Is Marginal Donor an Efficient Solution for Expanding the Donor Pool for Liver Transplant?

Once the techniques of hepatobiliopancreatic surgery improved, liver transplantation widely extended in different hospitals; therefore, the need of grafts and automatically of liver donors reported a significant increase in the last decade. In this respect, attention was focused on increasing the liver donor pool. The aim of this review is to study the benefits of using marginal grafts in liver transplantation. With the advent of multiple methods of liver preservation, the use of grafts previously considered unsuitable has become possible. Thus, extended allocation criteria have emerged. However, the allocation of these grafts must be carefully considered and analyzed in the context of both recipient and donor factors.

Recurrence and Carcinogenetic Rates of Colorectal Polyps

AIM

to determin the recurrence rate of benign recto-colonic polyps in a 5-year interval, and compare the development rate of intrapolypoid carcinomatous lesions in polypectomized versus nonpolypectomized subjects.

MATERIAL AND METHOD

a group of 77 patients diagnosed with recto-colonic polypoid lesions during the period 2014-2019 underwent colonoscopy at the time of study initiation and then annually during a five-year interval. Results: The recurrence rate of polyps increased annually from 5 to 12.5%; the highest rate was noted in the last two years. The five-year cumulative risk of neoplastic lesions was 73% in patients without polypectomy and 20% among those with endoscopic resection (p 0.05). Comparing the recurrence rate of benign lesions (60%) in patients without neoplastic findings with the recurrence rate of adenomas in patients with benign lesions (40%), a higher risk of recurrence was found in the first category, and seemed to be influenced by the personal history of pre-existing adenomatous lesions.

CONCLUSION

an increased risk of colorectal polyps recurrence was reported during five year follow up; moreover, during the first three years an increased risk of malignant transformation was observed among cases in which endoscopic resection was not feasible when compared to those in which complete excision was feasible.

Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer

Ovarian cancer remains one of the most lethal gynaecological malignancies affecting women worldwide; therefore, attention has been focused on identifying new prognostic factors which might help the clinician to select cases who could benefit most from surgery versus cases in which neoadjuvant systemic therapy followed by interval debulking surgery should be performed. The aim of the current paper is to identify whether preoperative inflammation could serve as a prognostic factor for advanced-stage ovarian cancer. Material and methods: The data of 57 patients who underwent to surgery for advanced-stage ovarian cancer between 2014 and 2020 at the Cantacuzino Clinical Hospital were retrospectively reviewed. The receiver operating characteristic curve was used to determine the optimal cut-off value of different inflammatory markers for the overall survival analysis. The analysed parameters were the preoperative level of CA125, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation index (SII). Results: Baseline CA125 > 780 µ/mL, NLR ≥ 2.7, MLR > 0.25, PLR > 200 and a systemic immune inflammation index (SII, defined as platelet × neutrophil-lymphocyte ratio) ≥ 84,1000 were associated with significantly worse disease-free and overall survival in a univariate analysis. In a multivariate analysis, MLR and SII were significantly associated with higher values of overall survival (p < 0.0001 and p = 0.0124); meanwhile, preoperative values of CA125, PLR and MLR were not associated with the overall survival values (p = 0.5612, p = 0.6137 and p = 0.1982, respectively). In conclusion, patients presenting higher levels of MLR and SII preoperatively are expected to have a poorer outcome even if complete debulking surgery is performed and should be instead considered candidates for neoadjuvant systemic therapy followed by interval surgery.

Intrahepatic Cholangiocarcinoma - Where Do We Stand Today? Literature Review

Intrahepatic cholangiocarcinomas represent rare and aggressive malignancies developing from the second order bile ducts to the smaller biliary branches. The aim of this narrative review is to discuss about the main diagnostic and therapeutic challenges in order to help medical and surgical oncologists to gain familiarity in regard to this subject. Articles discussing about epidemiology, histology, diagnostic, perioperative management and surgery which were published from January 2000 to September 2023 included in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar databases were reviewed. Articles reviewed in the current paper came to demonstrate that the main problem in such cases is related to the fact that most cases remain asymptomatic for a long period of time and therefore are diagnosed in advanced stages of the disease when curative procedures are feasible after performing extended visceral sacrifice or even worse, are no longer possible; however, the most efficient therapeutic strategy in order to improve the long term outcomes remains radical surgery. In this respect, attention was focused on improving the accuracy of the diagnostic tools and on identifying non-surgical therapeutic options which might increase the chances of achieving complete resection. Intrahepatic cholangiocarcinoma represent rare aggressive tumors with poor outcomes especially if radical surgery is not feasible.

Is pelvic exenteration in the presence of liver metastases justified?

The presence of liver metastases in association with pelvic recurrence has been considered for a long period of time as the sign of systemic neoplastic impregnation and therefore, these patients were considered as candidates for palliative chemotherapy. However, in the last decades attention was focused on identifying patients who could benefit from surgery in such cases. The aim of the current paper is to discuss about the indications and contraindications of associating extended pelvic resections and liver resections in order to maximize the benefits in terms of survival for patients with advanced stage or recurrent rectal cancer.

Vascular reconstructions using synthetic prostheses after extended pancreatic resections for locally advanced pancreatic cancer

Pancreatic cancer represents one of the most aggressive malignancies affecting patients worldwide which are usually associated with high rates of vascular invasion. In order to achieve radical resection, in such cases extended vascular resections have been proposed with promising results. Once resected, the vascular structures should be reconstructed by direct re-anastomosis if a short length is resected or by placing a graft. The aim of the current paper is to review the most important aspects regarding the vascular reconstructions by using synthetic prostheses.

The influence of lymphocyte to monocyte ratio on the postoperative outcome of patients diagnosed with advanced stage ovarian cancer

Introduction: the lymphocyte to monocyte ratio has been widely investigated in patients with different malignancies and proved to have prognostic value for both early and long-term evolution. Aim: Current paper investigates the influence of this parameter on the perioperative course of patients submitted to surgery for advanced stage ovarian cancer. Material and methods: between 2016-2018 there were 34 patients diagnosed with advanced stage ovarian cancer who were submitted to surgery with curative intent and in whom this parameter was evaluated. Results: a low rate of this parameter seemed to be significantly associated with a more advanced stage at diagnostic (p=0,002), with higher risk of the presence of lymph node metastases (p=0,003), with larger residual tumor (p=0,002). Meanwhile, patients with a lower lymphocyte to monocyte ratio usually had a higher level of CA 125, but this fact did not have statistical significance (p=0,87). Conclusions: patients with a lower lymphocyte to monocyte rate are expected to present more aggressive ovarian tumors and therefore a personalized therapeutic strategy might be needed.

The correlation between the preoperative number of lymphocytes and monocytes and the postoperative outcomes of gastric cancer patients

Gastric cancer remains an important health problem worldwide, being associated with poor rates of survival even if radical resection is achieved. Therefore attention was focused on identifying different prognostic markers which might provide a better selection of the patients and a more personalized therapeutic approach. One of the most widely investigated parameters in the last decade is represented by the preoperative hemogram, significant influence being given to the preoperative number of monocytes and lymphocytes. The aim of the current paper is to discuss about the correlation ship which might be established between these parameters and the overall prognostic in gastric cancer patients.

The impact of the presence of the aberrant right hepatic artery in pancreatoduodenectomy for pancreatic head cancer

An aberrant right hepatic artery usually originates from the superior mesenteric artery, it has an ascendant trajectory through the head of the pancreas or behind it and represents a technical challenge in pancreatic head tumors due to the fact that it needs to be carefully dissected and preserved in order to maintain an adequate blood supply for the right hemi-liver. Meanwhile, this dissection should be performed in an oncological manner in order to obtain the premises of a radical resection with negative margins. The aim of the current paper is to discuss about the influence of this anatomical arterial particularity and the possibility of obtaining a resection with curative intent in pancreatic head adenocarcinoma.

Is liver resection justified for ovarian sarcoma liver metastases?

Ovarian sarcoma represents an aggressive subtype of ovarian malignancies which is characterized by poor outcomes. However, it seems that applying the principles of radical surgery might increase the long-term outcomes especially if no residual disease is achievable. Even though, most cases will experience a recurrent disease. As expected a significant number of cases will present disseminated lesions and will be therefore submitted to palliative treatment. The aim of the current paper is to present two such cases, the first one being diagnosed with a metachronous metastatic liver lesion while the second one being diagnosed with synchronous liver metastases.

The impact of preoperative platelet count in vulvar cancer patients

The preoperative platelet count proved to be a significant prognostic factor for short term and long-term prognostic in gynecological cancers such as endometrial or ovarian cancer. However, more recently it has been supposed that this parameter could also influence the outcomes of vulvar cancer patients. The aim of the current paper is to study the influence of the preoperative platelet count on the perioperative outcomes in vulvar cancer patients submitted to surgery between June 2021 and May 2022 in “Cantacuzino” Clinical Hospital.

The effects of Curcuma longa on metabolic syndrome related to obesity

Once obesity has become a global health problem, the incidence of obesity related diseases also reported an increasing trend, one of the most serious such issues being represented of diabetes mellitus. Therefore it is widely known the fact that obese, diabetic patients are predisposed to the apparition of a significant number of complications, associated with significant economic impacts. The aim om the current paper is to discuss about the possible benefits of Curcuma longa administration in such patients.

Does the number of circulating platelets influence the postoperative evolution of endometrial cancer?

Endometrial cancer is a frequently encountered gynecologic malignancy with increasing incidence; in order to maximize the chances to achieve a long-term survival rate, attention was focused on better identifying the patients at risk to develop more aggressive forms of the disease. The aim of the current paper is to investigate the influence of the number of circulating platelets alone or in association with other biomarkers on the perioperative outcomes of endometrial cancer patients.

The influence of platelet counts on the postoperative outcome of patients with advanced stage ovarian cancer

Introduction: Ovarian cancer represents one of the most aggressive gynecological malignancies which is associated with poor rates of survival especially if surgery with curative intent is not feasible. Aim: The current paper analyzes the correlation ship between the preoperative number of platelets and the perioperative outcomes of patients submitted to primary cytoreduction for ovarian cancer. Material and methods: between 2016-2018, 34 patients with advanced stage ovarian cancer were submitted to surgery; among these patients there were 21 cases with a preoperative platelet number lower than 450.000/microliter and 13 cases with higher than 450.000/microliter values. Results: higher serum levels of platelets were significantly associated with more advanced stages at the time of the diagnostic, higher tumoral burden (defined as a peritoneal cancer index higher than 20) and lower rates of complete debulking surgery. Meanwhile, these patients reported a significantly higher rate of postoperative complications. Conclusions: patients presenting a platelet number higher than 450.000/microliter are associated with worse perioperative outcomes after debulking surgery for advanced stage ovarian cancer.

Do products containing Calendula officinalis have a positive role in treating uterine cervix disorders?

Once screening tests and national programs for early detection of cervical cancer have been widely developed, a significant number of patients are diagnosed with preneoplastic lesions at this level; therefore, in such cases, a conservative treatment is feasible, increasing therefore the possibility of fertility preservation and conceiving. Meanwhile, after performing an invasive maneuver at this level attention should be focused on obtaining an adequate healing process at this level. The aim of the current paper is to conduct a literature review regarding the benefits of Calendula officinalis in maximizing the healing process after local invasive procedures at the level of the uterine cervix as well as on human papilloma virus infection prevention.

The anti-inflammatory, anti-infectious and anticancerous effects of Thymus vulgaris

Thymus vulgaris represents a medical herb from the southern region of Europe with anti-infectious, anti-inflammatory and immunomodulatory effects. More recently an antiviral and anti-cancerous activity has been demonstrated. Therefore multiple products have been imagined in order to put in value all these properties. The aim of this paper is to discuss the mechanisms of action, properties and means of administration of this product.

Bismuth subgallate and cervico-vaginal disorders

Bismuth subgallate represents a salt which has been widely used in the last decades in gastroenterology and otorhinolaryngology for hemostatic, astringent, anti-inflammatory and antibacterial purposes. The product seems to be efficient also in terms of inducing a more rapid wound healing stimulating all the key points of this process. Once the benefits of bismuth subgallate administration have been widely demonstrated in topical administration at the level of the postoperative wounds in oto-rhinolaryngology, it was further investigated in treating other mucosal lesions such as cervico-vaginal ones especially due to the fact that the two types of mucosa present similar features. Therefore, this bismuth salt was successfully associated in the composition of vaginal topical products with promising results. The aim of the current paper is to discuss the properties, mechanisms of action and benefits of adding bismuth subgallate in topic vaginal products.

The correlation between the embryological development of the pancreas and the local extent of the pancreatic tumors

Progression reported so far in the field of hepato-bilio-pancreatic surgery leaded to a significant increase of the number of cases diagnosed with borderline or locally advanced pancreatic tumors which are successfully submitted to radical surgery. However, it has been observed that local invasion of the vascular structures respects the embryological and anatomical development of the pancreatic parenchyma. The aim of the current paper is to analyze the correlation ship between the embryological development of the pancreas, location, extent and possible therapeutic strategies in borderline or locally advanced pancreatic head cancer.

Does the preoperative thrombocytosis influence the postoperative outcomes in cervical cancer?

Cervical cancer still remains a significant health problem in our country, an increased number of patients being diagnosed with this pathology. In order to achieve the best management in such cases, a combination of surgery and radiation therapy has been widely proposed. However, different results have been achieved; therefore attention was focused on identifying patients who could benefit most from neoadjuvant radiation therapy and multiple prognostic factors have been studied. The aim of the current paper is to study the influence of the preoperative platelet count on the postoperative outcomes of cervical cancer patients; the study was conducted on a study group of 82 patients submitted to surgery between June 2021 and May 2022 in “Cantacuzino” Clinical Hospital and the patients were classified in two groups according to the number of circulating platelets, a cut off value of 450.000 platelets/microliter being used.

Vascular Resections in Association With Pancreatic Resections for Locally Advanced Pancreatic Cancer

BACKGROUND/AIM

Locally advanced pancreatic cancer has been considered for a long period of time as an unresectable lesion and therefore, all patients have been traditionally addressed to the oncological services for palliative purposes. However, due to the wide usage of newer oncological agents in association with improved surgical techniques, radical surgical procedures became feasible. The aim of this study was to present the different surgical procedures that were performed in locally advanced pancreatic cancer patients in order to achieve radical resections.

PATIENTS AND METHODS

Between 2019 and 2020, six cases were submitted to pancreatic and vascular resections in Fundeni Clinical Hospital.

RESULTS

In all cases, surgery with curative intent was attempted; portal vein resection was performed in five cases, whereas arterial resection was performed in three cases. Reconstruction was performed by direct re-anastomosis, by placing cadaveric or synthetic grafts. The postoperative outcomes were favourable in all cases.

CONCLUSION

Vascular resections can be safely associated with pancreatic resections in cases presenting locally advanced pancreatic lesions, with acceptable morbidity rates.

Retinoids and teratogenicity

For more than 30 years, retinoids have been used for acne treatment also their teratogenic effects are widely known. For any woman at a fertility age and under retinoid treatment, a contraception program should be in place. Pregnancy should be postponed until the completion of treatment and one month afterwards. Multiple fetal abnormalities are directly linked to isotretinoin.

The role of multidisciplinary team in breast cancer patients

Breast cancer has become a significant health problem worldwide being one of the most commonly diagnosed malignancies especially due to the wild implementation of screening tests and genetic counselling. Therefore attention was focused on improving the therapeutic strategies in such cases and to offer for each patient the chance of a personalized treatment. In this respect specialized teams have been organized in which each case is discussed and the final decision is transmitted to the patient. That is how the concept of multidisciplinary team developed. The aim of the current paper is to discuss about the concept and benefits of the multidisciplinary meetings in breast cancer patients.

The role of sentinel lymph node dissection in lobular breast cancer

Lobular breast cancer represents a rare histopathological subtype of this malignancy, being characterized by a particular way of lymphatic spread. Therefore, the most widely known property of this tumor is the one of skipping certain lymphatic groups. Due to this aspect, the benefits of sentinel node identification were considered to be controversial so far. The aim of the current paper is to discuss about the indications and contraindication of this procedure in lobular carcinoma of the breast.

Postoperative diaphragmatic herniation after cytoreductive surgery in advanced stage ovarian cancer

Ovarian cancer is frequently associated with upper abdominal involvement necessitating extensive resections at this level. In such cases a significant increase of the postoperative complications is to be expected, the most commonly encountered one being represented by pleural effusion. Another complication which is described less frequently but which is associated with higher risks is represented by upper abdominal herniation at the level of the thorax. The aim of this paper is to discuss the risk factors and the therapeutic strategies in such cases.

The role of embolization in unresectable, haemorrhagic, gynaecological tumors

Once the techniques of interventional radiology improved, various methods have been proposed in order to achieve a good control of bleeding with different origins. When it comes to the role of arterial embolization for uncontrollable gynaecological bleeding, the method proved to be particularly efficient when it comes to uterine fibroids. Meanwhile, it has been also proposed as salvage therapy in cases presenting massive vaginal bleeding due to unresectable gynaecological malignancies. The aim of the current paper is to review the efficiency of the method in patients presenting large tumoral masses with uterine origin.

Ureteric injury in gynecology

Ureteric damage is a rare but a well known complication in obstetric and gynaecological practice. It has repercussions in terms of morbidity and medico-legal practice. There is wide variation of reported incidence is related to the type of surgery. Preoperative and intraoperative precautions can prevent the injury up to a point the injury but the effectiveness of these actions has not been fully assessed.

Endometrial scratching technique

Problems of female subfertility are a current challenge. Implant failure of the embryo after an assisted human reproduction technique is undesirable and unpleasant, and strategies to improve this implant rate are welcome. One of these techniques is endometrial scratching. We performed a literature review by searching in the PubMed and Cochrane databases for relevant information regarding the technique of endometrial scratching. The technique of endometrial scratching is not complex, but choosing an optimal period in the menstrual cycle seems to produce the desired effects for the successful implantation of the embryo. Pregnancy rates obtained through assisted human reproduction techniques have been improved due to endometrial scratching techniques.

Management of uterine perforation

Uterine perforation, although extremely rare, can have lifelong consequences. Any procedure that can cause perforation has to take into account the risk of damage to the uterine wall. As this is a blind method, adequate training and certification is necessary, before trainees can performed hysteroscopy, D&C (dilatation and curettage), coil insertion independently.

Multiple ovulations between ovarian stimulation treatment and primary ovarian insufficiency

The release of several oocytes during the same menstrual cycle can occur both physiologically and iatrogenic, following ovarian stimulation treatments. Ovarian induction can be achieved either by mild stimulation, in the case of anovulatory or dysovulatory patients, or by controlled ovarian hyperstimulation, to obtain a large number of follicles in the In Vitro Fertilization procedure. At this time, the ideal ovarian stimulation treatment is to suppress the pituitary release of gonadotrophin-releasing hormone (GnRH), a co-opted regimen with high doses of exogenous follicle-stimulating hormone (FSH). The physiological process of multiple ovulations can lead to superfertilization (SF). SF is a biological process by which two eggs are fertilized successively, at intervals of a few days apart, both eggs coming from the same ovulation. Among the factors that can lead to superfertilization are mentioned: family history of dizygotic pregnancies (DZ), increased parity, advanced age, high stature of women, a high weight index, the use of oral contraceptives and folic acid. The premenopausal period is characterized by elevated levels of FSH and a low ovarian reserve, both conditions contributing to the development of multiple follicular and DZ pregnancies.

Triple metachronous primary malignancy – case report and literature review

Multiple primary malignancies (MPMs) are defined as more than two synchronous or metachronous cancers in the same individual. Common risk factors for multiple primaries are represented by inherited predisposition to cancer, cancer-promoting aspects of lifestyle, hormonal and environmental factors, history of previously treated primary cancer and increased lifespan of cancer survivors. Herein, we report a single case of a 68-year-old woman with triple metachronous primary neoplasms of the breast, colon and endometrium with three distinct histological patterns. The patient was initially submitted to a supero-external quadrant sectorectomy and axillary lymph node dissection in May 2016, followed by radical sigmoidectomy for perforated sigmoid malignant lesion in December 2018 and respectively by total hysterectomy with adnexectomy and pelvic lymph node dissection for endometrial cancer in September 2021. The histopathological studies confirmed the different histopathological origins for the three lesions. In conclusion, once the lifespan of cancer survivors increased, multiple metachronous malignancies are to be expected.

Minimum invasive sentinel lymph nodes dissection in cervical, endometrial and vulvar cancers

Genital cancer in women is an ongoing challenge. A correct diagnosis together with a correct staging can lead to a favorable oncological or surgical conduct with an improvement of the prognosis. A literature review was performed to find relevant information regarding the sentinel node mapping in uterine and vulvar cancer. Different dyes are available, but the bioavailability and toxicity of green indocyanine are factors that seem to bring superiority to this tracer. Tracing the sentinel node with green indocyanine is a method that involves special equipment, but the benefits are visible.

Surgical strategies in uterine adenomyosis

Uterine adenomyosis is defined by the presence of heterotopic endometrial glands and stroma at the myometrial level. Although imagistic studies improved, the incidence of adenomyosis is still underestimated, in a significant number of cases the final diagnostic of adenomyosis being established on the histopathological specimen of hysterectomy. The aim of the current paper is to discuss about the most efficient therapeutic strategies in adenomyosis.

Improving laparoscopic myomectomy outcomes

In the field of benign gynecology, laparoscopic myomectomy has clear advantages, although learning curve is longer. Our study aims to review the factors that improve the technique of laparoscopic myomectomies. For women with symptomatic fibroids who wish to maintain their fertility minimally invasive myomectomy is in most cases the best option. Therefore, laparoscopic approach is associated with shorter hospital stay, faster recovery, less postoperative pain, and reduced adhesion formation. Standardization of laparoscopic techniques could help to reduce the learning curve. The costs are higher compared with open myomectomy, but when we take into account the numerous advantages that laparoscopy has, including shorter operative time, less blood loss, shorter hospital stay and a more rapid recovery time, laparoscopy is more cost-efficient.

Abdominal incisions in gynecology

Wound infection post-surgery contributes extensively at the healthcare cost, translated not only by the direct care, but also for the medical leave that most patients request it. Every step is essential for achieving a successful surgery. A suitable incision is most helpful for both patient and surgeon alike. This review focuses on the multiple types of incisions used in gynecological field.

Is routine appendectomy justified in mucinous borderline ovarian cancer?

Mucinous borderline ovarian tumors represent up to one half of cases diagnosed with borderline lesions and are usually associated with favourable outcomes. When it comes to the therapeutic options in these cases, the initial trend was to adopt the same strategy as in cases presenting invasive mucinous lesions. However, studies conducted so far cam to demonstrate that the appendix presented tumoral infiltration in an extremely low number of cases especially if a normal macroscopical aspect was present and therefore routine appendectomy was no longer recommended. The aim of the current paper is to investigate in which cases appendectomy should still be part of the therapeutic strategy in mucinous borderline ovarian tumors.

Uncommon malignancy arising within mature ovarian teratoma: Case report and literature review

Background. Clear cell carcinoma of the ovary developing in the background of an ovarian teratoma represents an extremely rare entity of the gynecologic tract. Giving the rarity of this entity, the histologic challenges, prognosis and the adequate treatment is still uncertain. Methods. We herein present a case of clear cell carcinoma coexisting with a teratoma, accompanied by a scrutinous literature review. The authors have reviewed all case reports published in the literature (1978-2021), adding our new case, in order to enrich current literature data. Results. A thorough search of the PubMed/MEDLINE and Google Scholar databases has revealed 7 cases of clear cell carcinoma of the ovary developing in association with a teratoma. Out of the 7 cases, 4 were part of a more complex tumor, including other malignancies (e.g. angiosarcoma, endometrioid carcinoma). The mean size of the tumors was 16 cm and most patients died of disease or suffered multiple recurrences. Additionally, we report a case of a 54-year-old patient who presented with an ovarian tumor and which upon microscopic examination featured a cystic structure lined by squamous keratinizing epithelium and sebaceous glands. Inside the wall of the cyst, a small nodule made out of tubules and papillae lined by clear cells, which invaded the surrounding stroma was identified. Four months later, the patient developed a small nodule in the liver and she has subsequently received adjuvant chemotherapy. Conclusion. Clear cell carcinoma of the ovary developing in association with a teratoma is an extremely rare entity, that requires thorough sampling of the cyst and which is usually associated with a relatively poor prognosis.

Microvascular surgery for upper limb lymphedema treatment

Although the necessity of performing radical mastectomy has significantly decreased over the last decades there are still cases in which this procedure is required, predisposing the patient to the development of long-term complications such as upper limb lymphedema. Meanwhile, due to the increased implementation of indocyanine green usage, the rates of this complication have decreased, preservation of the lymphatic vessels of the arm being more and more possible. Even though, upper limb lymphedema can be still encountered, in such cases vascular surgical procedures such as lymphovenous anastomoses might be performed in order to treat this complication. This is a literature review regarding the usage and effectiveness of indocyanine green administration in the upper limb lymphedema treatment.

Obesity in gynecological surgery

Despite the effort made by authorities, obesity is rising worldwide. Together with the multiple issues that obesity is bringing with it, the surgical outcome can be influenced significantly. In case of morbid obesity, preoperative assessment of the cardiopulmonary and respiratory system is vital as the compromise of either might be fatal. Obese patients tend to develop hemodynamic instability, hypoxia intolerance, deep venous thrombosis, wound infection and decreased drug clearance. This review aims to underline obesity risks as well as their management.

Hysteroscopic sterilisation

A patient requesting sterilization envisages an easy to perform, safe cheap and reversible method. Despite best efforts of researchers and pharma companies, such a device has not been produced yet. Female sterilization is one of the most common procedures and encompasses tubal ligation, laparoscopic salpingectomy or hysteroscopic sterilization. This short review focuses on role of hysteroscopy on sterilization and informed consent as sterilization is a legacy for the rest of a woman life.

Is laparoscopic sclerotherapy justified in the management of endometriomas?

Endometriomas represent a common finding among women at fertile age and usually associated with pelvic pain, infertility, heavy menstrual periods and dyspareunia. For a long period of time surgical resection has been considered the golden standard in such cases. However, although resection aims to take off only the cyst, in certain cases a decrease of the ovarian reserve and secondarily, to a decrease of the fertility is observed. Due to this reason, attention was focused on creating other methods for cyst destroying without impeding the ovarian reserve. The aim of the current paper is to discuss about the effectiveness and safety of sclerotherapy as part of the therapeutic strategy for endometriomas.

Risk factors and significance of lymph node involvement in serous borderline ovarian tumors

Borderline ovarian tumors represent a particular category of ovarian neoplasms characterized by a more favourable outcome, lower risk of recurrence and association of long term survival rates. Although in up to one third of cases lymph node metastases are present, they seem that they do not affect significantly the survival. The aim of the current paper is to identify the most important risk factors for lymph node invasion in serous borderline ovarian tumors and to study their influence on survival.

Indocyanine green utility in prevention and treatment of upper limb lymphedema

Although screening tests have been widely implemented globally, there are still cases diagnosed with breast cancer in which radical mastectomy and axillary lymph node dissection remains the option of choice. In such cases significant alteration of the quality of life can occur especially in cases in which upper limb lymphedema develops. Therefore, attention was focused on determining the causes related to upper limb lymphedema as well as the therapeutic options in such cases. Special attention was given to the utility of indocyanine green for upper limb lymphatic preservation as well as for the utility of the method in treating this complication. This is a literature review regarding the possibilities of prevention and treatment of upper limb lymphedema by using indocyanine green.

Programmed cell death pathway in epithelial ovarian cancer: Brief review of a novel immunotherapeutic perspective

During the past several decades, ovarian carcinoma has remained the leading cause of death among gynecologic malignancies. The current therapeutic guidelines recommend, in most cases, a combination of surgery and chemotherapy based on platinum agents and taxanes. Despite the increasing usage of newer drug categories, such as bevacizumab and PARP inhibitors, and the expansion of patient groups for these drugs, ovarian cancer is characterized by multiple recurrences, particularly in the form of peritoneal implants. In this article, we perform a short incursion into the programmed cell death pathway in epithelial ovarian cancer and conduct a brief review of literature regarding this novel immunotherapeutic perspective.

Management of interstitial (cornual) pregnancy

Cornual pregnancy is an infrequent event. Goal of cornual pregnancy treatment is the expulsion of the pregnancy and haemostasis in case of haemorrhagic rupture. Treatment involves the removal of the pregnancy and hemostasis of the cornus if required by hemorrhagic rupture. New ultrasound techniques have brought an additional tool in the early diagnosis, which is vital in preserving fertility and enabling medical (methotrexate treatment).

Utility of indocyanine green in the administration of cytotoxic drugs in breast cancer patients

Indocyanine green has been widely introduced in breast cancer protocol for sentinel node detection, for upper limb lymphedema prevention and for breast reconstruction. However, more recent studies came to demonstrate that these particles can be also used in order to provide an efficient intraoperative detection of metastatic deposits as well as for a more targeted delivery of cytotoxic drugs. The current paper aims to investigate the mechanisms of action, the principles and the benefits of indocyanine green as a therapeutic tool, part of the medical oncologic treatment of breast cancer patients.

The role of novel poly (ADP-ribose) inhibitors in the treatment of locally advanced and metastatic Her-2/neu negative breast cancer with inherited germline BRCA1/2 mutations. A review of the literature

The use of the PARP inhibitors (PARPi) in the treatment of breast cancer (BC) with germine mutations has evolved over the years, and further research has been done in order to broaden the horizon of this treatment strategy. Therefore the aim of this paper is to review the efficiency of PARPi in the treatment of BRCA 1/2-mutated locally advanced and metastatic Her-2/net negative BC mentioning their side effects, mechanism of resistance and future directions. Inhibition of PARP transforms single-strand breaks into double-strand breaks (DBS), the accumulation of the latter causing cell death (cell apoptosis). The Olympia AD phase III trial demonstrated a statistically significant progression-free survival rate (PFS) when using the PARPi olaparib in metastatic BC with germline BRCA1/2 mutations without any benefit of the overall survival rate. PARPi therapy is associated with acceptable responsive rates and progression-free survival rates in locally advanced and metastatic BRCA1/2 associated BC through mechanisms that enhance and increase the sensitivity to chemotherapeutic or target agents as they induce a synthetic lethality and cell apoptosis. The side effects are not significant, the most adverse effects being related to the hematological and gastrointestinal systems. Olaparib is currently approved in the first-line treatment of BRCA1/2 mutated Her-2/neu negative metastatic BC at an oral dose of 300 mg twice daily, while Talazoparib represents a category one recommendation in locally advanced and metastatic Her-2/neu negative BC in women with central nervous system metastases.