Surgical Treatment of Splenic Artery Pseudoaneurysm with Digestive Tract Communication - Presentation of Two Cases

Splenopancreatectomy performed for pancreatic pseudo-cyst with splenic artery pseudo-aneurysm and communication with the digestive tract (stomach or colon) is a very rare indication and a small number of these procedures are described in literature. Managing peri-pancreatic pseudo-aneurysm is complex and can be challenging. Surgical treatment is of curative intent and can involve multiple visceral resections. Surgery can be performed in an emergency setting, if the patient presents cataclysmic bleeding, or in a planned manner if the pseudo-aneurysm is discovered incidentally or if the patient manages to overcome the initial bleeding. In this paper we present two cases of pancreatic pseudo-cysts with splenic artery pseudo-aneurysms and communication with the digestive tract (one with pseudo-cystic-colonic communication and the other one with gastric communication). Both patients were males, suffered from chronic pancreatitis and were known to have pancreatic pseudo-cysts. For the treatment of the first patient, surgery was performed in an elective setting, after intensive investigations. The other patient presented with cataclysmic bleeding and emergency surgery was performed in order to control the bleeding. We conclude that surgery remains the main option of treatment for these patients. It can be used as a first line of treatment or secondary to endovascular procedures.

Cholecysto-cutaneous fistula in a patient with biliary lithiasis

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Vulvar Metastasis in Renal Cell Carcinoma: A Case Report Highlighting the Aggressive Nature of Clear Cell Renal Cell Carcinoma

Vulvar cancer is one of the rarest gynecological malignancies. The development of this condition can be associated with either dysplasia linked to human papillomavirus (HPV), primarily affecting younger women, or vulvar dermatoses such as lichen sclerosus, which predominantly affect older women. Over the last decade, the incidence of vulvar cancer has risen by 0.6% annually, while the relative survival rate has declined. Although metastasis to the vulva is uncommon, it can occur, particularly from cancers in nearby organs such as the cervix, bladder, rectum, or anus. More rarely, metastases from breast cancer and renal cell carcinoma have been reported in the vulva. Vaginal metastases from clear cell renal carcinoma are especially rare. In this article, we present the case of a 56-year-old patient diagnosed with clear cell renal carcinoma, who came to our clinic with a lesion on the right labia, which was identified as a metastasis originating from the kidney. Given the rarity of genital metastases in renal cancer, such cases should be examined and discussed to encourage further research and studies.

Evaluation of the metabolic balance in type 1 (insulin-dependent) diabetics, by assay of the hair biochemical components

A new method of long-term retrospective evaluation of the metabolic balance in type 1 diabetic was based on the variations of the hair biochemical components. Glucose, proteic sulfur and amino acid assays were performed in two consecutive hair segments, proximal and distal, of 1.5 cm each. The differences between the glucose and the sulfur values in the two segments correlated with the HbA1 levels (r = +0.971 and r = +0.957, respectively), being statistically significant in both situations (p less than 0.001). The hair components assay permits to follow up the diabetics' metabolic balance on longer time periods than by determination of the HbA1 values.

Laparoscopic Cholecystectomy Under Combined Spinal and Epidural Anesthesia in the First Trimester of Pregnancy-Case Report and Literature Review

Can combined spinal and epidural anesthesia be the gold standard for laparoscopic surgery for pregnant patients? This case report presents a first trimester pregnant patient who was admitted for obstructive jaundice syndrome (pain in the right hypochondrium, nausea, and vomiting). Initially, because of the risk/benefit ratio of pregnancy, the treatment was medical and the patient was immediately discharged because her clinical condition improved, but she was rapidly readmitted to the surgery department because of worsening symptoms. Emergency surgical intervention (laparoscopic cholecystectomy) under combined spinal and epidural anesthesia (CSEA) was performed to reduce the patient's risks. Since most analgesics are insufficiently studied in pregnancy, analgesia with ropivacaine 0.2% was used on the epidural catheter. No pathological changes were identified in the fetal Doppler ultrasound preoperatively and postoperatively. Similarly to other studies, our case highlights the necessity for cholecystectomy for acute cholecystitis even if the patient is in the first trimester of pregnancy. If the decision is delayed, the morbidity and mortality for mother and fetus become unjustified. The peculiarity of the present report is the type of anesthesia chosen. We consider that combined spinal and epidural anesthesia may become a possible gold standard suitable for laparoscopy in the first trimester of pregnancy.

Surgical treatment of advanced ovarian cancer

BACKGROUND

The classical treatment for advanced ovarian cancer (OC) consists of a optimal cytoreductive surgery (when the postoperative residual tumor is under 1 cm.), followed by adjuvant chemotherapy based on platinum or paclitaxel derivatives. The 5-year survival rate in case of advanced OC with secondary peritoneal carcinomatosis (PC) is below 25%. The treatment of PC (interpreted as a local-regional disease and not as a systemic disease) is based on an aggressive surgical act (a full or maximal cytoreduction without residual tumor), followed by local chemotherapy or hypertermic intraperitoneal chemotherapy. This is a retrospective study which reassesses the surgical treatment of advanced OC within the period January 2004 - December 2010 in the Center of General Surgery and Liver Transplantation within Fundeni Institute.

METHODS

In the period January 2004 - December 2010 in the Center of General Surgery and Liver Transplantation within Fundeni Institute were operated 405 patients with advanced ovarian cancer. In 105 patients (25.9%) intraperitoneal chemotherapy with Cisplatin was performed.

RESULTS

Overal survival was calculated for a subsample of 297 patients, for whom it was possible to properly ensure the follow-up, being of 43 months in the patients with intraperitoneal chemotherapy (p = 0.02) and 37 months in the patients without intraperitoneal chemotherapy.

CONCLUSIONS

The maximal cytoreduction associating IPCH is an aggressive multidisciplinary therapeutic approach in advanced OC, reserved for difficult cases, considered in the past without solution. In properly selected cases, this shows a clear increase in survival rate.

Biomathematical approach of (188)Re radiopharmaceutical therapy characterization

PURPOSE

In order to optimize radioimmunotherapy (RIT) as a cancer treatment modality, it is necessary to select the appropriate radionuclide and the biomolecule carrier. We have developed the radiolabeling with (188)Re (beta emitter) of anti-carcinoembryonic antigen (CEA) monoclonal antibody (Mab) for targeting CEA-producing tumors.

MATERIALS AND METHODS

Labeling was realized by the addition of Na(188)ReO(4) eluted from (188)W- (188)Re generator to a preformulated biomolecule in SH prereduction form in the presence of supplemental stannous ions. Wistar London rats were used for the biological studies. For the mathematical processing of the obtained results we used interpolation functions, as well as the different organs under investigation. Used were those interpolation functions for which the standard error is zero, correlation coefficient is the unit and the analytic expression emphasize generally exponential forms (the differential equations specific to the radioactive biodistribution have exponential integral curves as solutions).

RESULTS

The achieved radiochemical purity was 92-96%. The resulting solutions had a pH value 5-7 and were used for intravenous (i.v.) administration. The optimum field of interpolation functions was determined, comprising Hoerl, Modified Hoerl, Heart Capacity, Gaussian, Logistic, and Exponential type models. The optimum model existing in that field was also determined in the condition in which the ratio between absolute error of the biodistribution surface/the mean surface of the optimum biodistribution was minimal.

CONCLUSION

The obtained optimum model has a predictive character, allowing the identification of the moment to which the maximum percent value for every other time point in the considered time interval t(o)-t(f). This mathematical model can be used for every other pharmacokinetic paradigm.