long term outcome following surgical treatment for distal gastric cancer. J Gastrointestin Liver Dis 2013; 22:53-58. [PMID: 23539391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND. At the current time, the belief that total gastrectomy (TG) offers a better survival benefit compared with distal gastrectomy (DG) in distal gastric cancer still persists among many surgeons. The aim of the study was to determine whether TG in patients with distal stomach cancer offers a benefit in long term survival compared with DG. METHODS. Data on 180 consecutive patients with adenocarcinoma of the distal stomach that underwent surgery during the period 2000-2003 were analyzed. Distal gastrectomy was performed on 91 patients (50.5%), and 89 patients (49.5%) underwent TG. RESULTS. The postoperative morbidity (anastomotic leakage, intraperitoneal hemorrhage and pulmonary complications) was significantly higher in the TG group than in the DG group. The TG group had a significantly higher rate of 30-day postoperative mortality than DG group, and a longer mean postoperative hospital stay. The 5-year survival rate was significantly higher for the DG group than for the TG group. The number of lymph node metastases and TNM stages are significant predictors of poor survival. CONCLUSIONS. Compared with patients undergoing TG, a better long-term survival time, lower postoperative morbidity and mortality rates and a lower hospitalization stay was obtained in patients that underwent DG for distal gastric cancer. This observation justifies the use of this procedure for the surgical therapy of the cancer of distal stomach.
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Affiliation(s)
- Lucian Mocan
- Regional Institute of Gastroenterology and Hepatology 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Zaharie F, Bartos D, Mocan L, Zaharie R, Iancu C, Tomus C. Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience. Surg Endosc 2013; 27:2110-6. [PMID: 23370963 PMCID: PMC3661041 DOI: 10.1007/s00464-012-2719-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/13/2012] [Indexed: 01/22/2023]
Abstract
Background Selection of the most appropriate treatment to obtain the lowest morbidity, mortality, and recurrence rates is mandatory for hydatid disease of the liver. This study evaluated the results of laparoscopic treatment (compared with the open approach) in the context of a 10-year single-institution experience. Methods Between January 1998 and January 2008, 333 patients with hydatid disease of the liver underwent surgery in the authors’ department. Only the following aspects were considered as selection criteria for laparoscopic surgery: liver cyst not located in segment 1 or 7, with corticalization on the surface and no evidence of intrabiliary rupture. Of 62 patients who underwent laparoscopic treatment, 3 required conversion to open surgery. The remaining 59 patients (group 1) were analyzed. During the same period, 271 patients with hepatic hydatid disease underwent conventional surgery, but only 172 records were compatible with the criteria for the laparoscopic approach and the respective patients were retrospectively reviewed (group 2). Results Conversion to open surgery occurred in three cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2–18 cm) in group 2 (p = 0.699). The mean operative time was 72 min (range, 45–140 min) in group 1 and 65 min (range, 35–120 min) in group 2 (p < 0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p = 0.015). The mean hospital stay was 6.42 days (range, 1–21 days) in group 1 and 11.7 days (range, 4–80 days) in group 2 (p < 0.001). The mean follow-up period was 24.2 months (range, 6–32 months) in group 1 and 28.4 months (range, 6–40 months) in group 2. No recurrences were observed in either group during this period. Conclusion Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, Iuliu Hatieganu, University of Medicine and Pharmacy, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, 400162, Cluj-Napoca, Romania.
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Zaharie F, Tomuş C, Mocan L, Spârchez Z, Zaharie R, Iancu C. Intestinal obstruction secondary to appendiceal mucocele. Chirurgia (Bucur) 2012; 107:802-804. [PMID: 23294962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 06/01/2023]
Abstract
Few cases of intestinal obstruction complicating an appendiceal mucocele have been recorded. We report the case of a young woman who presented to the emergency room with diffusely abdominal pain, nausea, vomiting and disruption of bowel movements. Her abdomen was mildly distended and tympanic. A flat film of the abdomen revealed dilated small bowel loops with air-fluid levels suggestive of small bowel obstruction. She also had leukocytosis. An emergency operation was performed under the diagnosis of intestinal obstruction. The intraoperatory findings showed a tumoral appendiceal mass permeated into the ileum in two distinct points, causing an enteral stenosis. We performed an appendectomy "en bloc" with two enteral loop resections of the permeated ileum followed by two T-T enteral anastomoses. The pathologic examination revealed appendiceal mucinous cystadenoma. Postoperative course was favorable, the patient being discharged on the seventh postoperative day. Postoperative checks performed at 3, 6, 12 and 24 months (including colonoscopy) have not showed pathological changes.
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Affiliation(s)
- F Zaharie
- 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Fetti A, Zaharie F, Geza M, Graur F, Scurtu R, Seiceanu R, Binţinţan V, Motocu R, Mocanu T, Fetti L, Ciuce C, Iancu C. Laparoscopic surgery for the treatment of rectal cancer: short-term results. Chirurgia (Bucur) 2012; 107:730-736. [PMID: 23294950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED The aim of this study was to establish the efficiency, safety and feasibility of laparoscopic surgery for rectal cancer by assessing the short-term outcomes. MATERIALS AND METHODS In this prospective clinical study, from 2008 to 2011, 60 patients with laparoscopic resection for rectal cancer were included, treated in "Prof. Dr. Octavian Fodor" Gastroenterology and Hepatology Institute, Department of Surgery and Surgery Clinic I, Cluj-Napoca. RESULTS Surgical procedures included 38 abdominal-perineal resections, 21 anterior resections and 1 Hartmann procedure. Average blood loss was 250 ml (100-800 ml) and median length of postoperative hospital stay was 9 days (4-91 days). Blood loss was significantly higher in patients with low rectal cancer than those with upper rectal cancer (300 ml vs 200 ml, p=0.031). Conversion to open surgery was required in 8 patients (13.3%). Overall postoperative complications were 28.8%. Positive circumferential margins occurred in 1 patient (1.7%), while distal margins were negative in all patients. CONCLUSIONS Laparoscopic surgery is safe and feasible in selected patients with rectal cancer, with favorable shortterm results.
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Affiliation(s)
- A Fetti
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", UMF "Iuliu Haţieganu" Cluj-Napoca, Romania.
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Zaharie F, Tomuş C, Mocan L, Bartoş A, Bartoş D, Zaharie R, Iancu C. Perforated appendix with periappendicular abscess in a inguinal hernia sac--Amyand's hernia. Chirurgia (Bucur) 2012; 107:521-523. [PMID: 23025121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Amyand's hernia is a rare form of inguinal hernia, where the appendix is included in the hernia sac. We present the emergency case of an 81-year-old patient with right inguinal pseudo-tumor, accompanied by marked local pain, nausea, low grade fever and bowel disorders. Emergency surgery is indicated due to a suspected incarcerated inguinal hernia with imminent strangulation. The intraoperatory findings reveal the presence of a periappendicular abscess as the cause of gangrenous appendicitis, perforated in the right indirect inguinal hernia sac. The practice includes the evacuation of the abscess, appendectomy and surgical cure of the inguinal hernia--Bassini's procedure, Douglas drainage and subcutaneous drainage. The postoperative outcome was favorable, the patient being discharged on the fifth postoperative day. Postoperative checks performed at 3 and 9 months have not revealed the presence of a hernia recurrence.
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Affiliation(s)
- F Zaharie
- 3rd Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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