Renal tumor biomarkers (Review)

One of the most common types of cancer worldwide (9th most commonly diagnosed) is renal cell carcinoma (RCC). It is more common in developed countries and it usually develops in individuals between 60 and 70 years of age. The earlier the disease is identified, the lower the morbidity. Therefore molecular markers that exist in blood and urine may be used for earlier detection and diagnosis but also for the follow-up of the patient after treatment, whether surgical or oncological. The trend is to analyze the gene and protein expression as they constitute a source for new biomarkers. These markers are promising but in clinical practice regarding disease management, they are rarely used. Biological markers can be employed in many tumors because they can identify the prognostic value for individual treatment. However, markers for RCC are not validated, and their analysis is currently under investigation. Previous findings have demonstrated that the metastatic potential of RCC can be predicted using the biological features of the tumor cell. It is believed that the transformation from epithelial to mesenchymal phenotype gives the tumor cell the ability to metastasize. The purpose of this review was to identify the most valuable tumor markers that can be clinically used for the prognosis, treatment and follow-up of patients with renal tumors.

Tumoral markers in bladder cancer (Review)

Bladder tumors are frequently diagnosed urologic malignant diseases with an extremely high recurrence rate compared to other neoplastic tumors. Urothelial bladder carcinomas are mostly identified in their incipient form, as non-muscle invasive, but despite that, a third of them develop into aggressive recurrent disease. The diagnosis of bladder carcinoma at this moment is established using cytology and cystoscopy and is a great challenge for clinicians due to the lack of sensitivity. Urinary biomarkers could improve and enhance the diagnosis and screening techniques and determine a more accurate recurrence rate. However, bladder cancer is a heterogeneous disease and the existence of a single marker test with reduced cost is unlikely; thus, until then, the use of a panel of markers to obtain valuable information is inevitable even though suboptimal for use. To improve this deadlock, new biomarker panels should be identified and prepared to equalize the cost-efficiency balance. The present paper is a literature review concerning the most commonly used tumor markers in urinary bladder cancer as well as the most commonly encountered genetic modifications in such patients.

Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report

Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.

Neuroendocrine syndrome in bronchial carcinoid tumors

Pulmonary carcinoid tumors represent bronchopulmonary neuroendocrine neoplasms which might synthetize serotonin, histamine, bombesin or other types of hormones responsible for the development of a broad spectrum of signs and symptoms, known as carcinoid syndrome. Data of 98 patients submitted to surgery for bronchial carcinoid tumors in the Thoracic Surgery Clinic of the 'Marius Nasta' Institute of Pneumophtisiology between 2014 and 2018 were retrospectively reviewed. All patients were submitted to paraclinical tests, imagistic studies (computed tomography or magnetic resonance imaging), bronchoscopy and biopsy in order to have a positive diagnostic of pulmonary carcinoid. The most common clinical symptoms at the time of presentation were: Persistent cough followed by dyspnea and recurrent pulmonary infections. The main neuroendocrine syndromes found were Cushing and Carcinoid Syndrome. All patients were submitted to surgery with curative intent consisting of wedge resection (in 4 cases, 4.08%), lobectomy (in 79 cases, 80.61%), bilobectomy (in 5 cases, 5.1%) and pneumonectomy respectively (in 10 cases, 10.2%). In all cases neuroendocrine specific symptoms disappeared once the carcinoid tumor was removed. In conclusion, bronchial carcinoid tumors have a positive outcome in most cases. Specific neuroendocrine markers as well as neuroendocrine syndrome disappears once the tumor is removed.

Reconstruction of superior mesenteric artery by prostheses placement in a case of chronic mesenteric ischemia: A case report and literature review

Although superior mesenteric artery stenosis is a relatively common situation, it is rarely symptomatic due to the fact that in a significant number of cases an adequate collateral circulation exists. The aim of this study is to report a case in which arterial reconstruction was needed due to the absence of such a patent collateral circulation. The 47-year-old patient was investigated for chronic postprandial pain and was diagnosed with superior mesenteric artery stenosis. Percutaneous treatment was the initial option of choice but the patient rapidly became symptomatic again. Therefore surgery was performed, the segment of arterial stenosis was resected and the arterial continuity was re-established by using a synthetic prosthesis. The postoperative outcome was uneventful, the patient was discharged in the seventh postoperative day under anticoagulant therapy. In conclusion, superior mesenteric artery reconstruction by using a synthetic prosthesis can be useful in cases presenting chronic mesenteric ischemia and failure of percutaneous treatment.

Malignant Priapism - What Do We Know About It?

Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from primary penile tumors or from metastatic penile tumors, or due to hematological malignancies. Non-urological penile metastases are associated with significant worse prognosis compared to urological penile metastases, the appearance of priapism in such cases affecting even more the prognosis and the survival of these patients. Patients diagnosed with hematological malignancies and priapism present significant higher survival rates compared to those who develop MP in the context of a non-hematological malignancy, this being related to the fact that hematological malignancies are more sensitive to chemo- and radiotherapy. Most malignant priapism cases are ischemic; therefore the management should be based on the initial steps of the IP therapeutic protocol. Considering the trigger factor that has led to the priapic event specific oncologic treatment can be added as well.

Utility of indocyanine green injection in patients with cervical cancer besides the identification of sentinel lymph node (Review)

Due to the wide introduction of screening tests, patients with neoplastic diseases of the uterine cervix trend to be diagnosed in early stages of the disease, and less invasive surgical procedures are needed in certain cases. In this respect, the technique of sentinel lymph node dissection has been widely implemented as part of the therapeutic strategy, indocyanine green (ICG) being one of the most reliable markers for sentinel lymph node detection. However, it seems that this agent is extremely useful in order to achieve better short-term and long-term results after cervical cancer surgery, due to its capacity to determine the uterine vascular perfusion in cases in which conservative treatment, such as trachelectomy, is performed, as well as to prevent and treat lower limb lymphedema. A literature review was conducted of the studies which focused on the role of ICG utility in cervical cancer patients besides sentinel lymph node detection, special focus was given to vascularization preservation and lower limb lymphedema prevention and treatment.

Mast cell activation syndromes - evaluation of current diagnostic criteria and laboratory tools in clinical practice (Review)

Mast cell activation syndromes (MCAS) represent a heterogeneous clinical entity caused by episodic and severe mast cell activation, including primary and secondary mast cell disorders (MCDs). The group of primary or clonal MCDs refers to systemic mastocytosis, other clonal MCAS and hereditary hypertryptasemia, while the secondary MCAS is characterized by normal mast cells (MCs) which are activated by external triggers, such as allergens or physical stimuli. Another category of MCAS is the idiopathic form, when no trigger or genetic mutation can be identified. Symptoms of mast cell activation are due to release of specific mediators and can be seen in many diseases, such as allergies, with localized or systemic clinical manifestations. Confirmation of MCAS is based on diagnostic criteria proposed by an international group of experts and the best available evidence in this field. It is generally accepted that the clinical picture of MCAS is non-specific and there are few available laboratory tools, making it difficult for clinicians to identify and confirm this entity. The diagnosis is established after exclusion of other possible clinical entities in most of the cases. Therefore, the actual diagnostic criteria of MCASs, some relevant clinical aspects and laboratory tools used in clinical practice were reviewed.

Influence of inflammation and adipocyte biochemical markers on the components of metabolic syndrome

Metabolic syndrome is associated with increased risk of cardiovascular disease. This study investigated the correlation between adipocyte and inflammation biomarkers, and metabolic syndrome and its components. The study included 80 patients with normal body-mass index and 80 obese patients. The groups were assessed for serum values of adiponectin, leptin and highly sensitive C reactive protein (hsCRP), the homeostatic model assessment of insulin resistance (HOMA-IR), as well as the influence of these biochemical markers on the prevalence of metabolic syndrome and its components. Leptin, HOMA-IR and hsCRP had statistically significant (P<0.01) higher values in the group of obese subjects, while adiponectin had statistically significant (P<0.01) lower values. The prevalence of metabolic syndrome was 35% in the obese group and 5% in the normal weight group. Adiponectin and HOMA-IR were the variables significantly associated with metabolic syndrome (P<0.01), adiponectin/HOMA-IR ratio and leptin/adiponectin ratio were also associated with metabolic syndrome (P<0.01). No relationship was found between metabolic syndrome and hsCRP. Adiponectin and adiponectin/HOMA-IR were associated with all the components of metabolic syndrome and they can be useful to identify patients with high risk of diabetes mellitus and cardiovascular disease.

Endometriosis of the Abdominal Wall - Clinical, Histopathological and Immunohistochemical Aspects

Endometriosis is a benign gynecological pathology that mostly affects the organs of the pelvis,but also organs located at a distance maybe affected. Tissue immunohistochemically identified as ectopic endometrium may undergo certain structural and functional changes that may lead to preneoplastic alterations (hyperplasia, dysplasia) in normal cellswhich can evolve to neoplasia. Clinical, genetic, metabolic conditions and local factors may influence degenerationof a benign pathology into a malignant pathology. Endometriosis of the abdominal wall is more frequently encountered, as the number of casarean section has increased. Endometriomas surrounding tissue has a direct impact on the structure of the cells that form the mass. By remodeling cellular morphology, corroborated with the hormonal factors action and the inflammatory response ( via lymphocyte cell secretion), the cell cycle is altered and antiapoptotic activity may be promoted. Immune system via lymphocyte cell secretion, the pressure exerted on the tumor area by surrounding tissueswith its size change, conditioned by the fluctuation of hormonal factors, act directly on the cellular structure and can increase anti-apoptotic action and decrease cell cycle regulation. The presence of endometriomas is identified by the positivity of immunohistochemical reactions for estrogen receptors (ER), progesteron receptors (PR), Cytokeratin 7 (CK7) for endometrial tissue. Negative reaction at Cytokeratin 20 (CK20) shows that the studied area is not a metastasis of a digestive tumor. The presence of abundant inflammatory, peritumoral cells markedwith anti-CD68 / Tryptase for macrophages / mast cells demonstrates the involvement of the inflammatory system in the structural and functional modification of endometrial cells.The pronounced cell division was demonstrated by intense reaction with the anti-Ki67 antibody.The signigicant anti-apoptotic action of the endometrial tissue is shown by the positivity of anti-B cell Lymphoma 2 (BCL2) / anti-Phosphatase and tensin homolog (PTEN) / anti-p53 antibodies.

Reinforcing involvement of NK cells in psoriasiform dermatitis animal model

Psoriasis (Ps) is a chronic inflammatory immune-mediated disease with skin and joint manifestations, characterized by abnormal and rapid proliferation of keratinocytes and infiltration of psoriatic lesions with immune cells. Extensive literature suggests that Ps is a T-cell mediated disease its pathogenesis being highly related to innate and adaptative immune cells. Although natural killer (NK) cells are involved in the inflammatory process of Ps through pro-inflammatory cytokine secretion (tumor necrosis factor α, interferon γ), their role in this pathology is not yet fully elucidated. In order to study the involvement of NK subpopulations in the pathogenesis of Ps we used the imiquimod-based mouse model of psoriasiform dermatitis and NK cells complex phenotype patterns from peripheral blood (PB) and spleen were investigated. Skin inflammation and the disease severity were assessed using in vivo measurements (erythema, desquamation and induration parameters, PASI modified score), splenomegaly assessment and histopathological evaluation. Phenotypic characterization of NK cells in imiquimod (IMQ)-treated mice was performed by flow cytometry, for both PB and spleen cell suspension. A large panel of surface markers was used: maturation and activation markers [cluster of differentiation (CD)49b, CD11b, CD43, CD27, KLRG1, CD335, CD69, CD28, gp49R, CD45R, CD11c] and markers for cytokine receptors (CD25, CD122, CD132). Our experimental data showed important differences in IMQ-treated mouse NK cell phenotype as compared to control group. The maturation markers (CD11b, CD43, CD27, KLRG1) were found increased on NK cells, in periphery and spleen, while CD49b⁺NK1.1⁺ was significantly lower, and the alterations correlated with the severity of the disease. Our findings reflect the immune engagement toward activatory profile of NK cells and draw attention to evaluating Ps intensity correlated with the mature profile of circulating NK cells.

Laser-driven radiation: Biomarkers for molecular imaging of high dose-rate effects

Recently developed short‐pulsed laser sources garner high dose‐rate beams such as energetic ions and electrons, x rays, and gamma rays. The biological effects of laser‐generated ion beams observed in recent studies are different from those triggered by radiation generated using classical accelerators or sources, and this difference can be used to develop new strategies for cancer radiotherapy. High‐power lasers can now deliver particles in doses of up to several Gy within nanoseconds. The fast interaction of laser‐generated particles with cells alters cell viability via distinct molecular pathways compared to traditional, prolonged radiation exposure. The emerging consensus of recent literature is that the differences are due to the timescales on which reactive molecules are generated and persist, in various forms. Suitable molecular markers have to be adopted to monitor radiation effects, addressing relevant endogenous molecules that are accessible for investigation by noninvasive procedures and enable translation to clinical imaging. High sensitivity has to be attained for imaging molecular biomarkers in cells and in vivo to follow radiation‐induced functional changes. Signal‐enhanced MRI biomarkers enriched with stable magnetic nuclear isotopes can be used to monitor radiation effects, as demonstrated recently by the use of dynamic nuclear polarization (DNP) for biomolecular observations in vivo. In this context, nanoparticles can also be used as radiation enhancers or biomarker carriers. The radiobiology‐relevant features of high dose‐rate secondary radiation generated using high‐power lasers and the importance of noninvasive biomarkers for real‐time monitoring the biological effects of radiation early on during radiation pulse sequences are discussed.

Mesh colposacropexy in the management of anterior vaginal compartment prolapse

Pelvic organ prolapse is a frequent female pathology, often causing a negative impact on the patient’s quality of life. The purpose of this paper is to present the results that we have achieved in 32 patients with anterior vaginal compartment prolapse, managed using the transvaginal mesh approach.

Over a period of twelve months, we have performed 32 transvaginal reconstructive procedures using a four arms polypropylene mesh. The superior arms of the mesh have been passed through the obturator foramen while the inferior arms have been passed through the sacrospinous ligament.

The surgery has lead to a significant improvement in the quality of life in this group of patients, this being assessed using self-administered questionnaires that evaluated the quality of life, the sexual function, and urinary continence. Anatomical success was achieved in 96.87% of the cases. In terms of postoperative complications, we mention one case of vaginal erosion, one case of de novo dyspareunia and three cases of pelvic discomfort. So far we have not encountered any mesh exposure cases nor prolapse recurrence.

Considering the results that we have achieved in our study, we can conclude that the transvaginal polypropylene mesh approach can prove itself to be a viable solution for the management of genital prolapse, especially if we consider the high postoperative rates of anatomical success and low rates of postoperative complications, as well as improving the patient’s quality of life. In spite of these encouraging results, the fact that in recent years FDA has emitted several warnings in terms of postoperative complications following such procedures, as well as the fact that our study was conducted on a small group of patients, limits the strength of our research, its only purpose being to present our experience for this surgical approach over a limited period of time.

Natural killer cell monitoring in cutaneous melanoma - new dynamic biomarker

Melanoma is responsible for most skin cancer deaths in humans. The immune system plays a major role in regulating tumor cell proliferation by initiating defence responses against tumor aggression. Research on murine cancer models allow for a better understanding of immune response in malignancies, revealing specific changes of the immune status in the presence of tumors. Melanoma resistance to conventional therapies and its high immunogenicity justify the development of new therapies. These features reinforce melanoma as a suitable model for studying antitumor immunity. Recent findings on NK cell activation in cancer patients indicate that several important parameters, such as tumor capacity to modulate the function and phenotype of NK cells, require consideration for the choice of an NK-based therapy. In this study, we investigated T-CD4⁺ and T-CD8⁺ lymphocytes, B lymphocytes and NK cells in peripheral blood and spleen cells suspension from melanoma-bearing mice compared to healthy controls in order to assess the potential for tumor growth-promoting immunosuppression. Our results indicate that in a melanoma-bearing mouse model the percentage of NK cells in spleen is reduced and that their phenotype is different compared to control mouse NK cells.

Chemotherapy and other Factors Affecting Quality of Life in Non-Small Cell Lung Cancer (NSCLC) Patients

NSCLC accounts around 80% of all lung cancers. NSCLC patients have usually a lousy quality of life (QoL), influenced by the malignant disease itself and by cancer treatment modalities. We conducted an observational study in Oncology Department, Clinical Emergency Hospital, Constanta, on a sample of 50 patients diagnosed with NSCLC one year. Our study data showed that younger patients have a better QoL regarding social/family well-being, but without other significant differences. Also, patients living in the urban area have a better QoL regarding social/family well-being. Patients having better performance status obtain higher scores from all subscales of the FACT- G questionnaire and, also a higher FACT-G total scale, these results are showing that better the performance status and general status of the patient, better the QoL. We detected a significant relationship between QoL and disease stage or presence of metastasis. We found no clinical significance between QoL scores with respect with chemotherapy protocol or the number of cycles of chemotherapy. We aimed to show that factors influencing the QoL of NSCLC patients are stage of the disease and performance status of the patients. To diminish the negative impact, one important step in ameliorating the QoL of NSCLC patients is to detect all factors influencing it and offer psychological spiritual and social support.

Controled Ovarian Stimulation with Urinary Gonadotrophins and Recombinant Gonadotrophins in Current Practice

The main objective of the this study is to compare the effectiveness of ovarian stimulation with recombinant gonadotrophins (FSHr) versus urinary gonadotrophins (hMG) within the number of oocytes obtained and the number of embryos in the two patient groups, according to age groups and associated pathologies. The study design was retrospective, monocentric. All patients (71) who have addressed the In Vitro Fertilization Clinic of the Prof. Dr. Panait Sirbu Clinical Obstetrics and Gynecology Hospital during 01.01.2010 and 31.12.2010 were included in this research. The total number of oocytes (8.5�3.9 vs 5.7�3.9, p=0.045), the number of fertilized oocytes (7.5�3.6 versus 3.6�2.8 p=0.004) and the number of embryos (6.6�3.5 versus 3.7�2.6, p=0.013) were higher in women under 35 years of age treated with recombinant FSHr compared to women treated with urinary gonadotrophins hMG. Ovarian stimulation with recombinant gonadotrophins provides a greater number of oocytes and a greater number of embryos in all patients, regardless of age and associated pathology. There are many variables that can influence the success rate, but the first variable that can be controlled is the choice of FSHr in daily clinical practice.

Specific Adverse Effects of Bevacizumab in the Treatment of Non-Squamous Non-Small Cell Lung Cancer (NSCLC) in Clinical Practice

Lung cancer is the most common cause of cancer-related mortality, and non-small cell lung cancer (NSCLC) represents about 85% of all lung cancers. In the last years, novel targeted therapies have been developed and approved in the treatment of NSCLC. Angiogenesis is a very complex process, and cancer angiogenesis is the most important event concerning cancer growth, invasion and metastasis. VEGF signalling pathway plays a significant role in cancer angiogenesis, and it is demonstrated that VEGF levels are correlated with increased angiogenesis and with poor prognosis and metastasis in NSCLC patients. Bevacizumab is a recombinant humanised monoclonal IgG1 antibody, it is one of the first agent used for anti-angiogenic treatment, and it was approved for the treatment of non-squamous NSCLC in combination with chemotherapy.

Synthesis, Characterization and Toxicity Evaluation of Cu(II), Mn(II), Co(II), Ni(II), Pd(II) Complexes with Ligand Derived from Hydrazinecarbothioamide

New copper(II), manganese(II), cobalt(II), nickel(II) and palladium(II) complexes, [Cu(L)(X)(H2O)] [X= OAc- (1), Cl- (3), ClO4- (4)], [M(L)2(H2O)2] [M= Cu2+(2), Mn2+(5)], [M(L)(OAc)(H2O)] [M= Co2+(6), Pd2+(8)], [Ni(L)(OAc)] (7) were synthesized with 2-(5H-dibenzo [a,d][7] annulen-5-ylacetyl)-N-(4-chlorophenyl) hydrazinecarbothioamide (HL). All the metal complexes have been characterized by different physico-chemical techniques like molar conductivity, magnetic susceptibility measurements, electronic and infrared spectral studies, elemental and thermal analysis. The toxicity of newly synthesized compounds was evaluated using the Daphnia magna bioassay.

Phenotypic changes of lymphocyte populations in psoriasiform dermatitis animal model

Psoriasis is a T cell mediated, chronic inflammatory autoimmune skin disease that affects up to 2-3% of the global population and leads to a decrease in quality of life. Experimental data accumulated in recent years highlighted the important role played by the immune system in the pathogenesis of this disease. Non-human psoriasis models are an important research tool that attempts to reproduce the clinical features of the disease in order to explain the pathogenesis of psoriasis and to identify possible therapeutic targets. Imiquimod-based murine model of psoriatic dermatitis is an alternative to traditional models of experimental psoriasis in mice and the induced dermatitis closely mimics the pathologic changes in human psoriasis. In order to emphasize changes in immune cell populations involved in lesion pathogenesis, we performed a murine model of psoriasiform dermatitis model by topical IMQ application. The progress and the severity of IMQ-induced skin inflammation were clinically (PASI score) and histopathologically evaluated. The immunological changes induced by IMQ treatment in lymphocyte populations from peripheral blood and spleen were evaluated by flow cytometry. The main changes observed in peripheral blood were the significantly increased T-CD8a⁺ lymphocyte and NK1.1⁺ cell percentages and the decreased T-CD4⁺ and B lymphocyte percentages in IMQ-treated mice. In spleen samples, lymphocytes showed the same tendency of variation as in peripheral blood, but without statistical significance. A significant decrease of B cells percentages was observed in spleen suspensions. Data obtained in skin samples may suggest the involvement of CD3ε⁺, CD4⁺ and CD8a⁺ cells in the lesional process. This murine model was analyzed by performing a basic cellular profile at three levels: peripheral blood, spleen and skin. The evaluation aimed to establish the immune framework of this experimental model that could further be used for etipathogenic mechanism identification and/or for studies regarding targeted therapies.

The Efficacy of Synthetic Oral Progestin Pills in Patients with Severe Endometriosis

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.

A rare case of vulvar squamous cell carcinoma; case presentation

Objectives. Vulvar cancer is a rare gynecological malignancy, with an incidence of 1.5 per 100 000 women/year. The most common vulvar cancer is developed in squamous cells, the most encountered type of skin cells. Case report. We report a case of a 72-year-old female admitted in the Department of Plastic Surgery of Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu” with a 5/4.2 cm painful ulcerated tumoral mass located in the vulvar area. The lesion slowly increased in size over the past 12 months. The tumour was surgically removed with oncological safety margins and sent for histopathological evaluation. The histopathological examination revealed an ulcerated squamous carcinoma with lymphovascular and perineural invasion, but with negative margins. Postoperative results were favorable, and no local or general complications were observed. Conclusion. We highlight this case due to its unusual presentation in the clitoral area. Moreover, considering the potential for recurrence we point out the importance of the radical vulvectomy with regional lymphadenectomy and histopathological examination, in order to put a precise diagnosis and ensure the best possible treatment for the patient.

The Influence of Progesterone on Immunohystochemical Markers in Endometriosis

Endometriosis, one of the most common gynecologic pathologies, is defined as an inflammatory, estrogen-dependent disease characterized by the growth of endometrial stroma and glands outside the uterine cavity. It is a multifactorial disease, conditioned by genetic and immune factors and triggered by hormonal and environmental factors. Estrogen receptors (ER) and progesterone receptors (PR) expression is significantly modified in endometriotic tissue, compared to normal endometrium. We performed a prospective study that included 16 patients with endometriosis: 9 patients that underwent progesterone treatment with 0.075 mg desogestrel, daily for 24 weeks prior to the surgical procedure, and 7 patients that did not follow any kind of treatment. The purpose of the study was to evaluate the changes that occurred in the expression of ER, PR, B-cell lymphoma 2 (Bcl-2) and Ki-67 from the endometriotic tissue. Oral 0.075 mg desogestrel administration proved its benefits in the management of endometriomas.

The Use of ELISA and PCR in Identifying Correlations between Viral Infection and Benign Prostatic Hypertrophy

Benign prostatic hyperplasia (BPH) is induced by a persistent local inflammatory process that leads to cell proliferation. Viral infections associated with immune deficiencies can trigger the chronic inflammation of the prostate. Therefore, we have investigated several viral expressions in BPH patients and tried to establish a link with the diagnosed hyperplasia. 50 patients with BPH without urinary tract infection were tested for the presence of the following viruses: human papilloma virus (HPV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV). These viruses are the most common cause of asymptomatic viral infections. HPV-specific DNA detection by polymerase chain reaction (PCR) was used for freshly surgical removed tissue sample. Both anti-CMV (IgG, IgM) and anti-EBV (IgG, IgM) antibodies were detected in the patients� serum with standard enzyme-Linked Immunosorbent Assay technique (ELISA). Specific HPV-DNA in prostate tissue was found only in 4% of patients, while 98% and 100% patients were positive for serum anti-CMV IgG or anti-EBV, proving intense earlier contact with the virus. IgM anti-CMV evaluation was found in around 10% of the cases which were also negative for EBV, sustaining that this was a non-acute infection. The findings showed that BPH may be associated with a chronic inflammation due to the post-viral infection with CMV or EBV, or secondary to the presence of these viruses in the prostate, while the involvement of HPV infection in BPH development is comparably lower. Our data suggests that viral investigation in BPH should be considered in the screening protocol of BPH as an indicator of possible inflammatory-mediated tumorigenesis of urinary tract.

Vitamin K Influence on Cardiovascular Mortality in Chronic Hemodialysed Patients

Cardiovascular disease causes increased mortality in chronic hemodialysed patients. The decrease of vascular calcification is one of the main targets in the management of these patients. According to several experimental and clinical trials, choosing the proper diet and prescribing vitamin K2 supplements help to improve prognosis and decrease mortality, but further larger researchers are required to advocate the importance of this dietary intervention in hemodialysed population.

Erectile dysfunction post-radical prostatectomy - a challenge for both patient and physician

Post-radical prostatectomy erectile dysfunction (post RP ED) is a major postoperative complication with a great impact on the quality of life of the patients. Until present, no proper algorithm or guideline based on the clinical trials has been established for the management of post RP ED. According to literature, it is better to initiate a penile rehabilitation program as soon as possible after surgery than doing nothing, in order to prevent and limit the postoperative local hypoxygenation and fibrosis. The results of numerous clinical trials regarding the effectiveness of the phosphodiesterase 5 inhibitors therapy on post RP ED have made them the gold standard treatment. Encouraging results have been achieved in studies with vacuum erectile devices, intraurethral suppositories with alprostadil and intracavernosal injections, but due to their side effects, especially in the cases of intracavernosal injections and intraurethral suppositories, their clinical use was limited therefore making them a second line option for the post RP ED treatment. What should not be forgotten is that penile implant prosthesis has proven very effective, numerous studies confirming high rates of satisfaction for both patients and partners.

Synthesis and Characterization of Novel Cu(II), Pd(II) and Pt(II) Complexes with 8-Ethyl-2-hydroxytricyclo(7.3.1.0(2,7))tridecan-13-one-thiosemicarbazone: Antimicrobial and in Vitro Antiproliferative Activity

New Cu(II), Pd(II) and Pt(II) complexes, (Cu(L)(H₂O)₂(OAc)) (1), (Cu(HL)(H₂O)₂(SO₄)) (2), (Cu(L)(H₂O)₂(NO₃)) (3), (Cu(L)(H₂O)₂(ClO₄)) (4), (Cu(L)₂(H₂O)₂) (5), (Pd(L)(OAc))H₂O (6), and (Pt(L)₂) (7) were synthesized from 8-ethyl-2-hydroxytricyclo(7.3.1.0^2,7)tridecan-13-one thiosemicarbazone (HL). The ligand and its metal complexes were characterized by IR, ¹H-NMR, ¹³C-NMR, UV-Vis, FAB, EPR, mass spectroscopy, elemental and thermal analysis, magnetic susceptibility measurements and molar electric conductivity. The free ligand and the metal complexes have been tested for their antimicrobial activity against E. coli, S. enteritidis, S. aureus, E. faecalis, C. albicans and cytotoxicity against the NCI-H1573 lung adenocarcinoma, SKBR-3 human breast, MCF-7 human breast, A375 human melanoma and HL-60 human promyelocytic leukemia cell lines. Copper complex 2 exhibited the best antiproliferative activities against MCF-7 human breast cancer cells. A significant inhibition of malignant HL-60 cell growth was observed for copper complex 2, palladium complex 6 and platinum complex 7, with IC₅₀ values of 1.6 µM, 6.5 µM and 6.4 µM, respectively.

Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis

BACKGROUND

Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved.

AIM OF THE STUDY

The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis.

MATERIAL AND METHODS

216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day).

RESULTS

Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis.

CONCLUSIONS

In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.

Giant condyloma acuminatum - Buschke-Lowenstein disease - a literature review

AIM

Buschke-Lowenstein disease or giant condyloma acuminatum represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues; untreated, the outcome is unfavorable. The hallmark is the development of one or various prominent-sized vegetant tumors that usually ulcerate.

MATERIAL AND METHODS

The present article summarizes both the etiopathogenic features and the current approach of treatment management.

RESULTS

Minimally invasive surgery along with local and systemic therapy is adequate in patients with small-sized lesions or high intraoperative risk. The main treatment remains extensive surgery with wide resection and often reinterventions to complete the excision.

CONCLUSIONS

giant condyloma acuminatum represents a continuous surgical challenge, because of the need of exhaustive surgical procedures that should consider both the oncological principles and a better anatomical resolution. No standard treatment protocol can be established, because of the infrequency of the disease. Radical surgery including full thickness excision of the affected areas represents the "gold standard" therapy. Other known forms of treatment present unsatisfactory results without statistical significance, the studies having been conducted on small groups of patients. An adequate, long-term follow-up of Buschke-Lowenstein patients is highly recommended, because of the increased recurrence rate.

Immunological investigations in prostatic pathology--a prospective study

BACKGROUND

BPH with prostatitis represents one of the most common urological pathologies affecting most men. The etiology of both conditions remains at the discretion of the various assumptions.

OBJECTIVES

The body's cellular immune response in prostate adenoma is a less studied aspect which we have focused on, in this paper. The correlation with a wide range of information from specific investigations such as prostate-specific antigen (PSA) and total histopathology was the secondary aim of this work.

METHODS

The study included 31 patients who underwent surgery for prostate adenoma (TUR-P, simple prostatectomy) between 08.2013 and 03.2014. Patients presenting urinary tract infection were excluded from the study. Preoperative evaluation of the immunological examination consisted of lymphocyte immunophenotyping (T, B, NK cells) from peripheral blood performed by flow cytometry. Total PSA was performed in serum by enzyme immunoassay EIA.

RESULTS

In all forms of anatomoclinical BPH we found the presence of two major cellular changes: decrease of suppressor/cytotoxic T-cells and decrease of B cells. These deficits may confer an increased susceptibility to viral infection and tumor transformation. NK cells were grown in BPH associated with inflammation. PSA-prostate specific antigen values were grown at less than 50% of the patients in all clinical forms of BPH.

Calcific uremic arteriolopathy in hemodialyzed patients

In the present article, we discuss the case of 67-year-old female patient diagnosed with inferior limbs calciphylaxis and hemodialyzed since 2006. The clinical manifestations and pathological lab findings are typical for this rare and extremely severe complication in chronic hemodialyzed individuals. The favorable treatment response to sodium thiosulfate, not often used as elected therapy in international studies, represents the particularity of the case.

Left renal cyst - left duplex kidney with compromised superior renal unit and ectopic ureteral orifice in the prostatic urethra

The urinary abnormalities are an important health problem. If they are not recognized in due time, they usually lead to the loss of the renal unit function. In many cases, the diagnosis is late and incidental.

CASE PRESENTATION

We present the case of M.I., a 74-year-old male admitted in our surgical unit with diffuse left lumbar pain, low urinary tract symptoms and slow increase in abdomen volume in the past 4 years. Computer tomography scan and ecography showed a large left lumbar cyst like mass with a dilated supernumerary ureter with ectopic ureteral orifice in the prostatic urethra and apparently normal anatomic inferior renal unit. The goal was the excision of the "cyst like" mass (superior left renal unit) but because of the anatomical particularities (extensive fibrosis and local topographical changes) total nephrectomy was performed.

CONCLUSIONS

Given a normal contralateral kidney, the discovery of a urinary abnormality can be a real challenge, their evolution being a silent one. This type of disease can be suspected only with the development of clinical symptoms. The anatomic particularities (duplex kidney) together with the long evolution of the disease changed the local topography making the preservation of the inferior left renal unit a difficult, almost impossible task for the surgeon.

Transobturator urethral suspension surgical treatment of urinary incontinence in men

INTRODUCTION

Urinary incontinence represents involuntary urethral loss of urine and represents a major health problem worldwide, mainly due to the psychosocial implications it determines. The surgical treatment of urinary incontinence in men is needed especially postoperatively, after radical retropubic prostatectomy, transurethral resection or vaporization of prostate, bladder neck incision etc. Surgical indications appear when all the other conservatory means of treatment have failed, including antimuscarinic medication or pelvic floor training.

TECHNIQUE

The surgical procedure is similar to the one used for women, TOT to be more precise. The meshes are made of polypropylene, identical to those used for women or especially designed for urinary incontinence in men. The surgical technique can be "in-out" or "out-in" according to surgeon preferences.

RESULTS

Postoperative recovery was fast and without major complications. The urethral catheter was removed 24 hours after the procedure and the patients were discharged 48-72 hours after surgery. After 30 days postoperative, urodynamics and abdominal echography showed no vesical residue. Success rate is about 80%.

COMPLICATIONS

Intraoperative complications are minimal (urethral, vascular or vesical) and can be avoided in the hands of experienced surgeons. Mesh rejection and rupture or urethral erosion can occur as rare postoperative complications.

CONCLUSIONS

Transobturator urethral suspension procedure proved to be efficient. It is a minimally invasive procedure, easy and with relatively short surgical time. Inbound time is short, making this procedure cost-effective.

Paraneoplastic syndrome in primitive retroperitoneal tumours

INTRODUCTION

Retroperitoneal tumours represent a particular oncological pathology. No other human pathology is so deceiving and scarce in specific clinical symptoms as these tumours. Usually borrowing the symptoms of nearby organs they are discovered in advanced or incurable stages.

MATERIAL AND METHOD

We have tried to present to you the challenge of diagnosing some retroperitoneal tumours. One of the rarest signs was by far the paraneoplastic syndrome or the secretion of active biological substances. The study group is composed of histopatologically diagnosed patients. The vast majority were selected from urology and general surgery wards, but there were cases from gynaecology, neurosurgery and even from endocrinology and gastroenterology.

RESULTS

Paraneroplastic syndrome represents the secretion of various substances by the tumour, substances that make changes at bioumoral level. In our study we found 3 cases of 32 patients (9,37%) with paraneoplastic syndrome. What is to be noticed is that because of this syndrome the diagnosis was more difficult and was indirectly referred to a retroperitoneal tumour. We would like to present these cases and their particularities.

CONCLUSIONS

Every case was a surgical and diagnostic challenge. Biologic active substance secretion or the paraneoplastic syndrome makes the clinical picture even more complicated for primitive retroperitoneal tumours. The clinical symptoms of these tumours require a more careful approach of these patients. Close co-operation with other medical specialties in cases such as ours is mandatory.

[Difficulties in diagnosis and surgical treatment of a giant retroperitoneal lipoma]

Primary retroperitoneal tumors are relatively rare and the histological characters vary. We present the case of a retroperitoneal lipoma in a 51-year-old male patient, whose main complain was enlarging of the abdomen in the last 2 months. The CT of the abdomen and pelvis revealed a giant retroperitoneal tumor. The patient suffered a surgical intervention that revealed a giant retroperitoneal tumor, 40/35 cm, weighting 14 Kg. The pathology exam established the diagnosis: retroperitoneal lipoma with areas of necrosis and lipogranulomatosis. The postoperative evolution was simple.

About the urachus and its pathology. A clinical case of urachus tumor

Urachus diseases represent a relatively rare kind of affliction in child or adult abdominal or urological surgical pathology. The preservation of the urachus lumen leads to rare afflictions, noticed mostly after birth or when they become clinically manifest by various complications. More often than not, these pathological entities require surgical interventions (if the urachal lumen does not close by itself), consisting of partial or total excision of the urachus. Tumor pathology is mostly malign, to a large extent represented by urachus adenocarcinoma. Its initial symptomatology is scarce and confusing. Its treatment is mainly by surgery and consists of the surgical excision of the urachal ligament, of the umbilicus, of a part of the front abdominal wall and partial or total cystectomy, as necessary. The prognosis is unfavourable, since urachal adenocarcinoma is deemed to be a particularly aggressive tumor, strongly influenced by the status of the excision edges, that is by the radicalness of the surgical intervention. Irrespective of the latter, an adjuvant oncological treatment is to be prescribed, mainly systemic cytostatic therapy. Urachus adenocarcinoma is rarely encountered and very often diagnosed in late metastatic stages, when the only solution is at most paleative surgery.

Peno-scrotal limphedema with giant hydrocele--surgical treatment particularities

INTRODUCTION

The necessity for complex and multidisciplinary approach of "border" surgical pathology has unanimously been agreed upon for such a long period of time, its advantages becoming even more obvious in rare, particular cases.

PATIENTS AND METHODS

We report the case of a 39 year-old man diagnosed with lymphangiomatosis back in his childhood. He is admitted with a giant pseudotumoral scrotal mass presenting an important scrotal enlargement (40/35 cm). Physical examination, blood tests, ultrasound, IVP, abdominal and chest CT, psychiatric and plastic surgery evaluation established the diagnosis: peno-scrotal lymphedema with gigantic hydrocele and depressive disorder. Taking into account the important enlargement of the scrotum associated with the alteration of the local skin, we decided to form a mixed surgical team: urology--plastic and reconstructive surgery. We performed bilateral surgical therapy of hydrocele with partial excision and eversion of sac edges, excision of penoscrotal skin and subcutaneous tissue surplus. At the end we made a reconstruction by using a partial-thickness graft from the normal skin of the left thigh.

RESULTS

Spinal anaesthesia was sufficient in order to perform a qualitative complex surgery. Intra and postoperative course was uneventful with minimal blood loss.

CONCLUSION

Rare cases like this one clearly reveal the advantages of a multidisciplinary surgical team by combining usual surgical procedures from different specialities that could lead to spectacular results.

The management of primitive retroperitoneal tumors--problems of clinical, imaging diagnosis, and treatment

Retroperitoneal tumors, whether primary or resulting from the metastasis of other tumors, are a real challenge for the surgeon, in terms of their diagnosis and treatment. They are relatively rare, under 0.2% of the total number of tumors. The clinical examination of retroperitoneal tumors is uncharacteristic and misleading, consisting mainly in palpation of the tumor proper and in assessment of pain. The other signs and symptoms often result from the affected neighboring organs. The imaging investigations used in diagnosing retroperitoneal tumors are ecography, intravenous pyelography, computed tomography, MRI, PET/CT. The main treatment is surgical, consisting either in total or partial excision of the tumor, or in biopsy samples to make a histopathologic diagnosis. Post-operative course depends mainly on the thoroughness of the surgical treatment, that is the complete excision of the tumor, which increases the chances of survival, while lowering the risk of relapse.