The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Traian Patrascu

Traian Patrascu

The Outcome of Rectal Cancer Patients During SARS-CoV-2 Pandemic

Introduction: Rectal cancer is a complex pathology that requires a multidisciplinary approach according to current guidelines, and surgery is one of the main stages of treatment, the type of intervention being established in relation to the location of the tumor at the rectal level. Material and method: The present study aims to analyze the diagnostic features, study the evolution, treatment and complications of patients with rectal cancer in a period marked by the SARS-CoV-2 pandemic. After completing the inclusion criteria, but also the exclusion group, the remaining group consisted of 55 patients with rectal cancer. Results: For the 55 patients, abdominal-pelvic rectal amputation was performed in 17 cases, rectosigmoid resection with colostomy in 13 cases, and rectosigmoid resection with anastomosis in 25 cases. It was also taken into account that the access to medical services was delayed compared to the pre-pandemic period, the increase of the time interval between the treatment stages being an important aspect of the study. Complications associated with surgery have been reported in 13 patients, the most common being the pelvic abscess. Conclusions: The results of the study show a high incidence rate in the age group 60-69 years, with a predominance of males, a delay in making the diagnosis of certainty, an extension of the period from the beginning of neoadjuvant treatment to access to surgery, and the rate of postoperative complications is similar to that described in other studies conducted during the SARS-CoV-2 pandemic, but also outside it.

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Mesenteric Lymphangioma – a Rare Tumor of the Abdomen

Mesenteric lymphangioma (ML) is a cystic tumor developed at the base of the mesentery, which occurs frequently in children, rarely in adults, with nonspecific symptoms, often diagnosed late. The diagnosis is made by computer tomography and the curative treatment is the surgical one with good results and with optimal postoperative outcome. A 44-year-old patient for whom mesh surgery for incisional hernia post appendectomy has been performed was admitted to our clinic for non-specific gastrointestinal symptoms for which he has also been investigated multiple times in other services. On the right flank and iliac fossa, a tumor of firm-elastic consistency is detected, relatively well delimited. Computed tomography (CT) describes the lesion as a mesenteric tumor. Intraoperatively, a cystic tumor is detected, which is punctured, the biochemical result highlighting the lymphatic character. The surgical treatment was represented by segmental intestinal resection with entero-enteroanastomosis. No postoperative events were
reported.

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Personalized Treatment in Rectal Cancer – a Single Center Study

The study aims to evaluate the incidence, characteristics of diagnosis and treatment for patients with rectal cancer, but also the evolution of patients diagnosed with this neoplasia, so that a personalized treatment can be applied and followed, adapted to the patient’s clinical-imaging picture. The study included 127 patients operated on between January 2018 and November 2021. Dixon resection was performed in 63 patients, rectal amputation (Miles) in 42 patients, and Hartmann resection in 22 patients. For the Miles-type intervention, the patients in a more advanced stage were selected, which represented a percentage of 33.07% of the total. This type of intervention involves a permanent colostomy and has a strong impact on the patient’s life. Of the total of 127 patients, the presence of complications was relatively rare, occurring in only 14 patients. Of the 14 patients, the most common complication was abscess, which occurred in 6 patients, while peritonitis and occlusion occurred in only 4 patients. After analyzing the data obtained, it can be seen that the results coincide with world statistics, the highest incidence of rectal cancer occurring in the age range 60-69 years, with an increased incidence among male patients.

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Particularities of Surgical Treatment for the Neuropathic Diabetic Foot

Diabetic neuropathy is one of the chronic complications of diabetes and along with other complications causes a pathology called diabetic foot. The present study analyzed a group of 164 patients admitted to the surgery department of the Clinical Hospital “Doctor Ioan Cantacuzino” Bucharest, between September and December 2019. The results of the study highlight the potential for contamination of neuropathic lesions and the need for curative surgery, most conservative. The conclusion of the analysis emphasizes that the imbalance of the underlying disease changes, in a negative sense, the prognosis of any complication of it.

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Screening Criteria for Colorectal Cancer for Patients with Type II Diabetes Mellitus

Colorectal cancer and diabetes mellitus represent a major public health issue, first, by the number of new cases which are at an alarming rate. Secondly, by the negative effect over the quality of life, socio-economic status and lifespan, representing high morbidity and mortality causes. Diabetes Mellitus is the disease of the century with a global prevalence (standardised-age) which doubled since 1980, rising from 4.7% to 8.5% in adult population. In 2012, the estimated number of fatalities caused by diabetes mellitus and other related complications were at 3.7 million, out of which 43% were patients under the age of 70. Neoplasia represents the second cause of death, after cardiovascular disease. Colorectal cancer (CRC) ranks the 3rd regarding the global neoplasia incidence (10.2%) and the second regarding the mortality (9.5% of all cancer deaths). Colorectal cancer screening refers to the periodic evaluation of asymptomatic patients at risk of developing this neoplasia. Colorectal cancer has a number of peculiarities that make it ideal for screening. Since the end of the 19th century, the suspicion has been raised that diabetes mellitus has been involved, through directly etiological mechanisms, in carcinogenesis (breast, endometrium, colorectal, pancreas, liver, non-Hodgkin lymphoma). At the moment, there is already a consensus in the literature on the role of diabetes as an independent risk factor for colorectal cancer. However, despite the existence of numerous experimental evidence, epidemiological studies and meta-analyses, there is currently no adaptation of colorectal cancer screening for these patients. Material and method: Prospective case-control study conducted over a 2-year period including a number of 442 patients presented at „Dr. I Cantacuzino” Clinical Hospital, asymptomatic, who underwent lower digestive endoscopies in order to assess and define using anamnestic, clinical and paraclinical criteria, the profile of the patient with type II diabetes mellitus that should be given an endoscopic examination because diagnosing precursor lesions or even CRC is likely probable. Results: In the analyzed group, statistically significant correlations (p<0.05) were recorded between positive colonoscopy results (defined as precursor lesions - polyps - or tumors) and certain clinical characteristics (age, sex, BMI, duration of diabetes, type of antidiabetic treatment) and also paraclinical (reactive C protein and glycated hemoglobin). Conclusions: Criteria of patients with type II diabetes who have the maximum probability of developing colorectal cancer have been outlined. Thus this patient is more likely male, with a BMI > 25, aged over 60 years, with an unbalanced diabetes mellitus counted by HbA1c > 7 mg/dL, with over 5 years of diabetes evolution, in treatment with insulin most likely or combined insulin with oral antidiabetics and with an inflammatory biological profile expressed by PCR> 2 mg/dL threshold values.

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Existing Controversies in Inguinal Hernia Treatment

Inguinal hernia is one of the most frequently encountered adult pathologies requiring surgical treatment, and it represents an important problem for healthcare systems, with multiple consequences on both the social and economic plan. Although its incidence and prevalence are not exactly known, the admitted possibility for an individual to get an inguinal hernia during his lifetime ranges around 27% for men compared to only 3% for women. [1] [2]. The evolution of surgery has brought to the fore multiple technical developments which, although technically alluring, could not manage to become surgical standard procedures. The 80’s saw the development of synthetic alloplastic materials and also "tension-free" repair principles, peaking with the Lichtenstein technique, which decreased the relapse rate so much that it made this procedure the "gold standard" of this type of pathology for many surgeons. The development of minimal invasive surgery gradually overtook all abdominal "organs" and the early nineties, starting with 1993, saw the rapid development of minimal invasive techniques for the treatment of inguinal hernia, which proved to be statistically as efficient as the technique Lichtenstein initially described. From that moment on, the surgical world adopted radically different positions, each surgical school offering arguments for or against classical or laparoscopy methods, a dispute which triggered many controversies, more or less backed by statistical data.

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Split-thickness Skin Grafting in the Treatment of Surgically Operated Diabetic Foot. A Retrospective 2-Year Study (2010-2011)

Diabetes mellitus is a major health problem with significant impact on the quality of life, due to both its complications and comorbidities and due to the costs it generates. There is widespread agreement that the incidence of the disease has increased over the last years, both due to better population monitoring and improvements in diagnosing methods.
Thus, the number of cases of diabetes mellitus worldwide was 382 million in 2013 and the number is rising
there are 75 million cases of diabetes mellitus which go undiagnosed, as the majority of diabetic patients are discovered only when complications set in. (1)

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Revascularization - A Key Element for Obtaining Granulation Tissue in a Patient with Diabetes and Arteriopathy

The morbidity of the patients with diabetes is generated - besides the renal, occular, cerebral, cardiac impairment - to a great extent by the diabetic foot infections. The infection develops due to the ulcerations whose etiology (neuropathy or arteriopathy) is particularly important for the approach of the therapeutic algorhythm, which often involves an interdisciplinary collaboration. Diabetes mellitus is the risk factor associated with the highest rate of critical ischemia of the lower limbs. [1]
The association of peripheral arterial disease with infection represents the determining binomial of major amputations in the patient with diabetes and, in 80% of the cases, the gateway is an ulceration of the foot. [1].

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