The Role of Helicobacter Pylori Infection in the Development of Gastric Cancer - Review of the Literature

Helicobacter pylori (H. pylori), classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), is linked to gastric cancer. The progression from atrophy to metaplasia, dysplasia, and carcinoma constitutes the pathway for intestinal-type gastric carcinoma development. H. pylori infection significantly increases gastric cancer risk, particularly in individuals with atrophic gastritis. Virulence factors like CagA and VacA disrupt host signaling pathways, contributing to chronic inflammation and carcinogenesis. Pro-inflammatory cytokines and dysregulated tumor suppressor genes further fuel this process. Eradicating H. pylori reduces gastric cancer incidence, especially in patients with atrophic gastritis and/or intestinal metaplasia. However, it may not prevent cancer in those with advanced pre-neoplastic lesions. Early detection and management of H. pylori infection are crucial in mitigating gastric cancer risk, offering significant benefits.

Chronic Wound Management: From Gauze to Homologous Cellular Matrix

BACKGROUND

Chronic wounds are a significant health problem with devastating consequences for patients' physical, social, and mental health, increasing healthcare systems' costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients' mobility and functionality make them a major concern for healthcare professionals.

PURPOSE

This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management.

METHODS USED

We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument.

RESULTS

We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient's pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing.

CONCLUSION

Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.

Mortality Risk Stratification in Emergency Surgery for Obstructive Colon Cancer-External Validation of International Scores, American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC), and the Dedicated Score of French Surgical Association (AFC/OCC Score)

BACKGROUND

The increased rates of postoperative mortality after emergency surgery for obstructive colon cancer (OCC) require the use of risk-stratification scores. The study purpose is to external validate the surgical risk calculator (SRC) and the AFC/OCC score and to create a score for risk stratification.

PATIENTS AND METHODS

Overall, 435 patients with emergency surgery for OCC were included in this retrospective study. We used statistical methods suitable for the aimed purpose.

RESULTS

Postoperative mortality was 11.72%. SRC performance: strong discrimination (AUC = 0.864) and excellent calibration (11.80% predicted versus 11.72% observed); AFC/OCC score performance: adequate discrimination (AUC = 0.787) and underestimated mortality (6.93% predicted versus 11.72% observed). We identified nine predictors of postoperative mortality: age > 70 years, CHF, ECOG > 2, sepsis, obesity or cachexia, creatinine (aN) or platelets (aN), and proximal tumors (AUC = 0.947). Based on the score, we obtained four risk groups of mortality rate: low risk (0.7%)-0-2 factors, medium risk (12.5%)-3 factors, high risk (40.0%)-4 factors, very high risk (84.4%)-5-6 factors.

CONCLUSIONS

The two scores were externally validated. The easy identification of predictors and its performance recommend the mortality score of the Clinic County Emergency Hospital of Galați/OCC for clinical use.

Nomogram for Prediction of Postoperative Morbidity in Patients with Colon Cancer Requiring Emergency Therapy

Background

Postoperative complications are the major cause of mortality and prolonged hospitalization after emergency surgery for colon cancer. This study aimed to propose an effective nomogram to predict postoperative complications in order to improve the outcomes.

Material/Methods

We retrospectively analyzed 449 patients who underwent emergency surgery for complicated colon cancer at the County Emergency Hospital Clinic “St. Apostle Andrei” in Galaţi, in the period from 2008 to 2017. Postoperative complications were intestinal obstruction, leakage, bleeding, peritonitis, wound infection, surgical wound dehiscence, respiratory failure, heart failure, acute renal failure, sepsis, and Clostridium difficile colitis, within a month after surgery. Logistic regression models were used to identify the independent prediction factors, and a nomogram was created, based on the best model.

Results

A total of 106 patients (21%) presented postoperative complications after emergency surgery for colon cancer; 51 patients (11.36%) died during the postoperative period. After identifying the risk factors through univariate regression analysis, we identified the independent prediction factors in 2 multivariate regression models. The model with the highest accuracy included the following 7 independent prediction factors: Eastern Cooperative Oncology Group performance status, Charlson score, white blood cell count, electrolyte and coagulation disorders, surgery time, and cachexia (P<0.05 for all). This model showed good precision in predicting postoperative complications, with an area under curve of 0.83 and ideal accordance between the predicted and observed probabilities.

Conclusions

The nomogram developed in this study, which was based on a multivariate logistic regression model, had good individual prediction of postoperative complications.

Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer

BACKGROUND/AIM

Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival.

PATIENTS AND METHODS

Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence.

RESULTS

Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients.

CONCLUSION

The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.

When Should We Expect Curative Results of Neoadjuvant Treatment in Locally Advanced Rectal Cancer Patients?

This review on recently published literature aims to summarize published data on pathologic complete response following neoadjuvant treatment in biopsy proven locally advanced rectal cancer patients. Published articles referring to pCR rectal cancer patients were identified using PubMed search. Eleven relevant articles were selected, based on tumor, treatment, and patient characteristics reporting. As a conclusion, rectal cancer patients with the highest chances of complete clinical or pathological response to neoadjuvant treatment are males, who are around 60 years, diagnosed with well or moderate differentiated locally advanced rectal cancer.

THE MARK OF THE DURATION OF SURGERY ON THE POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH COMPLICATED COLON CANCER

Postoperative complications are common in patients with complicated colon cancers operated in Emergency. Most complications are those of the sound (suppurations, hematoma, dehiscence), postoperative ileus, anastomotic fistula. The purpose of this study is to evaluate the influence of the duration of the surgery on the postoperative complications in patients with complicated colon tumors, operated in emergency. We made a retrospective study on 451 patients treated for complicated colon cancers in the surgery clinics I and II of the Clinical Emergency County Hospital Galați between 2008 and 2017. In this study, we found all the 3 types of complications of colon tumors, but the most common was the intestinal obstruction. The operations varied from colostomies to subtotal and total colectomies. Most complications occured on the postoperatory days 4-8. The statistical analysis that we made revealed important statistical significance in the correlation of the postoperative complications and the duration of the surgical intervention (p value less than 0,001).The emergency colon cancer surgery has a high rate of postoperative complications, of which the most common are cardio-respiratory, parietal and fistulous. Their occurrence is directly influenced by the duration of the surgery.  

Hepatic hydatid cyst - diagnose and treatment algorithm

Introduction: the hydatic disease, caused by the larvae of Echinococcus granulosus, is a serious disease, potentially lethal, which can be found anywhere in the world, but especially in endemic areas such as the Mediterranean Basin, Australia, New Zealand, North Africa, Eastern Europe, the Balkans, Middle East and South America. The hydatic cyst is mainly found in the liver (75% of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound performed for diagnosing other pathologies. The hepatic hydatid cyst therapy is multimodal, including medical, surgical, and, lately, minimally invasive techniques.

Materials and methods: 88 patients were diagnosed with liver hydatid cyst at the General Surgery Clinic of the Colentina Hospital in Bucharest where they were admitted from January 2014 to July 2017. Data collection was realized by consulting the patients’ observation sheets, followed by organizing a database of clinical, paraclinical and treatment parameters. Age, gender, place of origin, year and duration of admission, symptoms and signs at admission, paraclinical serological tests relevant for liver function and E. granulosus infection, imaging investigations performed and their results, type of treatment received and post-treatment progress with the complications that occurred were taken in account.

Results: some of the results of the study showed some differences comparing to the data from specialty literature, the possible causes being the small number of patients, the paraclinical examinations that were not sufficiently detailed to allow the study of a phenomenon in all its complexity, the lack of information from the patients’ first presentation to a doctor or from their previous admissions.

Conclusions: patients with hepatic hydatid cyst form a heterogeneous group, semiology being poor and unspecific. Among the laboratory examinations, eosinophilia is a sign of concern but is present in less than half of the patients. Imaging findings are the basis for the diagnosis of hepatic hydatid cysts. Surgical treatment remains the “gold standard” in therapy, but minimally invasive methods with high applicability, less frequent complications and lower hospital requirements are starting to gain ground.

Correction to: Hepatic hydatid cyst – diagnose and treatment algorithm

In the original publication, the corresponding author field has been omitted. The correct corresponding author name is: Bogdan Mastalier. The original article is now corrected.

Hepatic hemangioma -review-

Hepatic hemangiomas are benign tumors of the liver consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery. The vast majority of HH are asymptomatic, most often being discovered incidentally during imaging investigations for various unrelated pathologies. Typical hemangiomas, the so-called capillary hemangiomas, range from a few mm to 3 cm, do not increase in size over time and therefore are unlikely to generate future symptomatology. Small (mm-3 cm) and medium (3 cm-10 cm) hemangiomas are well-defined lesions, requiring no active treatment beside regular follow-ups. However, the so-called giant liver hemangiomas, of up to 10 cm (most commonly) and even 20+ cm in size (according to occasional reports) can, and usually will develop symptoms and complications that require prompt surgical intervention or other kind of therapy. HH belong to the class of hepatic "incidentalomas", so-called because they are diagnosed incidentally, on imaging studies performed as routine examinations or for other reasons than the evaluation of a possible liver mass. Less than half of HH present with overt clinical symptoms, consisting, most often, of upper abdominal pain (this is usually the case for large lesions, which cause the distension of Glisson's capsule). Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, co-occurring diagnoses are also possible.

Analysis of cases of acute occlusive abdomen in elderly patients

Mechanisms of acute abdomen in the elderly patient are not different from the ones of young adults. What differs is the large number of associated diseases and specific geriatric pathology, ischemic disorders, diverticular disease. The diagnosis of acute abdomen in the elderly patient is difficult due to unclear symptoms, laboratory samples less modified and low cooperation. The article analyzed two groups of patients over 65 years, hospitalized in surgery in the last three years, with the diagnosis of acute surgical abdomen, from the point of view of the appearance of complications depending on the days of delay until surgery.

Predictors for length of hospital stay after inguinal hernia surgery

AIM

identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery.

METHOD

257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay.

RESULTS

out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology.

CONCLUSIONS

the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources.

Ruptured liver cavernous hemangioma - rare cause of hemoperitoneum

We present the case of a 70-year-old patient admitted with strong abdominal pains and operated in our service for hemorrhagic acute abdomen. Intraoperative hepatic cavernous hemangioma was found with capsular rupture and hemoperitoneum. Due to liver cirrhosis, and no proper technical equipment we chose to perform simple hemostasis. Postoperative evolution was favorable.