The interparietoperitoneal (IPP) space, by a broad definition, is the space between the musculo-fascial walls of the abdomen and the parietal peritoneum. A review of the literature on this subject has been performed through a search in the databases according to the following keywords: Bogros space, Retzius space, preperitoneal approach, and urogenital fascia. We have also analyzed the video recordings of the dissections of the inguinopreperitoneal region during TAPP, conducted by a single team, evaluating the dissection planes in the two compartments (medial and lateral) of the IPPS. Based on the latest data from the literature, as well as on our own experience in laparo-endoscopic herniation surgery, we aim to provide answers to several questions. IPPS from the inguinal region is an area as complex as it is narrow, but of great current surgical interest (approaches of hernias, vessels, prostate). The fascial distribution has its origin in the embryological development of the urogenital apparatus. The basic fascial structure in understanding IPPS compartmentalization is the UGF, along with its extensions.
Gut microbiota is a superorganism involved in homeostasis and in pathogenesis. Microbiota composition is influenced by several factors such as: type of birth (cesarean or natural), role of age, role of diet. Pathological consequences of certain type of diet (especially western type of diet) may, in fact, be mediated by gut microbiota alteration. Also few studies have investigated the issue of gut microbiota composition in patients suffering of colorectal cancer, several reports notice relevant differences. Certain pathogenic bacteria in gut microbiota have been extensively studied in relation to their role in colorectal cancer. Thus, Fusobacterium nucleatum, which is abundant in colorectal cancer patient's colon, may initiate the progression from adenoma to adenocarcinoma. A suggested pattern of oncogenesis in colorectal cancer may be represented by this: dysbiosis-inflammation-oncogenesis. A metanalysis that has been published in 2006 concluded a protective role of probiotics in colorectal cancer and in colonic adenoma.
Background and aim: Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir in association with ribavirin was the only interferon-free regimen available in 2015 in Romania for compensated HCV cirrhosis. The aim of our study is to reveal our experience with interferon-free therapy in compensated HCV cirrhosis. Materials and methods: We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for twelve weeks. The HCV infection was diagnosed using clinical, biological, and FibroMax tests. Each patient had follow-up visits at four, eight, twelve and twenty-four weeks after the initiation of the treatment. Results: 44 (49% of) patients were female and 46 (51 % of) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. It was noticed a decreasing of cytolysis, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had a virologic response (VR) at the end of treatment (EOT) and sustained virologic response (SVR) twelve weeks after the last dose administration. Conclusion: The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon-free combination treatment was safe and highly effective in compensated HCV cirrhosis.
Introduction: UTI (urinary tract infections) represent a central pathology for a urological service. Antibiotic resistance is growing at a steady and alarming rate worldwide and especially in Romania. Method and materials: We have analyzed all the patients that were admitted to our clinic for continuous hospitalization between January 2015 and October 2015. All patients undergone urine culture and all cultures positive had an antibiogram worked up. We have selected all patients that had antibiotic resistance to at least an antibiotic. Results: From 1745 patients admitted for continuous hospitalization, we had 180 positive urine cultures at admission from which 125 had at least an antibiotic resistance. Conclusions: Antibiotic resistance is a serious phenomenon, with potential lethal complications, which we encounter daily in urological practice.
Introduction: Radical retropubic prostatectomy represents in its various forms (open, laparoscopic and robotic) the ""gold standard"" treatment for adenocarcinoma of the prostate. Unfortunately like al treatment solutions it has its shortcomings. Retropubic radical prostatectomy, external beam radiation therapy and brachytherapy are the curative options. Materials and Method: The experience of Clinic of Urology from Central Military Hospital representing more than 100 cases was analyzed . Classical open retropubic prostatectomy was performed in all cases. We focused in this paper on intraoperative complications and also precocious and late postoperative complications. Results: Our results are matching the other centers in terms of intraoperative complications (blood loss), early postoperative complications (hematuria, urinary tract infection, lymphatic drainage) or late postoperative complications (erectile dysfunction and urinary incontinence). However none of these complications are to be underestimated Conclusions: The limits of this intervention can be pushed a litle bit further, in our opinion the age factor is a relative one, some of these patients having a longer than 10 years life expectancy. It provides good oncological outcome with manageable complications most of the times.
According to literature the primary retroperitoneal malignant pathology is rare, representing less than 0.5% of all malignancies. In spite of its low incidence, this pathology often proves challenging in terms of diagnosis and treatment. The most com¬mon retroperitoneal malignancy is represented by lymphoma that accounts for approximately 33 % of the retroperitoneal malignancies. Other frequent retroperitoneal tumors are sarcomas: liposarcomas, leiomyosarcomas and malignant fibrous histiocytoma (in order of incidence). We have analyzed the existing data regarding the most common primary retroperitoneal tumors in order to realize a brief classification and their differential diagnosis considering their clinical, imagistic, histopathological and molecular characteristics. The technological developments that have been made over the years in terms of imaging investigations, as well as in biomelecular and cytogenetic studies have offered new possibilities for of assessing a retroperitoneal mass in order achieve more precise informations that can guide physicians to better distinguish between different types of retroperitoneal tumors and therefore their therapeutical protocol.
Autoimmune cholangitis defines a spectrum of cholestatic liver diseases that are characterized by inflammation of bile ducts and a reasonable response to immunosuppressive therapy. The two most common diseases associated with this term in the literature are: an overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis and a form of hyper IgG4 syndrome (currently associated with autoimmune pancreatitis). Liver biopsy is mandatory for the diagnosis. There are, whatsoever, in clinical practice, many cases that do not meet current diagnostic criteria but that have a good response to corticosteroid treatment. Keywords: autoimmune cholangitis, primary biliary cirrhosis, hyper IgG4 syndrome.
Introduction: Erectile dysfunction(ED) is a serious condition which can affect men of all ages, with an important impact over the quality of life. When conservative therapy fails, a viable solution is the penile prosthesis implantation (PPI). Objective: The purpose of this paper is to present data from recent literature regarding the satisfaction rates of men who have undergone penile PPI and as well as the partners satisfaction rates, ease of use, informations regarding long term survival of these prosthesis, postoperative complications and long distance complications, the effectiveness and the way that penile prosthesis have influenced the quality of life of the men who have opted for this solution. Material and methods: We have analyzed recent long term studies concerning the outcomes of the PPI, studies which were made retrospectively, over a period of time of 10 to 15 years. Results: Compared with the conservative treatment for ED, the satisfaction rates achieved after penile prosthesis implantation are higher. According to these studies, the overall patient's satisfaction is 70-90%. The difference between patient and their partners' satisfaction rate is negligible, this difference ranging between 2 to 8%. The satisfaction rate regarding the adequate erection for sexual intercourse is 80-90%. The overall satisfaction rates for the malleable prostheses are lower compared with inflatable devices, 30-75%, respectively 75-90% for the inflatable prosthesis. The mechanical and overall survival rates for the malleable prosthesis range between 65-80% at 10 years, and 58-75% for the inflatable devices. Overall ease of use is rated as 78%. Complications after implantation can be encountered in less than 5% of cases and infections in less than 2%. The likelihood of continued use is higher in the group of the patients with the inflatable prosthesis compared with the malleable ones 70-80%, respectively 50-60%. Up to 85- 90% of patients with inflatable prosthesis would recommend them. Conclusions: PPI is a high effective treatment for erectile dysfunction, refractory to pharmacological treatment. The inflatable penile prosthesis (IPP) provides more overall satisfaction than the malleable ones. The patients with IPP are more likely to continue using their devices than those with the malleable prosthesis. PPI improves significantly the quality of life for patients with erectile dysfunction.
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012 at "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest. Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infracentimetric tumor size. EUS has a high resolution which allows detection of lesions with very small diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases were demonstrated in 3 patients, one by US and all 3 by MRI. Conclusions: - CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes. - MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with infracentimetric size, and is the imaging test of choice for possible liver metastases. - EUS is the preoperative imaging test of choice.
Pathologists observed the presence of tumor infiltrating lymphocytes (TILs) in solid tumors many years before the research focus shifted from cancer cells to the tumoral microenvironment. In lung adenocarcinoma TILs vary in number, phenotype and distribution. Our study investigate the type and distribution of TILs regarding the stage of disease and histological subtype in 27 cases of lung adenocarcinoma. By immunohistochemistry we evaluated semi-quantitatively CD3, CD8 and cyclin D1. We have found that CD3+CD8- lymphocytes prevail at the invasive margin and in tumoral stroma. Cyclin D1 was diffusely positive in tumoral cells in all the five cases of lepidic type of lung adenocarcinoma. In other histological types cyclin D1 was focally positive, most at the margin of the tumor irrespective of the presence or absence of TILs.
Fever of unknown origin (FUO) is a diagnosis that describes a prolonged febrile illness without an established cause, despite investigations. From the first definition of the medical condition (given by Petersdorf and Beeson in 1961) the diagnostic criteria have changed over time, intending to improve the management and outcome of these patients. The main causes of FUO fall into 4 categories: infectious, non-infectious (inflammatory), neoplastic and diverse causes. The etiology of FUO has changed over time, due to ever-changing disease patterns and the development of diagnostic techniques. A significant percentage of patients with FUO remain without an etiologic diagnosis, despite advanced diagnostic tests. Gathering potentially diagnostic clues through history, physical examination and nonspecific key paraclinical abnormalities is the basis for the diagnosis of FUO.
Introduction: Matrix metalloproteinases (MMPs) are key enzymes involved in degradation of extracellular colagen matrix during periodontal disease progression. The aim of our work was to study the levels of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10 in saliva of patients with chronic periodontitis. Materials and methods: The study included 22 patients with chronic periodontal disease and 15 controls. We collect unstimulated whole saliva from all volunteers included in the study. Salivary levels of mentioned MMPs were analyzed using magnetic bead-based multiplex assays and Luminex technology. Results: MMP-1, MMP-7, MMP-9 and MMP-10 present statistically increased salivary levels at patients with periodontal disease versus the control group (p<0.05). Salivary level of MMP-2 at patients with chronic periodontitis was increased but statistically insignificant compared with healthy subjects (p=0.1). Conclusions. The increased level of these enzymes in patients diagnosed with periodontal disease reflects their implication in periodontal tissue degradation. Saliva is an excellent fluid useful in monitoring the severity of this oral disease that affects about half of the adult population around the world.
