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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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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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Tanţău A, Leucuţa DC, Tanţău M, Boţan E, Zaharie R, Mândruţiu A, Tomuleasa IC. Inflammation, Tumoral Markers and Interleukin-17, -10, and -6 Profiles in Pancreatic Adenocarcinoma and Chronic Pancreatitis. Dig Dis Sci 2021; 66:3427-3438. [PMID: 33184795 DOI: 10.1007/s10620-020-06700-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/15/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Interleukin profiles can be used as biochemical markers regarding the early diagnosis of pancreatic cancer. AIMS To assess CRP, CA 19-9, CEA levels, and interleukin-6, -10, and -17 profiles in pancreatic ductal adenocarcinoma, chronic pancreatitis was compared with a control group, and the correlation with pancreatic cancer survival. METHODS A total of 87 patients were prospective divided in pancreatic cancer (n = 53), chronic pancreatitis (n = 22) ,and control group (n = 12). The diagnosis of PDAC was made histologically. The diagnosis of chronic pancreatitis was based on medical history, imaging methods, and endoscopic ultrasound. Systemic concentrations of interleukins were measured using ELISA kits. The patients were followed at 1, 3, and 6 months. RESULTS CRP, CA 19-9, and CEA were higher in the pancreatic cancer group (p < 0.001). Interleukin-10 was significantly higher in the pancreatic cancer and chronic pancreatitis groups (p < 0.001). Interleukin-17 was statistically higher in the pancreatic cancer group (p < 0.0001). The cut-off of interleukin-17 of 0.273 had a sensitivity of 90.9 and a specificity of 80.9 with a curve under ROC of 0.80 in order to differentiate between pancreatic cancer and chronic pancreatitis. The serum levels of interleukins are not correlated with the stage of the disease. CRP, CA 19-9, CEA, and interleukin-6, -10, and -17 were lower in patients with survival more than 6 months. CONCLUSIONS We detected high levels of interleukin-6, -10, and -17 in chronic pancreatitis and pancreatic cancer. Serum interleukin-17 levels can discriminate between pancreatic cancer and chronic pancreatitis. The prognostic role of interleukins needs to be established.
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Affiliation(s)
- Alina Tanţău
- The 4th Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400015, Cluj-Napoca City, Cluj, Romania
- Department of Gastroenterology and Hepatology Medical Center, 400132, Cluj-Napoca City, Cluj, Romania
| | - Daniel-Corneliu Leucuţa
- Medical Informatics and Biostatistics Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca City, Cluj, Romania.
| | - Marcel Tanţău
- The 3rd Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca City, Cluj, Romania
- Department of Internal Medicine and Gastroenterology, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400158, Cluj-Napoca City, Cluj, Romania
| | - Emil Boţan
- Anatomopathology Department, "Regina Maria" Medical Center, 400117, Cluj-Napoca City, Cluj, Romania
| | - Roxana Zaharie
- The 3rd Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca City, Cluj, Romania
- Department of Internal Medicine and Gastroenterology, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400158, Cluj-Napoca City, Cluj, Romania
| | - Alina Mândruţiu
- Department of Gastroenterology and Hepatology Medical Center, 400132, Cluj-Napoca City, Cluj, Romania
| | - Ionuţ-Ciprian Tomuleasa
- Hematology Department, "Prof. Dr. Ion Chiricuţă" Institute of Oncology Cluj-Napoca, 400015, Cluj-Napoca City, Cluj, Romania
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Singeap AM, Girleanu I, Diculescu M, Gheorghe L, Ciocîrlan M, Gheorghe C, Costache A, Tanțău A, Zaharie R, Goldis A, Gheonea D, Dobru D, Dumitru E, Prelipcean CC, Gîlcă-Blanariu GE, Moscalu M, Stanciu C, Trifan A. Risk Factors for Extraintestinal Manifestations in Inflammatory Bowel Diseases - Data from the Romanian National Registry. J Gastrointestin Liver Dis 2021; 30:346-357. [PMID: 34375380 DOI: 10.15403/jgld-3818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. METHODS We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. RESULTS The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. CONCLUSIONS IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.
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Affiliation(s)
- Ana-Maria Singeap
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania. .
| | - Irina Girleanu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Maria Ciocîrlan
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Adrian Costache
- Carol Davila UMF, Dr. I. Cantacuzino Clinical Hospital, Bucharest.
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj- Napoca, Romania.
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Adrian Goldis
- Victor Babeș University of Medicine and Pharmacy, Municipal Emergency Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania.
| | - Dan Gheonea
- University of Medicine and Pharmacy, Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania.
| | - Daniela Dobru
- University of Medicine and Pharmacy, Tg Mures, Emergency County Hospital, Department of Gastroenterology, Târgu-Mureș, Romania.
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanța, Emergency County Hospital, Department of Gastroenterology, Constanta, Romania.
| | | | | | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | - Carol Stanciu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
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Matei D, Craciun R, Crisan D, Procopet B, Mocan T, Pasca S, Zaharie R, Popovici B, Sparchez Z. Hepatic Hydrothorax-An Independent Decompensating Event Associated with Long-Term Mortality in Patients with Cirrhosis. J Clin Med 2021; 10:3688. [PMID: 34441984 PMCID: PMC8396982 DOI: 10.3390/jcm10163688] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/21/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Hepatic hydrothorax (HH) is an understudied complication of decompensated cirrhosis. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. Methods: This retrospective study included 763 consecutive patients hospitalized for decompensated cirrhosis and ascites. Ninety-seven patients with HH were matched for survival analysis with non-HH patients based on liver disease severity. Results: The prevalence of HH was 13.1%. Patients with HH had significantly worse overall liver function. Upon matching, patients with HH had a lower long-term survival (15.4% vs. 30.9% at 5 years) with a mean overall survival of 22.2 ± 2.2 months for the HH group vs. 27.1 ± 2.6 months for the non-HH group (Log Rank-0.05). On multivariate survival analysis using Cox regression, the MELD-Na score, ALBI grade, hepato-renal syndrome, and grade III ascites had a significant impact on mortality in patients with HH. In patients with HH, a MELD-Na score ≥ 16, ALBI grade III, hepato-renal syndrome, or severe ascites delineated high-mortality risk groups. Conclusions: HH is consistently associated with more advanced liver disease. Patients with HH have worse long-term survival, their prognosis being closely intertwined with overlapping decompensating events.
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Affiliation(s)
- Daniela Matei
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Rares Craciun
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Dana Crisan
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Department of Gastroenterology, Cluj-Napoca Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Bogdan Procopet
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Tudor Mocan
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Sergiu Pasca
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
| | - Roxana Zaharie
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Bogdan Popovici
- Department of Thoracic Surgery, “Leon Daniello” Pulmonology Hospital, 400371 Cluj-Napoca, Romania;
| | - Zeno Sparchez
- Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.M.); (R.C.); (B.P.); (T.M.); (S.P.); (R.Z.); (Z.S.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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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, 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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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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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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12
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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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13
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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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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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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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Zaharie F, Mocan L, Tomuş C, Zaharie R, Bartos D, Iancu C. Thoracoscopic and laparoscopic esophagectomy with cervical manual anastomosis for esophageal cancer. ACTA ACUST UNITED AC 2012; 59:1835-9. [PMID: 22246192 DOI: 10.5754/hge11790] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence on the benefits of minimally invasive approach over traditional open procedure in gastrointestinal surgery is continuing to accumulate. This is also the case for esophageal surgery.Although laparoscopic esophageal surgery was initially reserved for benign pathology, the technical development, increasing experience with laparoscopic and thoracoscopic techniques and the theoretical advantages of minimally invasive surgery have widened the scope of minimally invasive approach to esophageal cancer. The surgical treatment of esophageal cancer often requires extensive procedures and is therefore, considered one of the most challenging and invasive procedure of gastrointestinal surgery. While transhiatal and transthoracic esophagectomy are common approaches for esophageal resection, data regarding the combined thoracoscopic and laparoscopic approach to esophagectomy are limited. The minimally invasive technique of esophagectomy to be described consists of three phases: thoracoscopic esophageal mobilization and mediastinal lymphadenectomy followed by laparoscopic gastric mobilization, abdominal lymphadenectomy and gastric conduit formation and finally retrieval of the resection specimen followed by an esophagogastric anastomosis via a left cervical incision.
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Affiliation(s)
- Florin Zaharie
- Third Surgery Clinic, "luliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Zaharie F, Mocan L, Tomuş C, Mocan T, Zaharie R, Bartoş D, Bartoş A, Vlad L, Iancu C. [Risk factors for anastomotic leakage following colorectal resection for cancer]. Chirurgia (Bucur) 2012; 107:27-32. [PMID: 22480112] [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: 05/31/2023]
Abstract
PURPOSE To identify the risk and prognosis factors and their predictive value for anastomotic leakage after colorectal resections following cancer. PATIENTS AND METHODS 1743 consecutive patients who underwent colic resections or rectal resections for colo-rectal cancer between 1996-2005 in Surgical Clinic no. 3 (Cluj-Napoca, Romania) were retrospectively analysed. RESULTS A total of 54 (3.09 percent) anastomotic leaks were confirmed. Univariate analisys showed that the preoperative variables significantly associated with anastomotic leakage included weight loss, smoking, cardiovascular disease, lung disease, hypoproteinemia, diabetes, anemia, leukocitosis, presence of two or more underlying diseases. Use of alcohol, cerebrovascular disease, bowel preparation, mode of antibiotic prophylaxis, type of handsewn anastomosis, tumor location, tumor stage and tumor histology were nonsignificant variables. Hipoproteniemia (S - proteins < 60g/dl) and anemia (S Hb < 11) remained significant in logistic regression model. CONCLUSIONS Our study shows that a value of S-proteins lower than 60 g/l and s-Hb lower than 99 g/l can be consider as predictive marker for anastomotik leak deshiscence.
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Affiliation(s)
- F Zaharie
- Clinica Chirurgie III, Universitatea de Medicină si Farmacie "Iuliu Haţieganu", Cluj-Napoca, România
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Zaharie F, Mocan L, Tomus C, Zaharie R, Iancu C. Laparoscopic low anterior resection with total mesorectal excision for rectal cancer. ACTA ACUST UNITED AC 2011; 59:405-8. [PMID: 22024035 DOI: 10.5754/hge11470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rectal resections are the only treatment with curative intent currently accepted world wide. When performed in elective circumstances, laparoscopic rectal excision is technically feasible in surgical approach of mid-rectal cancer in a considerable number of patients. There are many benefits of the laparoscopic approach to rectal resection such as short hospitalization, less pain, less postoperative complications and improved quality of life. However, one mandatory condition in laparoscopic resection of rectum includes complete excision of the rectum and mesorectum, generally ensuring a minimal distal margin of 2cm and circumferential radial clearance before performing a coloanal anastomosis. Here, we present a laparoscopic approach for rectal cancer treatment consisting in a wide resection of the rectum, including the entire fascia with the enclosed mesentery of the rectum.
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Affiliation(s)
- Florin Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Zaharie F, Mocan L, Mocan T, Tomus C, Hodor V, Al Hajjar N, Munteanu D, Puia I, Bala O, Zaharie R, Ilie O, Bartos D, Bartos A, Vlad L, Iancu C. [Surgical management of malignant large bowel obstructions]. Chirurgia (Bucur) 2011; 106:479-484. [PMID: 21991873] [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: 05/31/2023]
Abstract
INTRODUCTION Despite significant progress, the management of acute colonic obstruction still remains a challenging problem. The purpose of this study was represented by the evaluation of the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS We performed a non-randomized clinical study. 590 patients with malignant colorectal occlusion who underwent surgery treatment an 3rd Surgical Clinic Cluj-Napoca between 1996-2005 were included. RESULTS Patients with large bowel obstruction underwent one-stage primary resection with anastomosis in 267 cases or staged interventions in 323 cases. The groups were matched in: age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins. The analysis of mortality and morbidity following surgical treatment for large bowel obstruction returned no significant difference among the two groups (p > 0.05). Moreover, the presented results showed a higher incidence of mortality (11.45% vs 9.33 %), morbidity (25.38% vs 14.6%) and increased hospitalization period (p = 0.029) among the patients that undergone seriate resections. CONCLUSIONS One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.
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Affiliation(s)
- F Zaharie
- Clinica Chirurgie III, Universitatea de Medicină si Farmacie "Iuliu Haţieganu", Cluj-Napoca, România
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Matei D, Dadu R, Prundus R, Danci I, Ciobanu L, Mocan T, Bocsan C, Zaharie R, Serban A, Tantau M, Iancu C, Alexandru I, Al-Hajjar N, Andreica V. Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy. J Gastrointestin Liver Dis 2010; 19:247-252. [PMID: 20922186] [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: 05/29/2023]
Abstract
BACKGROUND AND AIMS Alkaline reflux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of reflux esophagitis and the occurence of complications (Barrett's esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy. METHODS 92 patients with total gastrectomy performed for gastric cancer were included in the study. None of the patients had esophagitis prior to gastrectomy. The patients were assessed clinically and endoscopically after a certain interval from surgery. RESULTS An important number of patients (14 out of 92, 15.22%) had reflux esophagitis; 5.43% of the patients had also complications of reflux esophagitis (Barrett's esophagus and benign esophageal stenosis) and 6.52% had local tumor recurrence. Of the 14 patients with reflux esophagitis, the majority (9/14) had Los Angeles (LA) grade C esophagitis. The mean interval between surgery and the endoscopic evaluation was 4.43 years. Barrett's esophagus and benign stenosis were diagnosed after a longer period of time (10.33 and 8 years, respectively) as compared to reflux esophagitis (5.29 years). More than half of the esophagitis patients had reflux symptoms. CONCLUSIONS Although Roux en Y esojejunostomy is a reconstructive technique which prevents the reflux, an important percentage of our patients developed alkaline reflux esophagitis. In most cases, the esophagitis was moderate or severe. Complications of alkaline reflux, i.e. benign stenosis and Barrett's esophagus, also occurred after longer periods of time (8 to 10 years) in a small percentage of patients.
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Affiliation(s)
- Daniela Matei
- 3rd Medical Clinic, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj Napoca, Romania
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Zaharie F, Iancu C, Tanţău M, Mocan L, Bartoş A, Mihăileanu F, Iancu D, Tomuş C, Zaharie R, Vlad L. [Laparoscopic treatment of a large trichobezoar in the stomach with gastric perforation and abdominal wall abscess]. Chirurgia (Bucur) 2010; 105:713-716. [PMID: 21141102] [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: 05/30/2023]
Abstract
Trichobezoar represents a mass of swallowed hair inside the stomach. Here we report a 17-year-old girl who presented in our department with symptoms of gastric ulcer. Ultrasound examination followed by upper endoscopy revealed a large trichobezoar in the stomach with simultaneous gastric perforation. Laparoscopy also revealed a penetration into the anterior abdominal wall accompanied by abscess at this level. We performed a laparoscopic gastrotomy with trichobezoar extraction and laparoscopic treatment of perforation and abdominal wall abscess. The postoperative evolution was normal and the patient was discharged on the fifth postoperative day. We show that laparoscopic approach may be safely used in the treatment of the large gastric complicated trichobezoar. Several laparoscopic approaches were described for the treatment of tricobezoar and its complications but as far as we know this is the first report of laparoscopic treatment of large tricobezoar and associate gastric perforation.
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Affiliation(s)
- F Zaharie
- UMF "Iuliu Haţieganu", Clinica Chirurgie III, Cluj-Napoca, România
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