Background: Rectal surgery has evolved through the combined efforts of anatomists and surgeons. Minimally invasive surgery has gained recognition over open surgery due to fewer perioperative complications, and faster postoperative recovery. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science to identify studies published between 2014 and December 2024 comparing laparoscopic surgery (LS) and open surgery (OS) for rectal cancer. Primary outcomes included postoperative complications, number of lymph nodes harvested, overall survival, and disease-free survival. Results: Eight randomized controlled trials and one non-randomized study, including a total of 3,935 patients, were analyzed. LS showed a lower incidence of postoperative complications [OR: 0.64; 95% CI, 0.53, 0.77; p=0.008] and a slight advantage in lymph node harvest (WMD: 0.66; 95% CI: -0.63â?"1.95). No significant differences were found in overall or disease-free survival. Conclusions: LS is a safe and effective option for rectal cancer treatment, offering better postoperative recovery and efficient lymph node retrieval, while maintaining long-term oncological outcomes comparable to OS.

Background Postoperative inflammatory response has been associated with complications after colorectal surgery. Early identification of patients at risk of major complications may improve postoperative management. The aim of this study was to evaluate postoperative inflammatory response and the predictive value of C – reactive protein (CRP) and neutrophil – to – lymphocyte ratio (NLR) for major complications after rectal cancer surgery. Methods A prospective observational cohort study of 98 patients undergoing rectal cancer surgery between October 2022 and January 2026. Patients underwent laparoscopic surgery (n = 43) or open surgery (n = 55). CRP levels and NLR were measured preoperatively and at 24 and 48 hours postoperatively. ROC curve analysis was performed to evaluate the predictive performance of CRP and NLR. Univariate and multivariate logistic regression analysis was used to identify predictors of major complications, and linear regression analysis was performed to identify factors associated with CRP levels at 48 hours. Results A total of 97 patients were included in the study. CRP and NLR levels at 48 hours were significantly higher in patients who developed major complications, while no significant differences were observed at 24 hours. CRP at 48 hours showed good predictive performance for major complications in ROC analysis. In logistic regression analysis, CRP at 48 hours was independently associated with major complications. Linear regression analysis showed that open surgery was associated with higher CRP levels at 48 hours compared with laparoscopic surgery Conclusions Postoperative inflammatory response, particularly CRP levels at 48 hours, is associated with major complications after rectal cancer surgery and may be useful for early identification of patients at risk. Monitoring CRP levels in the early postoperative period may help improve postoperative management and early detection of complications

BACKGROUND:Inferior rectal cancer, a malignancy occurring in the lower portion of the rectum, represents a significant clinical challenge due to its complex anatomical location and the diverse treatment approaches required for optimal patient outcomes. Over the past few decades, advancements in surgical techniques, radiotherapy, and systemic treatments have contributed to improving survival rates and minimizing morbidity associated with this disease. AREAS OF UNCERTAINTY:Neoadjuvant therapy combined with tumor resection surgery has demonstrated significant improvements in survival in patients with rectal cancer. However, uncertainty persists due to variability in therapeutic responses among different groups of patients and the limited availability of long-term data on the efficacy of pathologic responses. These limitations affirm the need for further studies to optimize and personalize the therapeutic approach to rectal cancer. DATA SOURCES:A search for information was conducted using recognized databases, including Cochrane, PubMed, Scielo, ScienceDirect, and Scopus. The search strategy was designed using specific terms such as: "rectal neoplasms" OR ("rectal AND neoplasms") OR "rectal cancer" AND ("therapeutics" OR "treatments"), to identify relevant publications. THERAPEUTIC ADVANCES:Minimally invasive techniques offer oncologic outcomes equivalent to open surgery with faster recovery and lower morbidity, supported by total neoadjuvant therapy, which has become the standard of care for locally advanced rectal cancer, achieving higher pathologic complete response rates (OR 2.44, 95% CI, 1.99-2.98) and longer disease-free survival (OR 2.07, 95% CI, 1.20-3.56) than conventional chemoradiotherapy. In addition, emerging targeted agents (VEGF and EGFR inhibitors) in molecularly selected patients and PD-1 blockade in dMMR tumors further improve response rates and support organ preservation strategies. CONCLUSIONS:Despite notable advances in treatment strategies for rectal cancer, challenges remain in identifying a therapeutic modality that can improve both overall survival and disease-free survival without exposing the patient to overly aggressive interventions.

In case of a traumatic event, preservation of the injured renal and kidney function represents the goal of non-operative management (NOM) of renal trauma. The substantial benefits of non-operative management for minor blunt renal injury have already been clearly described in current literature, but its value for major blunt and penetrating renal injuries are still under debate and not clearly highlighted. We hereby fully report a case of a 64 years old male patient with a history of a thoraco-abdominal blunt trauma, victim of aggression caused by a blunt object, which resulted in grade IV injury of the right kidney and associated grade II hepatic injury and right adrenal injury – grading according to the American Association for the Surgery of Trauma (AAST) injury scale guidelines – evaluated through contrast enhanced emergency CT imaging. The patient was hemodynamically stable upon admission to the Emergency Department of Clinical Emergency County Hospital of Brașov, Romania. Non-operative management strategy was chosen, therefore constant and close monitorization and follow-up CT examinations were performed. The patient was subsequently discharged after 8 days, with no further complications reported.

Myelolipomas are described as small tumors, with some authors referring to sizes less than 4 cm in diameter. However, when greater than 10 cm, myelolipomas are labeled as giant tumors and thus, have a definite indication for surgical resection. Myelolipomas represent a small percentage of adrenal tumors. Giant myelolipomas are usually discovered incidentally during imaging studies performed for other conditions. They are often slow-growing and may reach sizes that significantly distort the anatomy of the affected area. Despite their large size, they are usually benign and do not spread to other parts of the body. Adrenal myelolipoma is a benign tumor with a scarce number of detailed cases reported in literature. It is frequently discovered by chance, covering a variety of differential diagnoses. Imaging techniques and histopathological examinations are of great importance in the differential diagnosis of adrenal gland lesions, including retroperitoneal lipoma and liposarcoma, adrenal myelolipoma, adrenal lymphoma, adrenal adenoma, adrenocortical carcinoma, pheochromocytoma or metastasis. We performed a comprehensive review on PubMed of all cases of giant adrenal myelolipoma reported in literature with more than 10 cm in diameter, in order to estimate the incidence, diagnosis and treatment of giant myelolipoma. So far, only 15 cases of truly giant adrenal myelolipoma have been reported between 1981 and 2023.

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Panicum miliaceum L. is a medicinally effective plant used in indigenous system of medicine for a variety of ailments. However, there is no comprehensive study explaining its effectiveness in gastrointestinal tract, respiratory, and cardiovascular system ailments. This study was designed to validate the pharmacological basis for the folkloric use of Panicum miliaceum L. in diarrhea, asthma, and hypertension. Panicum miliaceum extract was analyzed to detect the presence of bioactive compounds by HPLC. The isolated rabbit jejunum, trachea, and aorta were used for in vitro experiments using tissue bath assembly coupled with Power Lab data acquisition system to explore their relative effects. In-vivo experiments were performed for anti-diarrheal activity. HPLC analysis revealed the presence of gallic acid, butylated hydroxytoluene, catechin, and quercetin. Concentration dependent activities were observed by relaxing K+ (low) induced contractions having spasmolytic effect with EC50 = .358 ± .052, bronchodilator (EC50 = 2.483 ± .05793), and vasorelaxant (EC50 = .383 ± .063), probably due to the ATP dependent potassium channel activation. It was confirmed through pre-exposure of glibenclamide (specific ATP-dependent K+ channel blocker) having similarities with cromakalim. Pm.Cr revealed its antidiarrheal via in vivo experiments on rats. This study indicates that Panicum miliaceum has antidiarrheal, spasmolytic, bronchodilator, and vasorelaxant activities probably due to the ATP dependent K+ channel activation.

The authors illustrate a case of a 49-year-old male patient admitted to our Emergency Department with dry persistent cough, fever, chills, vague abdominal discomfort and a recent history of dyspnoea and fatigability, symptoms suggestive of COVID-19 infection. Physical examination showed mild abdominal distension and no signs of peritoneal irritation. The patient was tested positive for COVID-19 and d-dimers were also found positive, raising a strong suspicion diagnosis of pulmonary thromboembolism as a complication of SARS-COV-2 infection, which required an immediate CT scan. No signs of pulmonary thromboembolism were present on the CT scan. Apart from bilateral pulmonary condensation areas having a ground glass pattern with a peripheral distribution, which are the characteristic radiologic feature of SARS-COV-2 infection, the CT scan also revealed the anterior interposition of the colon between the liver and diaphragm, this being highly suggestive for Chilaiditi Syndrome.

Panicum miliaceum L. is a medicinally effective plant used in indigenous system of medicine for a variety of ailments. However, there is no comprehensive study explaining its effectiveness in gastrointestinal tract, respiratory, and cardiovascular system ailments. This study was designed to validate the pharmacological basis for the folkloric use of Panicum miliaceum L. in diarrhea, asthma, and hypertension. Panicum miliaceum extract was analyzed to detect the presence of bioactive compounds by HPLC. The isolated rabbit jejunum, trachea, and aorta were used for in vitro experiments using tissue bath assembly coupled with Power Lab data acquisition system to explore their relative effects. In-vivo experiments were performed for anti-diarrheal activity. HPLC analysis revealed the presence of gallic acid, butylated hydroxytoluene, catechin, and quercetin. Concentration dependent activities were observed by relaxing K + (low) induced contractions having spasmolytic effect with EC50 = .358 ± .052, bronchodilator (EC50 = 2.483 ± .05793), and vasorelaxant (EC50 = .383 ± .063), probably due to the ATP dependent potassium channel activation. It was confirmed through pre-exposure of glibenclamide (specific ATP-dependent K + channel blocker) having similarities with cromakalim. Pm.Cr revealed its antidiarrheal via in vivo experiments on rats. This study indicates that Panicum miliaceum has antidiarrheal, spasmolytic, bronchodilator, and vasorelaxant activities probably due to the ATP dependent K + channel activation. Keywords , , HPLC , antidiarrheal , spasmolytic , bronchodilation , vasodilation , ATP-dependent K , channel opener

Cucumis sativus L. is globally cultivated as an edible vegetable. Besides its nutritional benefits, it is used in traditional medicines against various ailments. The current study was designed to elucidate the multi-target mechanisms of a C. sativus seeds extract against asthma and diarrhea using network pharmacology along with a molecular docking approach. Furthermore, in-vitro and in-vivo experiments were conducted to verify the mechanistic insight of in silico studies. LC-ESI-MS/MS was performed to identify the bioactive compounds in the extract; later, some compounds were quantified by HPLC. C. sativus seed. EtOH has kaempferol in higher concentration 783.02 µg/g, followed by quercetin (693.83 µg/g) and luteolin (617.17 µg/g). In silico studies showed that bioactive compounds interfered with asthma and diarrhea-associated target genes, which are members of calcium-mediated signaling to exert a calcium channel blocker activity. The seeds extract exerted a concentration-dependent spasmolytic response on isolated jejunum, trachea, and urinary bladder preparations and caused relaxation of spastic contraction of K+ (80 mM) with suppressed calcium concentration-response curves at dose 0.3 and 1 mg/mL. It also showed antiperistalsis, antidiarrheal and antisecretory activity in animal models. Thus, C. sativus seeds have therapeutic effects by regulating the contractile response through a calcium-mediated signaling pathway.

Hepatocellular Carcinoma (HCC) is the most prevalent liver malignancy. Trans arterial chemoembolization (TACE) is the gold standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B patients, who are considered to have unresectable HCC. In the following review it is shown that BCLC stage B group is too heterogenous, at the same time some patient may present a better outcome by receiving a more aggressive procedure, while others may benefit from systemic therapy. Those methods suggest which is the optimal treatment for BCLC stage B patients and when to apply it. Apart from alternatives to TACE, this review has highlighted other situations when TACE may be used – BCLC stage A or C.

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

Background: The spleen plays a central role in a range of diseases. As such, great emphasis has been placed on the procedure of spleen removal, the benefits and the numerous associated complications. Given the immediate risk of the thrombotic complications, the aim of this study was to evaluate clinical and laboratory patient characteristics in non-traumatic diseases of the spleen, and to investigate possible predictive factors for platelet count variation following the procedure. Methods: A total of 72 patients who underwent splenectomy were included in this retrospective study. Correlation coefficients as well as multiple linear regressions were used to assess the relationship between post-splenectomy platelet count and various preoperative clinical and laboratory patient characteristics. Results: Following multiple linear regression analysis, we determined that 54.93% of post-splenectomy platelet count variation was explained by admission platelet count (p = 0.00), lymphocyte count (p = 0.04), WBC count (p = 0.00), LOS (p = 0.00), patient gender (p = 0.00), spleen accessibility on admission (p = 0.02) and PT (p = 0.00). Conclusions: Platelet count variation following splenectomy for non-traumatic diseases can be predicted by assessing preoperative patient characteristics. The implications of this study suggest that by means of a prediction model, patient care could benefit from assessing and addressing various preoperative factors that lead to these complications.

Breast cancer is characterized by increased morbidity and mortality, this being influenced by the presence of risk factors, this time with hormonal involvement, in the development and development of breast cancer. The study was based on an analysis of a group of 90 patients with malignant breast tumors operated from 2009-to 2014 in our department. We used a questionnaire for highlighting the presence or absence of hormonal risk factors in these patients. The results were correlated with the histopathological examination. It is known that in general cancers that are considered hormone-dependent, have a distinctive feature, namely, that for their development the presence of hormones is necessary. This study aimed at detecting hormone-dependent breast cancers, and also highlight the risk factors for hormonal-dependent breast tumors. Rezumat Cancerul mamar se caracterizează printr-o morbiditate și mortalitate crescută, aceasta fiind influențată de prezența factorilor de risc, de această dată cu implicare hormonală, în dezvoltarea acestuia. Studiul s-a bazat pe analiza unui grup de 90 pacienți cu tumori maligne ale sânului operați în perioada 2009-2014 în secția de chirurgie a unui spital clinic. A fost utilizat un chestionar pentru evidențierea prezenței sau absenței factorilor de risc hormonal la acești pacienți. Rezultatele au fost corelate cu examenul histopatologic. Se știe că, în general, cancerele considerate dependente de hormoni, au o caracteristică distinctivă, și anume, că pentru dezvoltarea lor este necesară prezența hormonilor. Acest studiu a urmărit să detecteze cancerele mamare dependente de hormoni, precum și să evidențieze factorii de risc pentru tumorile mamare dependente de hormoni.

Abdominoperineal resection (APR) involves excision of the distal sigmoid colon and rectum along with mesorectum, peri-rectal fat and lymph tissue and the anal sphincter complex. The most frequent indication leading to amputation of the rectum is adenocarcinoma of the inferior and middle rectum. After APR results the perineal wound presents evolution peculiarities. In efforts of finding an optimal perineal plague approach, more management methods were proposed. In this article the authors present their experience on mesh rectal lodge along with a review of other reported data in the literature.

The antibiotic resistance of microorganisms involved in pediatric infections represents a significant cause of healthcare-associated infections (HAIs), and is also a matter of management, requiring specific intervention. The aim of the study was to evaluate the efficacy of some antibiotic molecules on pathogens isolated from patients admitted in a pediatric hospital. We carried out a descriptive study on a group of 411 patients admitted to the Si Maria Clinical Emergency Hospital for Children Iasi, between January 1st and March 31st, 2016. Bacterial infections were most prevalent in the age group of 0-1 year (54.98% of the total isolates). Most affected by multidrug-resistant bacterial infections services were: general pediatrics (24.08% of the total isolates), then the intensive care unit (19.95%), surgical wards (14.84%), and acute therapy (11.43%). The germs were isolated from pathological samples: most often pus (23.85%), hypo-pharyngeal aspiration (21.65%), conjunctival secretion (12.42%), and ear secretion (9.48%). Penicillin G and oxacillin were inefficient in 30.26% of the Staphylococcus aureus strains, while erythromycin in 18.42%. Antibiotic resistance of Streptococcus pneumoniae was observed for penicillin G in 7.14% of the strains, while for erythromycin in 13.09%. Klebsiella pneumoniae strains were resistant to amoxicillin + clavulanic acid in 35.85% of the cases, and to cefuroxime, ceftazidime, ceftriaxone, cefepime in 33.96%. Our study highlighted that Staphylococcus aureus was resistant to penicillin G and oxacillin in more than one-third of the isolates, Streptococcus pneumoniae was resistant to penicillin G and erythromycin, and Klebsiella pneumoniae to amoxicillin + clavulanic acid and 1st, 2nd and 3rd generation cephalosporins. Continuing antibioresistance monitoring is crucial in order to promote appropriate guidelines in antibiotic prescription, which could result in decreasing HAIs' rates.

Introduction. Le syndrome antiphospholipidique (APS) est un trouble auto-immun qui cause la thrombose, présentant un risque potentiel de récidive. Le traitement d’APS thrombotique est basé sur la coagulation à long terme. De nouvelles thérapies sont étudiées: le traitement ciblant l’inflammation, la modulation immunitaire et l’inhibition du complément. Cependant, avant d’établir la bonne thérapie, il est important de comprendre les mécanismes de l’APS. Objectif de l’étude. L’objectif de l’étude était d’évaluer la signification des taux sériques de la protéine C à haute sensibilité (hs-CRP), de la P sélectine et de sCD40L comme prédicteurs d’événements thrombotiques récurrents chez les patients atteints du syndrome antiphospholipidique. Matériel et méthode. Quarante et un patients atteints d’APS, diagnostiqués selon la classification ABSTRACT