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ABSTRACT: BACKGROUND. At the current time, the belief that total gastrectomy (TG) offers a better survival benefit compared with distal gastrectomy (DG) in distal gastric cancer still persists among many surgeons. The aim of the study was to determine whether TG in patients with distal stomach cancer offers a benefit in long term survival compared with DG. METHODS. Data on 180 consecutive patients with adenocarcinoma of the distal stomach that underwent surgery during the period 2000-2003 were analyzed. Distal gastrectomy was performed on 91 patients (50.5%), and 89 patients (49.5%) underwent TG. RESULTS. The postoperative morbidity (anastomotic leakage, intraperitoneal hemorrhage and pulmonary complications) was significantly higher in the TG group than in the DG group. The TG group had a significantly higher rate of 30-day postoperative mortality than DG group, and a longer mean postoperative hospital stay. The 5-year survival rate was significantly higher for the DG group than for the TG group. The number of lymph node metastases and TNM stages are significant predictors of poor survival. CONCLUSIONS. Compared with patients undergoing TG, a better long-term survival time, lower postoperative morbidity and mortality rates and a lower hospitalization stay was obtained in patients that underwent DG for distal gastric cancer. This observation justifies the use of this procedure for the surgical therapy of the cancer of distal stomach.
Journal of gastrointestinal and liver diseases: JGLD 03/2013; 22(1):53-8. · 1.81 Impact Factor
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ABSTRACT: BACKGROUND: Selection of the most appropriate treatment to obtain the lowest morbidity, mortality, and recurrence rates is mandatory for hydatid disease of the liver. This study evaluated the results of laparoscopic treatment (compared with the open approach) in the context of a 10-year single-institution experience. METHODS: Between January 1998 and January 2008, 333 patients with hydatid disease of the liver underwent surgery in the authors' department. Only the following aspects were considered as selection criteria for laparoscopic surgery: liver cyst not located in segment 1 or 7, with corticalization on the surface and no evidence of intrabiliary rupture. Of 62 patients who underwent laparoscopic treatment, 3 required conversion to open surgery. The remaining 59 patients (group 1) were analyzed. During the same period, 271 patients with hepatic hydatid disease underwent conventional surgery, but only 172 records were compatible with the criteria for the laparoscopic approach and the respective patients were retrospectively reviewed (group 2). RESULTS: Conversion to open surgery occurred in three cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2-15 cm) in group 1 and 7.23 cm (range, 2-18 cm) in group 2 (p = 0.699). The mean operative time was 72 min (range, 45-140 min) in group 1 and 65 min (range, 35-120 min) in group 2 (p < 0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p = 0.015). The mean hospital stay was 6.42 days (range, 1-21 days) in group 1 and 11.7 days (range, 4-80 days) in group 2 (p < 0.001). The mean follow-up period was 24.2 months (range, 6-32 months) in group 1 and 28.4 months (range, 6-40 months) in group 2. No recurrences were observed in either group during this period. CONCLUSION: Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.
Surgical Endoscopy 01/2013; · 4.01 Impact Factor
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ABSTRACT: Abstract Hydatid disease is a severe zoonosis, exerting a high economic and social impact through its numerous complications, leading to disabilities, even death. Because of technical developments, especially the increasing experience of surgeons, laparoscopic surgery has been extended so that it can be successfully applied to abdominal hydatid cysts. We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. The abdominal ultrasonography and computed tomography (CT) showed 2 cyst-like tumors, with hydatid features: one affecting the eighth liver segment and the other located at the upper pole of the spleen. We performed the surgical intervention using a laparoscopic approach, with an uneventful postoperative follow-up and the patient was discharged home on postoperative day 4. The postoperative images at 6 and 12 months showed a decrease in size of the remnant cystic cavities.
International surgery 01/2013; 98(1):61-4. · 0.36 Impact Factor
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ABSTRACT: The obstruction of the main bile duct by a foreign body, followed by lithogenesis at that level, is rarely encountered in the literature especially when the foreign body is a plastic biliary stent. We have not found referrals concerning the stone formation as a complication at the level of a biliary stent.
A 59-year-old female patient was referred with abdominal pain and jaundice. The patient had had a biliary prosthesis inserted 42 months earlier for treatment of biliary stenosis and fistula, complications that occurred after a laparoscopic cholecystectomy. Imaging investigations evidenced the presence of obstructive jaundice and the biliary stent with gall stones adherent on its surface. After the failure of an endoscopic extraction attempt, surgical intervention ensured the removal of the stent and the gallstones formed on its surface.
The particularity of the case consists of the rarity of such a complication after biliary stenting. At the same time, it emphasizes the need for postoperative follow-up, in order to avoid this kind of complication, potentially fatal.
Journal of gastrointestinal and liver diseases: JGLD 12/2012; 21(4):427-9. · 1.81 Impact Factor
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ABSTRACT: Pseudoaneurysm represents a rare complication in chronic pancreatitis, caused by enzymatic digestion of peripancreatic arteries or the erosion of a visceral artery by pseudocysts. The presence of multiple pseudoaneurysms is rarely seen and their association with splenic infarction has been rarely reported. This case presentation reports the concomitant presence of two pseudoaneurysms with different mechanisms of formation, one of them diagnosed by EUS features and histology of pseudotumoral chronic pancreatitis; the second was diagnosed by contrast-enhanced transabdominal US and CT scan. Their association with splenic infarction was explained by ischemic pathogenesis.
Journal of gastrointestinal and liver diseases: JGLD 09/2012; 21(3):313-5. · 1.81 Impact Factor
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ABSTRACT: AIMS. The aim of this study was to evaluate the leading causes of discrepancies between imaging studies [contrast enhanced ultrasound (CEUS) and contrast enhanced computer tomography (CECT)] diagnosis and histology in patients presenting to a tertiary referral center with previously detected pancreatic masses by standard abdominal ultrasound. METHODS. We performed a prospective longitudinal observational study on 76 patients with pancreatic masses: 57 (75%) patients with solid pancreatic tumors and 19 (25%) patients with cystic and mixed pancreatic masses. For each tumor the CEUS and CECT features were analyzed and compared with the final histological diagnosis. RESULTS. Testing the performance of CEUS and CECT in evaluating the benign or malignant etiology of pancreatic masses, we obtained a probability of 82% for CEUS and of 83% for CECT, for a randomly selected individual from the pancreatic tumor group to have an imaging result indicating suspicion for malignancy. We obtained discordances with the histopathological diagnosis in 25 (32.89%) patients for CEUS and in 23 (30.26%) patients for CECT. In multiple regression analysis, two variables independently influenced the discordance between the two imaging methods and histological conclusion: enhancement pattern and tumor nature (solid vs. cystic). CONCLUSIONS.CEUS and CECT showed a good diagnostic performance in differentiating benign from malignant pancreatic tumors. Enhancement pattern and tumor nature (solid vs. cystic) are independent confounders between imaging and histological diagnosis.
Journal of gastrointestinal and liver diseases: JGLD 09/2012; 21(3):285-92. · 1.81 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the added value of contrast-enhanced ultrasound (CEUS) in the pancreatic cystic mass (PCM) diagnosis by using a qualitative and quantitative analysis in order to make a relevant characterization.
Between December 2008 and November 2011, 37 patients with PCM discovered at ultrasound examination were prospectively followed. A qualitative and quantitative CEUS analysis was performed in order to differentiate etiologies of the PCM. In the quantitative analysis several parameters were followed: Peak Intensity (PI), Time to Peak (TTP), maximum ascending gradient (GRAD), Time to maximum gradient (TTG) and Area Under the Curve (AUC). Normalized ratios were also calculated. In all patients a definite cytological or histological diagnosis was obtained.
Thirty-seven patients were studied: 12 with pancreatitis-associated pseudocyst and 25 with cystic tumors (10 serous cystic adenoma, 5 mucinous cystic adenoma, 6 cystadenocarcinomas, 2 solid pseudopapillary tumors and 2 intraductal papillary mucinous neoplasms). There was a significant difference of the nAUC and nTTP between pseudocyst and cystic tumors, p=0.03 and p=0.01, respectively. A normalized TTP value above 7 sec was suggestive for the diagnosis of pseudocysts with 79.16 % accuracy. There was a significant difference of nTTP and nTTG between the benign and malignant lesions. nTTP < 9 sec and nTTG < 8.5 sec rules out malignant cysts in almost 90% of cases.
The CEUS is useful in the diagnosis of PCM. The quantitative analysis of the enhancement of the cystic wall may discriminate the different types of the PCM.
Medical ultrasonography 06/2012; 14(2):108-14.
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03/2012; , ISBN: 978-953-51-0321-9
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ABSTRACT: Evidence on the benefits of minimally invasive approach over traditional open procedure in gastrointestinal surgery is continuing to accumulate. This is also the case for esophageal surgery.Although laparoscopic esophageal surgery was initially reserved for benign pathology, the technical development, increasing experience with laparoscopic and thoracoscopic techniques and the theoretical advantages of minimally invasive surgery have widened the scope of minimally invasive approach to esophageal cancer. The surgical treatment of esophageal cancer often requires extensive procedures and is therefore, considered one of the most challenging and invasive procedure of gastrointestinal surgery. While transhiatal and transthoracic esophagectomy are common approaches for esophageal resection, data regarding the combined thoracoscopic and laparoscopic approach to esophagectomy are limited. The minimally invasive technique of esophagectomy to be described consists of three phases: thoracoscopic esophageal mobilization and mediastinal lymphadenectomy followed by laparoscopic gastric mobilization, abdominal lymphadenectomy and gastric conduit formation and finally retrieval of the resection specimen followed by an esophagogastric anastomosis via a left cervical incision.
Hepato-gastroenterology 01/2012; 59(118):1835-9. · 0.66 Impact Factor
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Alokita Karmakar, Cornel Iancu,
Dana Monica Bartos,
Meena W Mahmood,
Anindya Ghosh,
Yang Xu,
Enkeleda Dervishi,
Samuel L Collom,
Mariya Khodakovskaya,
Thikra Mustafa,
Fumiya Watanabe,
Alexandru R Biris,
Yongbin Zhang,
Syed F Ali,
Dan Casciano,
Samar Hassen,
Zeid Nima,
Alexandru S Biris
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ABSTRACT: Single-walled carbon nanotubes (SWCNTs) were covalently linked to epidermal growth factor (EGF) proteins through an esterification process that was found to be responsible for the docking of SWCNTs on the human pancreatic cancer cells (PANC-1) surface, thus providing a mechanism for the enhanced delivery and internalization of the nanotubes. Micro Raman spectroscopy and enzyme-linked immunosorbent assay were used to evaluate the delivery process and kinetics of the SWCNTs. In vitro studies indicated that the delivery kinetics of SWCNT-EGF conjugates, at a concentration of 85 µg ml(-1), to the PANC-1 cell surfaces was significant in the first 30 min of incubation, but reached a plateau with time in accordance with the establishment of equilibrium between the association and the dissociation of EGF with the cell receptors. SWCNT-EGF conjugates could act as strong thermal ablation agents and could induce higher percentages of cellular death compared with the nontargeted SWCNTs alone.
Journal of Applied Toxicology 12/2011; 32(5):365-75. · 2.48 Impact Factor
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08/2011; , ISBN: 978-953-307-797-0
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ABSTRACT: Endoscopic ultrasonography (EUS) is preferred for guiding drainage of pancreatic fluid collections, with a success rate exceeding 90% when fluoroscopy is used. When fluoroscopy cannot be used, drainage can still be performed, but no data regarding the safety of such a procedure have yet been published.
To establish the safety of EUS-guided drainage without fluoroscopic control and to identify criteria for the selection of suitable patients.
The pancreatic fluid collections considered suitable for EUS-guided drainage were >5 cm in diameter, symptomatic, without ductal communication. We attempted EUS-guided drainage of PC prospectively in 24 patients: 9 with abscesses and 15 with pseudocysts.
Drainage was successful in 20 cases (83.3%), with complete resolution after a median 18 months' follow-up. EUS-guided drainage failed in four patients (16.7%): one in the abscess group due to symptomatic pneumoperitoneum and three in the pseudocyst group due to thick wall. Drainage failure was associated with a diameter <6 cm and wall thickness >2 mm and was considered to be due to the sliding of the cystotome on the pseudocyst wall. During follow-up there was one procedure unrelated death (4.1%) and no pancreatic fluid collections relapses.
Fluoroscopic control represents a helpful tool, but it is not always necessary for EUS-guided drainage of pancreatic fluid collections. EUS-guided drainage is possible, efficient and safe without fluoroscopy in selected pancreatic fluid collections with a diameter larger than 6 cm and a thin wall. Collections with a thick wall should be drained under fluoroscopy or referred directly for surgery.
Journal of gastrointestinal and liver diseases: JGLD 03/2011; 20(1):39-45. · 1.81 Impact Factor
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ABSTRACT: Carbon nanotubes (CNTs) are emerging versatile tools in nanomedicine applications, particularly in the field of cancer targeting. Due to diverse surface chemistry and unique thermal properties, CNTs can act as strong optical absorbers in near infrared light where biological systems prove to be highly transparent. The process of laser-mediated ablation of cancer cells marked with biofunctionalized CNTs is frequently termed "nanophotothermolysis." This paper illustrates the potential of engineered CNTs as laser-activated photothermal agents for the selective nanophotothermolysis of cancer cells.
International Journal of Nanomedicine 01/2011; 6:1675-84. · 3.13 Impact Factor
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Cornel Iancu,
Lucian Mocan,
Constantin Bele,
Anamaria Ioana Orza,
Flaviu A Tabaran,
Cornel Catoi,
Rares Stiufiuc,
Ariana Stir,
Cristian Matea,
Dana Iancu,
Lucia Agoston-Coldea,
Florin Zaharie,
Teodora Mocan
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ABSTRACT: The main goal of this investigation was to develop and test a new method of treatment for human hepatocellular carcinoma (HCC). We present a method of carbon nanotube-enhanced laser thermal ablation of HepG2 cells (human hepatocellular liver carcinoma cell line) based on a simple multiwalled carbon nanotube (MWCNT) carrier system, such as human serum albumin (HSA), and demonstrate its selective therapeutic efficacy compared with normal hepatocyte cells. Both HepG2 cells and hepatocytes were treated with HSA-MWCNTs at various concentrations and at various incubation times and further irradiated using a 2 W, 808 nm laser beam. Transmission electron, phase contrast, and confocal microscopy combined with immunochemical staining were used to demonstrate the selective internalization of HSA-MWCNTs via Gp60 receptors and the caveolin-mediated endocytosis inside HepG2 cells. The postirradiation apoptotic rate of HepG2 cells treated with HSA-MWCNTs ranged from 88.24% (for 50 mg/L) at 60 sec to 92.34% (for 50 mg/L) at 30 min. Significantly lower necrotic rates were obtained when human hepatocytes were treated with HSA-MWCNTs in a similar manner. Our results clearly show that HSA-MWCNTs selectively attach on the albondin (aka Gp60) receptor located on the HepG2 membrane, followed by an uptake through a caveolin-dependent endocytosis process. These unique results may represent a major step in liver cancer treatment using nanolocalized thermal ablation by laser heating.
International Journal of Nanomedicine 01/2011; 6:129-41. · 3.13 Impact Factor
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Lucian Mocan,
Flaviu A Tabaran,
Teodora Mocan,
Constantin Bele,
Anamaria Ioana Orza,
Ciprian Lucan,
Rares Stiufiuc,
Ioana Manaila,
Ferencz Iulia,
Iancu Dana,
Florin Zaharie,
Gelu Osian,
Liviu Vlad, Cornel Iancu
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ABSTRACT: The process of laser-mediated ablation of cancer cells marked with biofunctionalized carbon nanotubes is frequently called "nanophotothermolysis". We herein present a method of selective nanophotothermolisys of pancreatic cancer (PC) using multiwalled carbon nanotubes (MWCNTs) functionalized with human serum albumin (HSA). With the purpose of testing the therapeutic value of these nanobioconjugates, we have developed an ex-vivo experimental platform. Surgically resected specimens from patients with PC were preserved in a cold medium and kept alive via intra-arterial perfusion. Additionally, the HSA-MWCNTs have been intra-arterially administered in the greater pancreatic artery under ultrasound guidance. Confocal and transmission electron microscopy combined with immunohistochemical staining have confirmed the selective accumulation of HSA-MWCNTs inside the human PC tissue. The external laser irradiation of the specimen has significantly produced extensive necrosis of the malign tissue after the intra-arterial administration of HSA-MWCNTs, without any harmful effects on the surrounding healthy parenchyma. We have obtained a selective photothermal ablation of the malign tissue based on the selective internalization of MWCNTs with HSA cargo inside the pancreatic adenocarcinoma after the ex-vivo intra-arterial perfusion.
International Journal of Nanomedicine 01/2011; 6:915-28. · 3.13 Impact Factor
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ABSTRACT: In recent years, a new concept of an anticancer vaccine has been proposed to prevent and control the proliferation and expansion of cancer cells by eliciting an immune boost in biological systems. The recent literature supports the role of embryonic stem cells (ESC) as cellular agents that stimulate the biological systems to destroy cancer cells. However, at present, a true anticancer vaccine remains elusive. There are several lines of evidence showing that carbon nanotubes may be used to initiate and maintain immune responses.
The authors proposed to test the therapeutic potential of multiwalled carbon nanotubes (MWCNTs) combined with ESC as agents to induce an immune boost and provide subsequent anticancer protection in mice.
C57 BL/6 mice were immunized with ESC and MWCNTs.
The proposed vaccine led to significant antitumor responses and enhanced tumor rejection in mice with subcutaneous inoculation of MC38 colon malign cells compared with groups only administered ESC, only MWCNTs, and controls.
The application and potential of ESC combined with MWCNTs as anticancer immunization agents may represent the beginning of a new chapter in the treatment of colon cancer.
International Journal of Nanomedicine 01/2011; 6:1945-54. · 3.13 Impact Factor
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ABSTRACT: A 49-year old female was admitted to the 3rd Surgical Clinic Cluj with clinical signs of cholangitis. She had had these symptoms for 30 years and in 2007 she was diagnosed as suffering from a diffuse form of Caroli's disease. On admission, a biological syndrome of cholestasis was noticed, associated with an inflammatory syndrome and hepatocytolysis. The imaging examinations confirmed the presence of bilateral intrahepatic cysts communicating with the biliary tree and intrahepatic lithiasis. Surgery was performed with left lobectomy, cholecystectomy, lavage of the right biliary tree and single loop cholangio-jejunal Roux-en-Y anastomosis. The patient had a favorable postoperative evolution and was discharged on the 7th day. The optimal therapeutic solution for this patient would have been a liver transplantation. However, given the emergency presentation, the surgery choice was to treat the present complications, namely the structural damage in the left lobe, the microabcesses at this level, the intrahepatic lithiasis and cholangitis. Caroli's disease, due to its complications, may impose to the surgeon to choose between different therapeutical strategies before liver transplantation.
Journal of gastrointestinal and liver diseases: JGLD 12/2010; 19(4):457-60. · 1.81 Impact Factor
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ABSTRACT: NAT2 gene polymorphisms can influence colorectal cancer (CRC) risk. We aimed to determine the extent to which NAT2 gene polymorphisms influence the survival of patients with sporadic colorectal cancer.
Seventy patients with sporadic colorectal cancer that underwent surgery at the 3rd Surgical Department of Cluj-Napoca between October 2003-May 2005 were randomly selected. Correlations between NAT2*5C(T341C), NAT2*5A(C481T), NAT2*6B(G590A), NAT2*7B(G857A) polymorphisms and survival of patients with different Dukes-MAC stages of CRC were analyzed. We compared patients with a slow acetylator genotype with those having an intermediate or rapid acetylator genotype.
The slow acetylator 341CC genotype is a negative prognostic factor, 20% vs. 30.8%, as compared to rapid acetylator 341TT/TC genotypes (p=0.02) in the patients diagnosed with stage C CRC. For the same stage patients, the slow acetylator 481CC was a positive prognostic factor, 33% vs. 25% (p=0.03). The slow acetylator 590AA was a negative prognostic factor for the survival of patients with stages B and C, 0% vs. 31% (p=0.02). The slow acetylator 857AA genotype was a negative prognostic factor for the patients in stage B, survival rate 0.69% vs. 50%, and positive for patients with stage C, survival rate 50% vs. 21% (p=0.0101). The rapid acetylator 341TT/TC represented a good prognostic factor, while the slow 341CC a negative one for stage D patients (p= 0.04, survival of 18.9%) HR=0.30 with 95%, CI[0.025- 0.9810].
The NAT2 gene may be considered as a prognostic factor for the survival of patients with CRC.
Journal of gastrointestinal and liver diseases: JGLD 12/2010; 19(4):361-8. · 1.81 Impact Factor
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Daniela Matei,
Razvan Dadu,
Raluca Prundus,
Ioana Danci,
Lidia Ciobanu,
Teodora Mocan,
Corina Bocsan,
Roxana Zaharie,
Alexandru Serban,
Marcel Tantau, Cornel Iancu,
Irimie Alexandru,
Nadim Al-Hajjar,
Vasile Andreica
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ABSTRACT: Alkaline reflux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of reflux esophagitis and the occurence of complications (Barrett's esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy.
92 patients with total gastrectomy performed for gastric cancer were included in the study. None of the patients had esophagitis prior to gastrectomy. The patients were assessed clinically and endoscopically after a certain interval from surgery.
An important number of patients (14 out of 92, 15.22%) had reflux esophagitis; 5.43% of the patients had also complications of reflux esophagitis (Barrett's esophagus and benign esophageal stenosis) and 6.52% had local tumor recurrence. Of the 14 patients with reflux esophagitis, the majority (9/14) had Los Angeles (LA) grade C esophagitis. The mean interval between surgery and the endoscopic evaluation was 4.43 years. Barrett's esophagus and benign stenosis were diagnosed after a longer period of time (10.33 and 8 years, respectively) as compared to reflux esophagitis (5.29 years). More than half of the esophagitis patients had reflux symptoms.
Although Roux en Y esojejunostomy is a reconstructive technique which prevents the reflux, an important percentage of our patients developed alkaline reflux esophagitis. In most cases, the esophagitis was moderate or severe. Complications of alkaline reflux, i.e. benign stenosis and Barrett's esophagus, also occurred after longer periods of time (8 to 10 years) in a small percentage of patients.
Journal of gastrointestinal and liver diseases: JGLD 09/2010; 19(3):247-52. · 1.81 Impact Factor
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ABSTRACT: Hepatoblastoma represents the child's most frequent malignant hepatic tumor. We present the case of a one-year old prematurely born patient with an abdominal mass. Ultrasound and CT scan demonstrated a solid hepatic tumor. Serum alpha fetoprotein level was increased. He presented thrombocytosis and a left lobe hepatectomy was performed. Pathological examination revealed complete excision of a mixed hepatoblastoma. Hepatic tumor at a child under 3 years old correlated with elevated serum alpha fetoprotein and thrombocytosis are almost patognomonic for hepatoblastoma. Complete surgery is the mainstay of therapy in hepatoblastoma.
Medical ultrasonography 06/2010; 12(2):157-62.
